eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
Current Issue Archive Supplements Articles in Press Journal Information Aims and Scope Editorial Office Editorial Board Register as Author Register as Reviewer Instructions for Authors Abstracting and indexing Subscription Advertising Information Links
SCImago Journal & Country Rank

Interview with Professor Janusz Skowronek
ABS 2015
vol. 10
Original paper

Single fraction computed tomography-guided high-dose-rate brachytherapy or stereotactic body radiotherapy for primary and metastatic lung tumors?

Mark KH Chan, Venus Wan Yan Lee, Noriyuki Kadoya, Chi-Leung Chiang, Matthew YP Wong, Ronnie WK Leung, Steven Cheung, Oliver Blanck

J Contemp Brachytherapy 2018; 10, 5: 446–453
Online publish date: 2018/10/31
View full text
Get citation
JabRef, Mendeley
Papers, Reference Manager, RefWorks, Zotero
To provide a pilot dosimetric study of computed tomography (CT)-guided high-dose-rate (HDR) brachytherapy (BRT) and stereotactic body radiotherapy (SBRT) for primary and metastatic lung lesions.

Material and methods
For nine lung primary and metastasis patients, 3D image-based BRT plan using a single virtual catheter was planned for 34 Gy in single fraction to the gross tumor volume (GTV) + 3 mm margin to account for tumor deformation. These plans were compared to margin-based (MB-) and robustness optimized (RO-) SBRT, assuming the same tumor deformation under real-time tumor tracking. Consistent dose calculation was ensured for both BRT and SBRT plans using the same class of collapsed cone convolution superposition algorithm. Plan quality metrics were compared by Friedman tests and Wilcoxon t-tests.

Results and Conclusions
Brachytherapy plans showed significant higher GTV mean dose compared to MB- and RO-SBRT (122.2 Gy vs. 50.4 and 44.7 Gy, p < 0.05), and better dose gradient index (R50) = 2.9 vs. 4.3 and 8.4 for MB- and RO-SBRT, respectively. Dose constraints per the RTOG 0915 protocol were achieved for all critical organs except chest wall in BRT. All other dose-volume histograms (DVH) metrics are comparable between BRT and SBRT. Treatment delivery time of BRT and SBRT plans significantly increased and decreased with increasing GTV size, respectively. SBRT using advanced MLC tracking technique and non-coplanar VMAT can achieve comparable dosimetric quality to HDR BRT. Whether or not, the significantly higher GTV dose can increase killing of radioresistant tumor cells and offset the effect of tumor reoxygenation in single fraction BRT, requires further clinical investigation.


CT-guided brachy, HDR, high-dose-rate, lung cancer, metastasis, stereotactic body radiotherapy

Yang B, Sun X, Pang H et al. Dosimetric analysis of rib interference of the CTV during interstitial brachytherapy of lung tumors. J Contemp Brachytherapy 2017; 9: 566-571.
Sharma M, Tandon S, Nayak U et al. Computerized tomography-guided percutaneous high-dose-rate interstitial brachytherapy for malignant lung lesions. J Cancer Res Ther 2011; 7: 174-179.
Bretschneider T, Ricke J, Gebauer B, Streitparth F. Image-guided high-dose-rate brachytherapy of malignancies in various inner organs – technique, indications, and perspectives. J Contemp Brachytherapy 2016; 8: 251-261.
Ricke J, Wust P, Wieners G et al. CT-guided interstitial single-fraction brachytherapy of lung tumors: phase I results of a novel technique. Chest 2005; 127: 2237-2242.
Peters N, Wieners G, Pech M et al. CT-guided interstitial brachytherapy of primary and secondary lung malignancies. Strahlenther Onkol 2008; 184: 296-301.
Tselis N, Ferentinos K, Kolotas C et al. Computed tomography-guided interstitial high-dose-rate brachytherapy in the local treatment of primary and secondary intrathoracic malignancies. J Thorac Oncol 2011; 6: 545-552.
Xiang L, Zhang JW, Lin S et al. Computed tomography-guided interstitial high-dose-rate brachytherapy in combination with regional positive lymph node intensity-modulated radiation therapy in locally advanced peripheral non-small cell lung cancer: a phase 1 clinical trial. Int J Radiat Oncol Biol Phys 2015; 92: 1027-1034.
Beaulieu L, Carlsson Å, Tedgren, Carrier JF et al. Report of the Task Group 186 on model-based dose calculation methods in brachytherapy beyond the TG-43 formalism: Current status and recommendations for clinical implementation. Med Phys 2012; 39: 6208-6236.
Timmerman RD, Hu C, Michalski J et al. Long-term results of RTOG 0236: A phase II trial of stereotactic body radiation therapy (SBRT) in the treatment of patients with medically inoperable stage I non-small cell lung cancer. Int J Radiat Oncol Biol Phys 2014; 90: S30.
Davis JN, Medbery C, Sharma S et al. Stereotactic body radiotherapy for centrally located early-stage non-small cell lung cancer or lung metastases from the RSSearch® patient registry. Radiat Oncol 2015; 10: 113.
Lischalk JW, Woo SM, Kataria S et al. Long-term outcomes of stereotactic body radiation therapy (SBRT) with fiducial tracking for inoperable stage I non-small cell lung cancer (NSCLC). J Radiat Oncol 2016; 5: 379-387.
Rusthoven KE, Kavanagh BD, Cardenes H et al. Multi-institutional phase I/II trial of stereotactic body radiation therapy for lung metastases. J Clin Oncol 2009; 27: 1572-1578.
Timmerman R, McGarry R, Yiannoutsos C et al. Excessive toxicity when treating central tumors in a phase II study of stereotactic body radiation therapy for medically inoperable early-stage lung cancer. J Clin Oncol 2006; 24: 4833-4839.
Chang JY, Bezjak A, Mornex F. Stereotactic ablative radiotherapy for centrally located early stage non-small-cell lung cancer: what we have learned. J Thorac Oncol 2015; 10: 577-585.
Videtic GM, Paulus R, Singh AK et al. Long-term follow-up on NRG Oncology RTOG 0915 (NCCTG N0927): A randomized phase 2 study comparing 2 stereotactic body radiation therapy schedules for medically inoperable patients with stage I peripheral non-small cell lung cancer. Int J Radiat Oncol Biol Phys 2017; 99: S15-S16.
Milickovic N, Tselis N, Karagiannis E et al. Iridium-Knife: Another knife in radiation oncology. Brachytherapy 2017; 16: 884-892.
Videtic G, Singh A, Olivier K et al. A randomized phase II study comparing 2 stereotactic body radiation therapy (SBRT) schedules for medically inoperable patients with stage I peripheral non-small cell lung cancer. RTOG Protocol 0915. 2009.
Liu HH, Balter P, Tutt T et al. Assessing respiration-induced tumor motion and internal target volume using four-dimensional computed tomography for radiotherapy of lung cancer. Int J Radiat Oncol Biol Phys 2017; 68: 531-540.
Tran A, Zhang J, Woods K et al. Treatment planning comparison of IMPT, VMAT and 4π radiotherapy for prostate cases. Radiat Oncol 2017; 12: 10.
Dong P, Lee P, Ruan D et al. 4π noncoplanar stereotactic body radiation therapy for centrally located or larger lung tumors. Int J Radiat Oncol Biol Phys 2013; 86: 407-413.
Caillet V, Keall PJ, Colvill E et al. MLC tracking for lung SABR reduces planning target volumes and dose to organs at risk. Radiother Oncol 2017; 124: 18-24.
Stieb S, Lang S, Linsenmeier C et al. Safety of high-dose-rate stereotactic body radiotherapy. Radiat Oncol 2015; 10: 27.
Navarria P, Ascolese AM, Mancosu P et al. Volumetric modulated arc therapy with flattening filter free (FFF) beams for stereotactic body radiation therapy (SBRT) in patients with medically inoperable early stage non-small cell lung cancer (NSCLC). Radiother Oncol 2013; 107: 414-418.
Booth JT, Caillet V, Hardcastle N et al. The first patient treatment of electromagnetic-guided real time adaptive radiotherapy using MLC tracking for lung SABR. Radiother Oncol 2016; 121: 19-25.
Ravkilde T, Keall PJ, Højbjerre K et al. Geometric accuracy of dynamic MLC tracking with an implantable wired electromagnetic transponder. Acta Oncol 2011; 50: 944-951.
Chan M, Wong M, Leung R et al. Optimizing the prescription isodose level in stereotactic volumetric-modulated arc radiotherapy of lung lesions as a potential for dose de-escalation. Radiat Oncol 2018; 13: 24.
Guckenberger M, Klement RJ, Allgäuer M et al. Local tumor control probability modeling of primary and secondary lung tumors in stereotactic body radiotherapy. Radiother Oncol 2016; 118: 485-491.
Paddick I, Lippitz B. A simple dose gradient measurement tool to complement the conformity index. J Neurosurg 2006; 105 (Suppl): 194-201.
Bhagat N, Fidelman N, Durack JC et al. Complications associated with the percutaneous insertion of fiducial markers in the thorax. Cardiovasc Intervent Radiol 2010; 33: 1186-1191.
Kothary N, Heit JJ, Louie JD et al. Safety and efficacy of percutaneous fiducial marker implantation for image-guided radiation therapy. J Vasc Interv Radiol 2009; 20: 235-239.
Guckenberger M, Andratschke N, Alheit H et al. Definition of stereotactic body radiotherapy: principles and practice for the treatment of stage I non-small cell lung cancer. Strahlenther Onkol 2014; 190: 26-33.
Shibamoto Y, Miyakawa A, Otsuka S, Iwata H. Radiobiology of hypofractionated stereotactic radiotherapy: what are the optimal fractionation schedules? J Radiat Res 2016; 57: i76-i82.
Quick links
© 2018 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe