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Volume 24, Number 2, 2019

Local control rates in stereotactic body radiotherapy (SBRT) of lung metastases associated with the biologically effective dose

Daniel Zucca Aparicio, Ovidio Hernando Requejo, Miguel Ángel de la Casa de Julián, Carmen Rubio Rodríguez, Pedro Fernández Letón


Aim To evaluate dose differences in lung metastases treated with stereotactic body radiotherapy (SBRT), and the correlation with local control, regarding the dose algorithm, target volume and tissue density. Background Several studies showed excellent local control rates in SBRT for lung metastases, with different fractionation schemes depending on the tumour location or size. These results depend on the dose distributions received by the lesions in terms of the tissue heterogeneity corrections performed by the dose algorithms. Materials and methods Forty-seven lung metastases treated with SBRT, using intrafraction control and respiratory gating with internal fiducial markers as surrogates (ExacTrac, BrainLAB AG), were calculated using Pencil Beam (PB) and Monte Carlo (MC) (iPlan, BrainLAB AG). Dose differences between both algorithms were obtained for the dose received by 99% (D99%) and 50% (D50%) of the planning treatment volume (PTV). The biologically effective dose delivered to 99% (BED99%) and 50% (BED50%) of the PTV were estimated from the MC results. Local control was evaluated after 24 months of median follow-up (range: 3–52 months). Results The greatest variations (40.0% in ΔD99% and 38.4% in ΔD50%) were found for the lower volume and density cases. The BED99% and BED50% were strongly correlated with observed local control rates: 100% and 61.5% for BED99% > 85 Gy and <85 Gy (p < 0.0001), respectively, and 100% and 58.3% for BED50% > 100 Gy and <100 Gy (p < 0.0001), respectively. Conclusions Lung metastases treated with SBRT, with delivered BED99% > 85 Gy and BED50% > 100 Gy, present better local control rates than those treated with lower BED values (p = 0.001).

Signature: Rep Pract Oncol Radiother, 2019; 24(2) : 142-150

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