Stereotactic Body Radiation Therapy for Nonspine Bone Metastases: International Practice Patterns to Guide Treatment Planning

Nguyen, Timothy K; Sahgal, Arjun; Dagan, Roi; Eppinga, Wietse; Guckenberger, Matthias; Kim, Jin Ho; Lo, Simon S; Redmond, Kristin J; Siva, Shankar; Stish, Bradley J; Tseng, Chia-Lin

doi:https://doi.org/10.1016/j.prro.2020.02.011

Stereotactic Body Radiation Therapy for Nonspine Bone Metastases: International Practice Patterns to Guide Treatment Planning

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Stereotactic Body Radiation Therapy for Nonspine Bone Metastases: International Practice Patterns to Guide Treatment Planning

Nguyen, Timothy K; Sahgal, Arjun; Dagan, Roi; Eppinga, Wietse; Guckenberger, Matthias; Kim, Jin Ho; Lo, Simon S; Redmond, Kristin J; Siva, Shankar; Stish, Bradley J; Tseng, Chia-Lin

(2020) Practical Radiation Oncology, volume 10, issue 6, pp. e452 - e460

(Article)

Abstract

PURPOSE: Stereotactic body radiation therapy (SBRT) is increasingly used for nonspine bone metastases (NSBM); however, there are limited data informing treatment planning. We surveyed international experts to better understand worldwide practice patterns in delivering NSBM-SBRT. METHODS AND MATERIALS: Nine international radiation oncologists were invited to participate based on demonstrated expertise ... read more with NSBM-SBRT. Experts were sent gross tumor volume contours and planning computed tomography and magnetic resonance images for 11 NSBM cases that covered a range of bony sites, including metastases to long bones (femur, humerus), pelvic bones (ilium, ischium, acetabulum, pubic symphysis), and thoracic bones (rib, sternum, scapula, clavicle). Experts were surveyed regarding treatment planning decisions and dose-fractionation selection. Descriptive analysis was conducted on the survey data. RESULTS: All experts participated and completed the survey. Most (56%) routinely fused magnetic resonance imaging with planning computed tomography imaging for target delineation. Dose fractionation schedules included single-fraction (18-24 Gy/1), 2 fractions (24 Gy/2), 3 fractions (28-30 Gy/3), 5 fractions (30-50 Gy/5), and 10 fractions (42-50 Gy/10). Although doses varied considerably, all had a biological equivalent dose of ≤100 Gy10. Five-fraction schedules were most common, specifically 35 Gy/5, with 56% opting for this dose-fractionation in at least 1 case. Other dose-fractionation schedules used by at least 3 experts were 20 Gy/1, 30 Gy/3, and 30 Gy/5. Three experts prescribed 2 dose volumes using a simultaneous integrated boost. The 2 dose volumes were either the gross tumor volume and clinical target volume (CTV) or a smaller CTV (CTV1) encompassed within a larger CTV (CTV2) (eg, 30 Gy/3 to gross tumor volume or CTV1 and 15-24 Gy/3 to CTV or CTV2). Dose de-escalation was recommended by all experts in the setting of previous SBRT and by most in the context of previous convevoltherapy or in weight-bearing bones, especially if moderate-to-severe cortical erosion was present. CONCLUSIONS: Significant heterogeneity exists worldwide in radiation technique and dose-fractionation for NSBM-SBRT, which supports the need for consensus guidelines to inform practice and trial design. Nonetheless, these data demonstrate expert agreement on selecting dose schedules with a biologically effective dose ≤100 Gy10, reasons for dose de-escalation, and in determining acceptable dose schedules based on bony site.

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Keywords: Oncology, Radiology Nuclear Medicine and imaging, Journal Article

DOI: https://doi.org/10.1016/j.prro.2020.02.011

ISSN: 1879-8500

Publisher: Elsevier

Note: Funding Information: Sources of support: No funding was obtained for this study. Disclosures: Dr Eppinga reports personal fees from Elekta, outside the submitted work. Dr Lo reports grants from Elekta AB, outside the submitted work, and he was a part of the Gamma Knife ICON expert group. Dr Redmond reports grants and personal fees from Accuray, grants and personal fees from Elekta, personal fees from BioMimetix, and personal fees from Brainlab outside the submitted work. Dr Arjun Sahgal has been an advisor/consultant with Abbvie, Merck, Roche, Varian (Medical Advisory Group), and Elekta (Gamma Knife Icon); is an ex officio board member on the board of the International Stereotactic Radiosurgery Society (ISRS); received honorarium for past educational seminars with Elekta AB, Accuray Inc, Varian (CNS Teaching Faculty), BrainLAB, and Medtronic Kyphon; received a research grant from Elekta AB; and had travel accommodations/expenses paid by Elekta, Varian, and BrainLAB. Dr Sahgal also belongs to the Elekta MR Linac Research Consortium, Elekta Spine, and Oligometastases and Linac Based SRS Consortia. Dr Siva reports grants from Varian Industries; grants from Merck-Sharp-Dohme; grants, personal fees, and other from Astra Zeneca; personal fees from Bristol Meyer Squibb; personal fees from Astellas; personal fees from Janssen; and personal fees from Roche outside the submitted work. Dr Dagan reports personal fees from Elekta and personal fees from UptoDate outside the submitted work. Dr. Tseng reports travel accommodations/expenses and honoraria for past educational seminars by Elekta, belongs to the Elekta MR Linac Research Consortium, and has been an advisor/consultant for Sanofi. Publisher Copyright: © 2020 American Society for Radiation Oncology Copyright: Copyright 2020 Elsevier B.V., All rights reserved.

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