Name: treatment of liver metastases using an internal target volume method for stereotactic body radiotherapy
Uploaded: 2018-05-08T13:30:00
Description: Watch this Scientific Journal Video about Treatment of Liver Metastases Using an Internal Target Volume Method for Stereotactic Body Radiotherapy at JoVE.com

Denne forskning blev støttet af Taipei Medical University Hospital (106TMUH-NE-02).

Taipei medicinske universitet fælles institutionelle Review Board godkendelse blev opnået for denne undersøgelse.
1. SBRT høring
<ol><li>Vurdere patientens støtteberettigelse for SBRT til behandling af lever metastaser ved at konsultere en tværfaglig tumor board. Bemærk: Behovet for lokal ablation samt drift og andre behandlingsmuligheder skal evalueres af tumor board. Vores kriterier var som følger: 1) voksne patienter med en god performance status (østlige Cooperative onkologis...

<ol>
	<li>Mountain, C. F., McMurtrey, M. J., Hermes, K. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgery+for+pulmonary+metastasis:+a+20-year+experience.">Surgery for pulmonary metastasis: a 20-year experience.</a> Ann Thorac Surg. 38 (4), 323-330 (1984).</li><li>Hellman, S., Weichselbaum, R. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Oligometastases.">Oligometastases.</a> J Clin Oncol. 13 (1), 8-10 (1995).</li><li>Weichselbaum, R. R., Hellman, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Oligometastases+revisited.">Oligometastases revisited.</a> Na. 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A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=SIRFLOX:+Randomized+Phase+III+Trial+Comparing+First-Line+mFOLFOX6+(Plus+or+Minus+Bevacizumab)+Versus+mFOLFOX6+(Plus+or+Minus+Bevacizumab)+Plus+Selective+Internal+Radiation+Therapy+in+Patients+With+Metastatic+Colorectal+Cancer.">SIRFLOX: Randomized Phase III Trial Comparing First-Line mFOLFOX6 (Plus or Minus Bevacizumab) Versus mFOLFOX6 (Plus or Minus Bevacizumab) Plus Selective Internal Radiation Therapy in Patients With Metastatic Colorectal Cancer.</a> J Clin Oncol. 34 (15), 1723-1731 (2016).</li><li>Salama, J. K., Milano, M. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Radical+irradiation+of+extracranial+oligometastases.">Radical irradiation of extracranial oligometastases.</a> J Clin Oncol. 32 (26), 2902-2912 (2014).</li><li>Rusthoven, K. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Multi-institutional+phase+I/II+trial+of+stereotactic+body+radiation+therapy+for+liver+metastases.">Multi-institutional phase I/II trial of stereotactic body radiation therapy for liver metastases.</a> J Clin Oncol. 27 (10), 1572-1578 (2009).</li><li>Ricardi, U., Badellino, S., Filippi, A. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+applications+of+stereotactic+radiation+therapy+for+oligometastatic+cancer+patients:+a+disease-oriented+approach.">Clinical applications of stereotactic radiation therapy for oligometastatic cancer patients: a disease-oriented approach.</a> J Radiat Res. 57 (Suppl 1), i58-i68 (2016).</li><li>Wild, A. T., Yamada, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+Options+in+Oligometastatic+Disease:+Stereotactic+Body+Radiation+Therapy+-+Focus+on+Colorectal+Cancer.">Treatment Options in Oligometastatic Disease: Stereotactic Body Radiation Therapy - Focus on Colorectal Cancer.</a> Visc Med. 33 (1), 54-61 (2017).</li><li>Gill, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Patient-reported+complications+from+fiducial+marker+implantation+for+prostate+image-guided+radiotherapy.">Patient-reported complications from fiducial marker implantation for prostate image-guided radiotherapy.</a> Br J Radiol. 85 (1015), 1011-1017 (2012).</li><li>Eldredge-Hindy, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Active+Breathing+Coordinator+Reduces+Radiation+Dose+to+the+Heart+and+Preserves+Local+Control+in+Patients+with+Left+Breast+Cancer:+Report+of+a+Prospective+Trial.">Active Breathing Coordinator Reduces Radiation Dose to the Heart and Preserves Local Control in Patients with Left Breast Cancer: Report of a Prospective Trial.</a> Pract Radiat Oncol. 5 (1), 4-10 (2015).</li><li>Swanson, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Six-year+experience+routinely+using+moderate+deep+inspiration+breath-hold+for+the+reduction+of+cardiac+dose+in+left-sided+breast+irradiation+for+patients+with+early-stage+or+locally+advanced+breast+cancer.">Six-year experience routinely using moderate deep inspiration breath-hold for the reduction of cardiac dose in left-sided breast irradiation for patients with early-stage or locally advanced breast cancer.</a> Am J Clin Oncol. 36 (1), 24-30 (2013).</li><li>Sweeney, R. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Accuracy+and+inter-observer+variability+of+3D+versus+4D+cone-beam+CT+based+image-guidance+in+SBRT+for+lung+tumors.">Accuracy and inter-observer variability of 3D versus 4D cone-beam CT based image-guidance in SBRT for lung tumors.</a> Radiat Oncol. 7, 81 (2012).</li><li>Takahashi, W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Verification+of+Planning+Target+Volume+Settings+in+Volumetric+Modulated+Arc+Therapy+for+Stereotactic+Body+Radiation+Therapy+by+Using+In-Treatment+4-Dimensional+Cone+Beam+Computed+Tomography.">Verification of Planning Target Volume Settings in Volumetric Modulated Arc Therapy for Stereotactic Body Radiation Therapy by Using In-Treatment 4-Dimensional Cone Beam Computed Tomography.</a> Int J Radiat Oncol Biol Phys. 86 (3), 426-431 (2013).</li><li>Yeo, U. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluation+of+dosimetric+misrepresentations+from+3D+conventional+planning+of+liver+SBRT+using+4D+deformable+dose+integration.">Evaluation of dosimetric misrepresentations from 3D conventional planning of liver SBRT using 4D deformable dose integration.</a> J Appl Clin Med Phys. 15 (6), 4978 (2014).</li><li>Shinmohigashi, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tumor+motion+changes+in+stereotactic+body+radiotherapy+for+liver+tumors:+an+evaluation+based+on+four-dimensional+cone-beam+computed+tomography+and+fiducial+markers.">Tumor motion changes in stereotactic body radiotherapy for liver tumors: an evaluation based on four-dimensional cone-beam computed tomography and fiducial markers.</a> Radiat Oncol. 12, 61 (2017).</li><li>Goodman, B. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Long-term+safety+and+efficacy+of+stereotactic+body+radiation+therapy+for+hepatic+oligometastases.">Long-term safety and efficacy of stereotactic body radiation therapy for hepatic oligometastases.</a> Pract Radiat Oncol. 6 (2), 86-95 (2016).</li><li>Scorsetti, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Is+stereotactic+body+radiation+therapy+an+attractive+option+for+unresectable+liver+metastases?+A+preliminary+report+from+a+phase+2+trial.">Is stereotactic body radiation therapy an attractive option for unresectable liver metastases? A preliminary report from a phase 2 trial.</a> Int J Radiat Oncol Biol Phys. 86 (2), 336-342 (2013).</li><li>Andratschke, N. 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Respiration-induceret lever deformitet og orgel motion bidrager til vanskelighederne forbundet med stråling levering samt tilretning (target afgrænsning) problemer. Forbedringer i de teknikker, der anvendes for orgel bevægelse forvaltning har medført forbedringer i behandling nøjagtighed og præcision, som er grundlæggende for SBRT. Flere billede-styrede teknikker og respiratorisk bevægelse management systemer er tilgængelige i øjeblikket. Fiducial markør implantation er en fælles teknik til target lokaliserin...

Konventionelt, metastase betragtes den terminal fase af kræft og er forbundet med dårlig prognose og overlevelse. Men bjerg mfl. i 1984 rapporterede, at ifølge deres 20 års erfaring, fuldstændig kirurgisk fjernelse af pulmonale metastaser resulterer i en relativt højere overlevelsesrate, hvis primære tumor site er under systemisk kontrol på tidspunktet for kirurgi1. Hellman og Batth i 1995 første foreslåede oligometastases, en mellemfase mellem lokale læsioner og systemisk sygdom med polymetastases, som kan helbredes ved hjælp af ekstra lokal behandling2,3. I de seneste årtier, tidlig påvisning af metastaser, nye kirurgiske metoder til behandling af oligometastases (metastasectomy), og effektiv kemoterapi har forbedret prognosen hos patienter med metastaser. Leveren er en af de mest almindelige metastatisk organer for solide tumorer, og kirurgisk resektion af hepatisk oligometastases kan forbedre overlevelse. Lokal ablation metoder, herunder radiofrekvens ablation, radioembolization og strålebehandling til behandling af lever metastaser er blevet anbefalet til nogle ubrugeligt patienter til at opnå den nødvendige lokale tumor kontrol3,4 , 5 , 6 , 7. i de seneste år, flere prospektive og retrospektive undersøgelser har rapporteret effektive lokale tumor kontrol af hepatisk metastaser gennem stereotactic krop strålebehandling (SBRT), også kendt som stereotactic ablativ strålebehandling, med acceptable toksicitet4,5,8,9.
Er sket forbedringer i patient positionering og immobilisering metoder; billede erhvervelse, integration og overførsel til strålebehandling systemer; respiratorisk bevægelse forvaltning; højdosis output og hurtig stråling levering; og stejle dosis forløb fra target læsioner til omgivende normale væv. På grund af disse fremskridt opnår SBRT meget præcise og nøjagtige strålebehandling med minimal alvorlig toksicitet10,11. Respiratorisk bevægelse management er grundlæggende for SBRT, især for hepatisk og pulmonal læsioner. En respiratorisk teknik der er noninvasive og klinisk praktisk ville væsentligt øge populariteten af SBRT som en behandlingsmulighed. Denne artikel beskriver en SBRT protokol for lever metastaser, der bruger fire-dimensionelle computertomografi (4D-CT) med en abdominal kompressor (AC) for image-vejledt assistance og leveren bevægelse.

<table border="0" cellpadding="0" cellspacing="0" width="875">
	<tbody>
		<tr height="51">
			<td height="51" style="height:51px;width:195px;">CT scan</td>
			<td style="width:188px;">Philips</td>
			<td style="width:265px;">Brilliance&#160;Big Bore&#160;16 Slice&#160;CT, 7387</td>
			<td style="width:228px;">Acquire CT images for contouring and planning</td>
		</tr>
		<tr height="51">
			<td height="51" style="height:51px;width:195px;">CT contrast</td>
			<td style="width:188px;">GE Healthcare</td>
			<td style="width:265px;">Omnipaque 350 mg L/mL</td>
			<td style="width:228px;">Enhence lesion in CT images</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Linear accelerator</td>
			<td>Elekta</td>
			<td>Synergy</td>
			<td>Deliver radiotherapy</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Palnning system</td>
			<td>Pinnacle</td>
			<td>Pinnacle 9.8</td>
			<td>Implement radiotherapy planning</td>
		</tr>
		<tr height="65">
			<td height="65" style="height:65px;width:195px;">Immobilization: BlueBag BodyFix</td>
			<td>Elekta</td>
			<td>900 mm x 2325 mm, P10104840</td>
			<td>Immobilize the patient</td>
		</tr>
		<tr height="66">
			<td height="66" style="height:66px;width:195px;">Immobilization: BodyFix Cover sheet</td>
			<td>Elekta</td>
			<td>2700 mm x 1400 mm, P10102-304</td>
			<td>Immobilize the patient</td>
		</tr>
		<tr height="73">
			<td height="73" style="height:73px;width:195px;">Immobilization: BodyFix abdominal compressor</td>
			<td>Elekta</td>
			<td>diaphragm control, P10102-149</td>
			<td style="width:228px;">Restrict breath motion and organ/lesion motion</td>
		</tr>
		<tr height="57">
			<td height="57" style="height:57px;width:195px;">Immobilization: vacuum pump</td>
			<td>Elekta</td>
			<td>vacuum pump, p2 120V, P10102-110</td>
			<td style="width:228px;">Shape body bag and cover sheet according to the patient</td>
		</tr>
	</tbody>
</table>

treatment of liver metastases using an internal target volume method for stereotactic body radiotherapy

Prognosen for patienter med metastatisk kræft er blevet forbedret i de seneste årtier på grund af effektiv kemoterapi og oligometastatic kirurgi. For ubrugeligt patienter, kan lokal ablation terapier, som stereotactic kroppen strålebehandling (SBRT), give effektive lokale tumor kontrol med minimal toksicitet. På grund af sin høje præcision og nøjagtighed, SBRT leverer en højere strålingsdosis per fraktion, er mere effektiv, og mål mindre bestråling diskenheder end konventionel strålebehandling. Derudover er stejle dosis forløb fra target læsioner til omgivende normale væv opnået ved hjælp af SBRT; således SBRT giver mere effektiv tumor kontrol og udstiller færre bivirkninger end konventionel strålebehandling. Brugen af SBRT er udbredt til behandling af intrakranielle læsioner (kendt som stereotactic radiosurgery); Det er dog nu også bruges til behandling af spinal og adrenal metastaser. På grund af fremskridt i image-vejledt assistance og respiratorisk bevægelse, har flere studier undersøgt brugen af SBRT til behandling af lungerne eller leveren tumorer, der bevæger sig som en patient ånder. Resultaterne af disse undersøgelser har antydet, at SBRT positivt styrer tumorer i tilfælde af flytning læsioner.
Fire-dimensionelle computertomografi (4D-CT) med en abdominal kompressor (AC) er klinisk bekvemt for effektiv respiratorisk bevægelse forvaltning. Fordi denne metode er noninvasive og giver mulighed for gratis vejrtrækning, reducerer dens komplikationer. Desuden overveje patienter denne metode praktisk. Derudover er det anses mere effektiv end andre forvaltningsmetoder respiratorisk bevægelse af læger og terapeuter. Brug af 4D-CT med en AC til at behandle pulmonal læsioner er også blevet almindeligt undersøgt, og teknikken er ved at vinde accept for behandling af hepatisk læsioner. Protokoller for at bruge 4D-CT med en AC til behandling af hepatisk læsioner er dog forskellige fra dem, der anvendes til behandling af pulmonale læsioner. I denne artikel vil beskrive vi en ny protokol for SBRT med 4D-CT og en AC til behandling af lever metastaser.

SBRT kan gennemføres af intens-moduleret strålebehandling (IMRT) (med <img alt="image" src="/files/ftp_upload/57050/57050imgv2.jpg"> 6 stråling bjælker) eller volumetrisk bue strålebehandling (VMAT) (med kontinuerlig dosis levering og gantry rotation) til at dække alle mål i en enkelt behandling, fordi en enkelt operation kan ikke opnå fjernelse af alle tumorer. Et repræsentativt SBRT behandlingsplan demonstreret succes strålebehandling planlægning for to hepatisk metastatisk t...

Watch this Scientific Journal Video about Treatment of Liver Metastases Using an Internal Target Volume Method for Stereotactic Body Radiotherapy at JoVE.com

Treatment of Liver Metastases Using an Internal Target Volume Method for Stereotactic Body Radiotherapy

Stereotactic krop strålebehandling (SBRT) kræver streng nøjagtighed og præcision til at levere høje doser per fraktion til små behandling diskenheder til at forbedre tumor kontrol og samtidig reducere toksicitet. Heri, præsenterer vi en noninvasive og klinisk praktisk respiratorisk bevægelse management protocol til SBRT for lever metastaser.

Behandling af lever metastaser ved hjælp af en intern Target Volume metode for Stereotactic krop strålebehandling

The prognosis of patients with metastatic cancers has improved in the past decades due to effective chemotherapy and oligometastatic surgery. For ...

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Combination Radiotherapy in an Orthotopic Mouse Brain Tumor Model

Kombinationen Radioterapi i en orthotopisk musehjerne tumormodel

Glioblastoma multiforme (GBM) are the most common and aggressive adult primary brain tumors1. In recent years there has been substantial progress in the ...

Stereotactic Radiosurgery for Gynecologic Cancer

Stereotaktisk strålebehandling for gynækologisk kræft

Stereotactic body radiotherapy (SBRT) distinguishes itself by necessitating more rigid patient immobilization, accounting for respiratory motion, ...

Ex Vivo Treatment Response of Primary Tumors and/or Associated Metastases for Preclinical and Clinical Development of Therapeutics

Ex Vivo Treatment Response of Primary Tumors and/or Associated Metastases for Preclinical and Clinical Development of Therapeutics

Ex vivo-behandling Reaktion fra primære tumorer og / eller associerede Metastaser til præklinisk og klinisk udvikling af Therapeutics

The molecular analysis of established cancer cell lines has been the mainstay of cancer research for the past several decades. Cell culture provides both ...

Isolated Hepatic Perfusion as a Treatment for Liver Metastases of Uveal Melanoma

Isoleret Nedsat Perfusion som en behandling for levermetastaser af Uveal melanom

Isolated hepatic perfusion (IHP) is a procedure where the liver is surgically isolated and perfused with a high concentration of the chemotherapeutic ...

Dynamic Lung Tumor Tracking for Stereotactic Ablative Body Radiation Therapy

Dynamisk Lung Tumor Tracking for Stereotaktisk ablative Krop strålebehandling

Physicians considering stereotactic ablative body radiation therapy (SBRT) for the treatment of extracranial cancer targets must be aware of the sizeable ...

An Improved Method for Rapid Intubation of the Trachea in Mice

En forbedret fremgangsmåde til hurtig intubation af trachea i mus

Despite some anatomical and physiological differences, mouse models continue to be an essential tool for studying human lung disease. Bleomycin toxicity ...

Percutaneous Hepatic Perfusion (PHP) with Melphalan as a Treatment for Unresectable Metastases Confined to the Liver

Percutaneous Hepatic Perfusion PHP with Melphalan as a Treatment for Unresectable Metastases Confined to the Liver

Perkutan Nedsat Perfusion (PHP) med melphalan som behandling for inoperabel Metastaser begrænset til leveren

Unresectable liver metastases of colorectal cancer can be treated with systemic chemotherapy, aiming to limit the disease, extend survival or turn ...

Method of Direct Segmental Intra-hepatic Delivery Using a Rat Liver Hilar Clamp Model

Metode til direkte Segmentoplysninger Intra-hepatisk Levering Ved hjælp af en rotte Lever hilar Clamp Model

Major hepatic surgery with inflow occlusion, and liver transplantation, necessitate a period of warm ischemia, and a period of reperfusion leading to ...

Radiation Planning Assistant - A Streamlined, Fully Automated Radiotherapy Treatment Planning System

Stråling planlægning assistent - en strømlinet, fuldautomatisk strålebehandling behandling planlægning System

The Radiation Planning Assistant (RPA) is a system developed for the fully automated creation of radiotherapy treatment plans, including volume-modulated ...

Measurement of the Hepatic Venous Pressure Gradient and Transjugular Liver Biopsy

Måling af hepatisk venøs trykgradient og transjugular leverbiopsi

Here we provide a detailed protocol describing the clinical procedure of hepatic venous pressure gradient (HVPG) measurement in patients with advanced ...