Trattamenti stereo-RT e radiochirurgici
come opzioni standard di trattamento:
stato dell’arte in base a linee guida
intern...
Materials and MethodsMaterials and Methods
Materials and MethodsMaterials and Methods
Trattamenti stereo-RT e radiochirurgici
come opzioni standard di trattamento nei
tumori cerebrali primitivi:
stato dell’ar...
Enthusiasm for SRS
in low grade gliomas
has wanted due to
insufficient evidence
for therapeutic
advantage
No Evidence
At the diagnosis
SRS
GTV or CTV < 40mm
15-24 Gy (SRS) + 60 Gy (EBRT)
Conclusions:Conclusions: Stereotactic
radiosurgery ...
At the diagnosis
FSRT
CTV < 60mm
50 Gy (EBRT) +
20/28 Gy (FSRT) a 5/7 Gy/die
Conclusions:Conclusions: This first, multi-...
REIRRADIAZIONE
Retrospective Studies
Category 2A
Retrospectives
District Level I/
Category 1
Level II/
Category 2A
Level II/
Category 2B
Primary
Brain Tumors
None
-Adult Medulloblastoma ...
Trattamenti stereo-RT e radiochirurgici
come opzioni standard di trattamento nel
Metastasi Cerebrali/Vertebrali:
stato del...
Materials and MethodsMaterials and Methods
PFS OS
CH + WBRTCH + WBRT
CH + WBRTCH + WBRT
WBRTWBRT
WBRTWBRT
p=0,02 p<.01
Category 1
WBRT: 36Gy in 12fr
GTR + WBRT vs
WB...
Category 1
GTR + WBRT vs
GTR alone:
1 randomized study
p<,001 p<,001 p=,03
WBRT + SRS
should be
standard
treatment for
patients with a
single
unresectable
brain metastases
and considered
for patien...
SRS 18-25Gy
WBRT 30Gy in 10fr
+WBRT
-Did not improve
survival
-Reduce rate of new
mts
SRS alone vs
SRS +WBRT
1 randomized ...
WBRT + SRS >>
WBRT alone
WBRT + SRS >>
SRS alone
+WBRT
-Did not improve
survival
-Reduce rate of new
mts
Level II-2-3
No Evidence
Level II-3
Retrospectives studies
District Level I/
Category 1
Level II/
Category 2A
Level II/
Category 2B
Brain/Spinal
Metastases
-1-3 lesions:
GTR + WBRT
...
Ongoing Trials
• RTOGRTOG
- RTOG 0671/0574- A Phase III Randomized Trial of the Role of Whole
Brain Radiation Therapy in A...
Trattamenti stereo-RT e
radiochirurgici come opzioni
standard di trattamento nelle lesioni
benigne intracraniche:
stato de...
PATIENT SELECTION
Large tumor
sympoms related to mass
Elderly, minimal symptoms
incidentally discovered tumors and no grow...
District Level I Level II /
category 2a
Level II/
category 2b
Level III
Intracranial
benign lesions
None
-Primary Spinal
C...
Trattamenti stereo-RT come opzioni
standard di trattamento nei tumori
polmonari NSCLC:
stato dell’arte in base a linee gui...
SABR & LUNG CANCER :
WHEN? HOW?
WHY?
Early stage (I/II, N0):
• Medically inoperable
• High surgical risk
(eg. age 75 years or older, poor lung function)
Loco...
SABR & LUNG CANCER :
WHEN?
SABR & LUNG CANCER :
• early stage - medically inoperable
Eligibility Criteria
Stage I or II disease based on 1 of the fo...
SABR & LUNG CANCER
JAMA. 2010 March 17; 303(11): 1070–1076.
Timmerman R,; Paulus R,; Galvin J,; et al.
Results
Local contr...
SABR & LUNG CANCER
JAMA. 2010 March 17; 303(11): 1070–1076.
Timmerman R,; Paulus R,; Galvin J,; et al.
•Disease-free survi...
SABR & LUNG CANCER :
• early stage - medically inoperable/refused
SABR & LUNG CANCER :
• early stage - medically inoperable/refused
Toxicity
• Sixteen patients (28%) experienced grade
3 to...
SABR & LUNG CANCER :
• early stage - medically inoperable/refused
Toxicity
• Sixteen patients (28%) experienced grade
3 to...
Int J Radiat Oncol Biol Phys. 2012 Dec 1;84(5):1060-70.
SABR & LUNG CANCER :
• early stage - high risk patients
Int J Radiat Oncol Biol Phys. 2012 Dec 1;84(5):1060-70.
SABR & LUNG CANCER :
• early stage - high risk patients
Shirvani S...
Int J Radiat Oncol Biol Phys. 2012 Dec 1;84(5):1060-70.
SABR & LUNG CANCER :
• early stage - high risk patients
SABR & LUNG CANCER :
• early stage - high risk patients
SABR & LUNG CANCER :
WHEN?
Category 2A
V5
Risk-adapted SBRT fractionation
schemes were based on PTV size
and degree of overlap between
areas from conventionally
...
V5
Risk-adapted SBRT fractionation
schemes were based on PTV size
and degree of overlap between
areas from conventionally
...
SABR & LUNG CANCER :
•Limited lung metastases
1-3 lung metastases, < 7 cm.
Dose escalation : 48 - 60 Gy/ 3fr
The primary e...
SABR & LUNG CANCER :
•Limited lung metastases
.
Category 2A
1-3 lung metastases, < 7 cm.
Dose escalation : 48 - 60 Gy/ 3fr
SABR & LUNG CANCER :
HOW?
SABR & LUNG CANCER:
Fractionation schedule
• Local control
J Thorac Oncol. 2007 Jul;2(7 Suppl 3):S94-100.
Onishi H, Shirat...
Toxicity
•No side effects: 105/219 pt
•Grade ≥ 3 radiation
pneumonitis: 6/219pt
•Rib fractures: 4/219 pt
•Chronic toracic ...
SABR & LUNG CANCER :
Fractionation schedule
• Toxicity
BED3
<210 Gy reduce the risk of death by approximately 75%
Senthi S...
SABR & LUNG CANCER :
HOW?
SABR & LUNG CANCER :
ONGOING TRIALS
RTOG 0813
Phase I/II study of SBRT for early stage
centrally located NSCLC in medicall...
District Level I/
Category 1
Level II/
Category 2A
Level II/
Category 2B
Lung NSCLC
None
•Early stage (I/II, N0):
Medicall...
Trattamenti stereo-RT come opzioni
standard di trattamento nell’
Epatocarcinoma:
stato dell’arte in base a linee guida
int...
Category 2B
: Transaterial bland embolization (TAE), Transarterial
Chemoembolization (TACE) and radioembolization with
Yttrium-90 micr...
At IUSCC…
Percutaneus
ethanol injection
Radiofrequency
ablation
TACE SBRT
(At time of
trasplant)
2-year Local
Control rate...
… Integrated Therapies?
Trattamenti stereo-RT come opzioni
standard di trattamento nelle
Metastasi epatiche:
stato dell’arte in base a linee guida...
Category 3
• 69 Patients with 174 metstatic liver lesions
• Median toral dose of 48 Gy
• Dose for fraction = 2 – 6 Gy
• 69 Patients w...
Trattamenti stereo-RT come opzioni
standard di trattamento nell’
Adenocarcinoma Pancreatico:
stato dell’arte in base a lin...
Retrospective
Studies
PRO
6-months Overall Local Control =
91 %
12-months Overall Local Control =
84%
• Retrospective study
• 77 Patients
• Unre...
CONS
6-months late grade ≥2 toxicity =
11 %
12-months late grade ≥2 toxicity =
25%
• Retrospective study
• 77 Patients
• U...
Trattamenti stereo-RT come opzioni
standard di trattamento nell’
Adenocarcinoma Prostatico:
stato dell’arte in base a line...
Conclusions
Summary
District Level I/
Category 1
Level II/
Category 2A
Level II/
Category 2B
Level III
Category 3
Primary Brain
Tumors...
Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida intern...
Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida intern...
Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida intern...
Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida intern...
Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida intern...
Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida intern...
Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida intern...
Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida intern...
Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida intern...
Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida intern...
Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida intern...
Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida intern...
Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida intern...
Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida intern...
Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida intern...
Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida intern...
Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida intern...
Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida intern...
Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida intern...
Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida intern...
Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida intern...
Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida intern...
Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida intern...
Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida intern...
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Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida internazionali

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24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose

21 marzo 2014: Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida internazionali

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Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida internazionali

  1. 1. Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida internazionali Silvia Chiesa, Alessandra Castelluccia, Barbara Diletto, Domenico Marchesano
  2. 2. Materials and MethodsMaterials and Methods
  3. 3. Materials and MethodsMaterials and Methods
  4. 4. Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento nei tumori cerebrali primitivi: stato dell’arte in base a linee guida internazionali
  5. 5. Enthusiasm for SRS in low grade gliomas has wanted due to insufficient evidence for therapeutic advantage No Evidence
  6. 6. At the diagnosis SRS GTV or CTV < 40mm 15-24 Gy (SRS) + 60 Gy (EBRT) Conclusions:Conclusions: Stereotactic radiosurgery followed by EBRT and BCNU does not improve the outcome in patients with GBM nor does it change the general quality of life or cognitive functioning. Randomized RTOG 93-05
  7. 7. At the diagnosis FSRT CTV < 60mm 50 Gy (EBRT) + 20/28 Gy (FSRT) a 5/7 Gy/die Conclusions:Conclusions: This first, multi- institutional FSRT boost trial for GBM was feasible and well tolerated. There is no significant survival benefit using this dose-intense RT regimen. Subset analysis revealed a trend toward improved outcome for GTR patients suggesting that patients with minimal disease burden may benefit from this form of accelerated RT. Phase II p=0.24 RTOG 00-23
  8. 8. REIRRADIAZIONE Retrospective Studies
  9. 9. Category 2A Retrospectives
  10. 10. District Level I/ Category 1 Level II/ Category 2A Level II/ Category 2B Primary Brain Tumors None -Adult Medulloblastoma and Sopratentorial PNET: residual/recurrent -Gliomas: reirradiation in selected patients SummarySummary
  11. 11. Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento nel Metastasi Cerebrali/Vertebrali: stato dell’arte in base a linee guida internazionali
  12. 12. Materials and MethodsMaterials and Methods
  13. 13. PFS OS CH + WBRTCH + WBRT CH + WBRTCH + WBRT WBRTWBRT WBRTWBRT p=0,02 p<.01 Category 1 WBRT: 36Gy in 12fr GTR + WBRT vs WBRT alone: 1 randomized study
  14. 14. Category 1 GTR + WBRT vs GTR alone: 1 randomized study p<,001 p<,001 p=,03
  15. 15. WBRT + SRS should be standard treatment for patients with a single unresectable brain metastases and considered for patients with two or three brain metastases WBRT 37,5Gy in 15fr SRS 15-24Gy SRS + WBRT vs WBRT alone: 2 randomized studies -RTOG 95-08 - Kondziolka et al, IJROBP 1999; 45:427-434 Category 1
  16. 16. SRS 18-25Gy WBRT 30Gy in 10fr +WBRT -Did not improve survival -Reduce rate of new mts SRS alone vs SRS +WBRT 1 randomized study Category 1
  17. 17. WBRT + SRS >> WBRT alone
  18. 18. WBRT + SRS >> SRS alone
  19. 19. +WBRT -Did not improve survival -Reduce rate of new mts
  20. 20. Level II-2-3 No Evidence Level II-3 Retrospectives studies
  21. 21. District Level I/ Category 1 Level II/ Category 2A Level II/ Category 2B Brain/Spinal Metastases -1-3 lesions: GTR + WBRT -single lesion: SRS + WBRT -2-3 lesions: SRS + WBRT -1-3 lesions: SRS alone - Multiple lesions: SRS - Recurrence or progression: SRS -Spinal lesions at recurrence or in case of intractabil pain - Recurrence or progression: SRS SummarySummary
  22. 22. Ongoing Trials • RTOGRTOG - RTOG 0671/0574- A Phase III Randomized Trial of the Role of Whole Brain Radiation Therapy in Addition to Radiosurgery in the Management of Patients with One to Three Cerebral Metastases - RTOG 1270/NCCTG N107C – A Phase III Trial of Post-Surgical Stereotactic Radiosurgery (SRS) Compared With Whole Brain Radiotherapy (WBRT) for Resected Metastatic Brain Disease. - RTOG 0631- A Phase II/III Study of Image Guided Stereotactic Radiosurgery for Localized (1-3) Spine Metastasis: Phase II Results. • EORTCEORTC: None: None
  23. 23. Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento nelle lesioni benigne intracraniche: stato dell’arte in base a linee guida internazionali
  24. 24. PATIENT SELECTION Large tumor sympoms related to mass Elderly, minimal symptoms incidentally discovered tumors and no grow Growth (size and location) SRS SURGERY OBSERVATION SRS
  25. 25. District Level I Level II / category 2a Level II/ category 2b Level III Intracranial benign lesions None -Primary Spinal Cord Tumors: recurrence -Meningiomas: small, residual, recurrent •Vestibular schwannoma •Pituitary adenoma: residual, recurrent •Ependymoma: as boos after EBRT •AVM: small •Trigeminal neuralgia: if surgery not possible SummarySummary
  26. 26. Trattamenti stereo-RT come opzioni standard di trattamento nei tumori polmonari NSCLC: stato dell’arte in base a linee guida internazionali
  27. 27. SABR & LUNG CANCER : WHEN? HOW? WHY?
  28. 28. Early stage (I/II, N0): • Medically inoperable • High surgical risk (eg. age 75 years or older, poor lung function) Locoregional recurrence Limited lung metastases SABR & LUNG CANCER : WHEN?
  29. 29. SABR & LUNG CANCER : WHEN?
  30. 30. SABR & LUNG CANCER : • early stage - medically inoperable Eligibility Criteria Stage I or II disease based on 1 of the following tumor node metastasis (TNM) stage criteria •T1, N0, M0 •T2 (≤ 5 cm), N0, M0 •T3 (≤ 5 cm), N0, M0 (chest wall primary tumors only) •No primary tumor of any T-stage within or touching the zone of the proximal bronchial tree* NOTE: *Defined as a volume 2 cm in all directions around the proximal bronchial tree Deemed medically inoperable based on pulmonary function for surgical resection of NSCLC secondary to an underlying physiological problem RTOG 0236 Protocol Information A Phase II Trial of Stereotactic Body Radiation Therapy (SBRT) in the Treatment of Patients with Medically Inoperable Stage I/II Non-Small Cell Lung Cancer Patients receive 3 fractions of stereotactic body radiotherapy over 8-14 days (18 Gy x 3fr, 54 Gy total) in the absence of disease progression or unacceptable toxicity. The primary endpoint of this study was local control. Secondary endpoints included disease free survival, overall survival, and toxicity.
  31. 31. SABR & LUNG CANCER JAMA. 2010 March 17; 303(11): 1070–1076. Timmerman R,; Paulus R,; Galvin J,; et al. Results Local control •3-year primary tumor control rate: 97.6% (95% CI, 84.3%-99.7%). •median overall survival : 48.1 months (95% CI, 29.6 months to not reached) Toxicity •grade 3 adverse events : 12.7% (95% CI, 9.6%- 15.8%) •grade 4 adverse events : 3.6% (95% CI, 2.7%- 4.5%) •No grade 5 adverse events were reported •Disease-free survival at 3 years : 48.3% •Overall survival at 3 years : 55.8%
  32. 32. SABR & LUNG CANCER JAMA. 2010 March 17; 303(11): 1070–1076. Timmerman R,; Paulus R,; Galvin J,; et al. •Disease-free survival at 3 years : 48.3% •Overall survival at 3 years : 55.8% Results Local control •3-year primary tumor control rate: 97.6% (95% CI, 84.3%-99.7%). •median overall survival : 48.1 months (95% CI, 29.6 months to not reached) Toxicity •grade 3 adverse events : 12.7% (95% CI, 9.6%- 15.8%) •grade 4 adverse events : 3.6% (95% CI, 2.7%- 4.5%) •No grade 5 adverse events were reported
  33. 33. SABR & LUNG CANCER : • early stage - medically inoperable/refused
  34. 34. SABR & LUNG CANCER : • early stage - medically inoperable/refused Toxicity • Sixteen patients (28%) experienced grade 3 toxicity • 1 pt had grade 4 dyspnea at 36 months • No patient was lethally affected by SBRT • Fourteen patients (25%) had no pulmonary adverse effects
  35. 35. SABR & LUNG CANCER : • early stage - medically inoperable/refused Toxicity • Sixteen patients (28%) experienced grade 3 toxicity • 1 pt had grade 4 dyspnea at 36 months • No patient was lethally affected by SBRT • Fourteen patients (25%) had no pulmonary adverse effects
  36. 36. Int J Radiat Oncol Biol Phys. 2012 Dec 1;84(5):1060-70. SABR & LUNG CANCER : • early stage - high risk patients
  37. 37. Int J Radiat Oncol Biol Phys. 2012 Dec 1;84(5):1060-70. SABR & LUNG CANCER : • early stage - high risk patients Shirvani S.M. et al.
  38. 38. Int J Radiat Oncol Biol Phys. 2012 Dec 1;84(5):1060-70. SABR & LUNG CANCER : • early stage - high risk patients
  39. 39. SABR & LUNG CANCER : • early stage - high risk patients
  40. 40. SABR & LUNG CANCER : WHEN? Category 2A
  41. 41. V5 Risk-adapted SBRT fractionation schemes were based on PTV size and degree of overlap between areas from conventionally fractionated RT and SBRT
  42. 42. V5 Risk-adapted SBRT fractionation schemes were based on PTV size and degree of overlap between areas from conventionally fractionated RT and SBRT
  43. 43. SABR & LUNG CANCER : •Limited lung metastases 1-3 lung metastases, < 7 cm. Dose escalation : 48 - 60 Gy/ 3fr The primary end point was local control. Secondary end points included toxicity and survival. 3/38 pt Median survival was 19 months.
  44. 44. SABR & LUNG CANCER : •Limited lung metastases . Category 2A 1-3 lung metastases, < 7 cm. Dose escalation : 48 - 60 Gy/ 3fr
  45. 45. SABR & LUNG CANCER : HOW?
  46. 46. SABR & LUNG CANCER: Fractionation schedule • Local control J Thorac Oncol. 2007 Jul;2(7 Suppl 3):S94-100. Onishi H, Shirato H, Nagata Y, Hiraoka M, Fujino M, Gomi K, Niibe Y, Karasawa K, Hayakawa K, Takai Y, Kimura T, Takeda A, Ouchi A, Hareyama M, Kokubo M,Hara R, Itami J, Yamada K, Araki T. METHODS: This is a retrospective study to review 257 patients with stage I NSCLC (median age, 74 years: 164 T1N0M0, 93 T2N0M0) were treated with HypoFXSRT alone at 14 institutions. Stereotactic three-dimensional treatment was performed using noncoplanar dynamic arcs or multiple static ports. A total dose of 18 to 75 Gy at the isocenter was administered in one to 22 fractions. The median calculated biological effective dose (BED) was 111 Gy (range, 57-180 Gy) based on alpha/beta = 10. Overall survival rate in operable patients Local control rate BED≥100 improves LC and OS
  47. 47. Toxicity •No side effects: 105/219 pt •Grade ≥ 3 radiation pneumonitis: 6/219pt •Rib fractures: 4/219 pt •Chronic toracic pain syndromes: 3/219 pt
  48. 48. SABR & LUNG CANCER : Fractionation schedule • Toxicity BED3 <210 Gy reduce the risk of death by approximately 75% Senthi S et al. Outcomes of stereotactic ablative radiotherapy for central lung tumours: a systematic review.Radiother Oncol. 2013 Mar;106(3):276-82
  49. 49. SABR & LUNG CANCER : HOW?
  50. 50. SABR & LUNG CANCER : ONGOING TRIALS RTOG 0813 Phase I/II study of SBRT for early stage centrally located NSCLC in medically inoperable patients RTOG 0915 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 0618 A Phase II Trial of Stereotactic Body Radiation Therapy (SBRT) in the Treatment of Patients with Operable Stage I/II Non-Small Cell Lung Cancer This study is ongoing, but not recruiting participants Active, not recruiting Active, not recruiting
  51. 51. District Level I/ Category 1 Level II/ Category 2A Level II/ Category 2B Lung NSCLC None •Early stage (I/II, N0): Medically inoperable High surgical risk •Locoregional recurrence •Limited lung metastases None SummarySummary
  52. 52. Trattamenti stereo-RT come opzioni standard di trattamento nell’ Epatocarcinoma: stato dell’arte in base a linee guida internazionali
  53. 53. Category 2B
  54. 54. : Transaterial bland embolization (TAE), Transarterial Chemoembolization (TACE) and radioembolization with Yttrium-90 microsperes
  55. 55. At IUSCC… Percutaneus ethanol injection Radiofrequency ablation TACE SBRT (At time of trasplant) 2-year Local Control rate 70-85% Lesion <3cm = 85-98% Lesion >3cm = ≤ 80% 60-70% Median tumor (3,2 cm)= 90%
  56. 56. … Integrated Therapies?
  57. 57. Trattamenti stereo-RT come opzioni standard di trattamento nelle Metastasi epatiche: stato dell’arte in base a linee guida internazionali
  58. 58. Category 3
  59. 59. • 69 Patients with 174 metstatic liver lesions • Median toral dose of 48 Gy • Dose for fraction = 2 – 6 Gy • 69 Patients with 174 metstatic liver lesions • Median toral dose of 48 Gy • Dose for fraction = 2 – 6 Gy RESULTS 10-months Overall infiel Local Control 76% 20-months Overall infiel Local Control 57% Median Overall Survival time 14.5 months 6-m0nths Progression-Free Survival 46% 12-m0nths Progression-Free Survival 24% Patients developed grade ≥ 3 toxicity 0
  60. 60. Trattamenti stereo-RT come opzioni standard di trattamento nell’ Adenocarcinoma Pancreatico: stato dell’arte in base a linee guida internazionali
  61. 61. Retrospective Studies
  62. 62. PRO 6-months Overall Local Control = 91 % 12-months Overall Local Control = 84% • Retrospective study • 77 Patients • Unresectable • SBRT = 25 Gy in 1 Fraction
  63. 63. CONS 6-months late grade ≥2 toxicity = 11 % 12-months late grade ≥2 toxicity = 25% • Retrospective study • 77 Patients • Unresectable • SBRT = 25 Gy in 1 Fraction
  64. 64. Trattamenti stereo-RT come opzioni standard di trattamento nell’ Adenocarcinoma Prostatico: stato dell’arte in base a linee guida internazionali
  65. 65. Conclusions
  66. 66. Summary District Level I/ Category 1 Level II/ Category 2A Level II/ Category 2B Level III Category 3 Primary Brain Tumors None -Adult Medulloblastoma and Sopratentorial PNET: residual/recurrent -Gliomas: reirradiation in selected patients Brain/Spinal Metastases -1-3 lesions: GTR + WBRT -single lesion: SRS + WBRT -2-3 lesions: SRS + WBRT -1-3 lesions: SRS alone - Multiple lesions: SRS - Recurrence or progression: SRS -Spinal lesions at recurrence or in case of intractabile pain - Recurrence or progression: SRS Intracranial Benign Lesions -Meningiomi: residual7recurrent • Vestibular schwannoma •Pituitary adenoma •Ependimomi: as boost after EBRT •AVM: small •Trigeminal neuralgia: if surgery not possible Lung None •Early stage (I/II, N0): Medically inoperable High surgical risk •Locoregional recurrence •Limited lung metastases None Abdomen None -None HCC: unresectable, locally advanced, recurrence Pancreatic Adenocarcioma: unresectable, advanced Liver metastases Prostate None -None Low risk Localized None

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