SBRT or Stereotaxic Body Radiation Therapy - Targeted XRT

[Fictional]

Hi there,

I wanted to add a topic of SBRT which might be a newer therapy that could be helpful for some of you. Many people know that gamma knife can be successful for brain ASPS mets, but SBRT is the equivalent for other delicate areas such as certain tumors in the lung or bone.

The lung is very sensitive to radiation, so it cannot take regular XRT because it causes a pneumonitis, but like gamma knife, what SBRT does is uses subtoxic, but multiple streams of radiation - that all summates precisely in a tumor that has been mapped out in 3 dimensional coordinates.

This may be helpful in ASPS when a tumor is inoperable because it is located too close to blood vessels in the mediastinum or inoperable because it would require essentially a lobectomy or pneumonectomy. We just spoke yesterday to Noah Federman who said he had several patients (sarcoma / ASPS) who thus far have done very well with SBRT. It requires only 3-5 days of treatment - Noah said the tumor doesn't necessary go away, but it stops growing. Some may grow after months, years - then they can be treated with some other therapy like ablation.

I will paste in a an abstract below and other refs. This may be another helpful weapon for some in the arsenal against ASPS.

SBRT in Inoperable Lung Cancer: http://www.medscape.com/viewarticle/718760

SBRT at UCLA: http://radonc.ucla.edu/body.cfm?id=61

Acta Oncol. 2006;45(7):808-17.
Stereotactic Body Radiation Therapy (SBRT) for lung metastases.

Okunieff P, Petersen AL, Philip A, Milano MT, Katz AW, Boros L, Schell MC.

Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA. paul_okunieff@urmc.rochester.edu
Abstract

The curative treatment of oligometastases with radiotherapy remains an area of active investigation. We hypothesise that treating oligometastases with SBRT can prolong life and potentially cure patients, while in patients with multiple lung metastases SBRT can improve quality of life. Fifty patients with lung metastases were treated on this study. Individuals with five or fewer total lesions were treated with curative intent. Individuals with > five metastases were treated palliatively. Most patients (62%) received 5 Gy/fraction for a total of 50 Gy. The number of targets treated per patient ranged from one to five (mean 2.6). Tumor sizes ranged from 0.3-7.7 cm in maximal diameter (median 2.1 cm). Mean follow-up was 18.7 months. Local control of treated lesions was obtained in 42 of 49 evaluable patients (83%). Of the 125 total lesions treated, eight progressed after treatment (94% crude local control). The median overall survival time from time of treatment completion of the curatively treated patients was 23.4 months. The progression-free survival of the same group of patients was 25% and 16% at 12 and 24 months, respectively. Grade 1 toxicity occurred in 35% of all the patients, 6.1% had grade 2 toxicity, and 2% had grade 3 toxicity. Excellent local tumor control rates with low toxicity are seen with SBRT. Median survival time and progression-free survival both appear better than that achieved with standard care alone. Long-term progression-free survival can be seen in a subset of patients when all tumors are targeted.

[Olga]

There are a few branded units with the different names to perform SBRT or stereotactic radiosurgery (when higher versus lower doses of the radiation are send in 1-3 treatments) and there is already info on this subject on this board elsewhere. We have a few people that had this treatment for their unresectable centrally located lung mets or spinal mets.
1. Adam had Novalis for his lung met in Rochester by Dr.Okunieff, who since then moved to Shands and UF to be a head of the program there:
Paul G. Okunieff, MD
Professor & Program Director, UF Shands Cancer Center

Phone: 352-273-8010
Fax: 352-273-8109
Mailing Address: P.O. Box 103633
Gainesville, FL 32610-3633
E-mail: pokunieff@ufl.edu
Web Site: http://www.ufscc.ufl.edu
http://tinyurl.com/29yrq53

2. Tom had Radiosurgery Synergy at UPMC. for the spinal met the story is here:
http://www.cureasps.org/forum/viewtopic ... 0&start=15
3. Karen Imm had IMRT for her lung met.
4. Pamela had CyberKnife radiosurgery in LA with the implanted fiducials for her tracheal met.
The most important thing re. radiosurgery is to go with the experience/cutting edge technology that allows to lessen the dose scattering and damage to the surrounding tissue, when the technology is good they reduce the area of the additional coverage that is added for the reliability that the target is hit for sure. I think that it should not be used when there are other treatment options avail.