Fractionated Stereotactic Radiotherapy. Rationale, indications, & treatment techniques
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1 Fractionated Stereotactic Radiotherapy Rationale, indications, & treatment techniques
2 Radiobiological principles
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6 The BED (Gy) = D(1 + d/α/β) Assume BED 1 = BED 2 for tissue of an unknown α/β:
7 Optic ret dose = Dose (cgy)/ N0.53
8 Dose homogeneity MDPD ratio: Maximum dose/ prescribed dose
9 Dose conformality PTV ratio: Prescribed isodose/ target volume ratio
10 Isodose prescription Tumor control rate Rate of cranial neuropathy V VII VIII Gamma Knife Radiosurgery, Gy median Gamma Knife Radiosurgery, Gy median Conventional Dose Fractionated Stereotactic Radiotherapy 47.5 Gy median
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12 6000 BED and hearing ret doses hearing ret alpha/beta=1.63 alpha/beta = # of fractions
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17 ONSM Patient 9 with left ONSM with visual field before and 132 weeks after SRT
18 ONSM Patient 6 with right ONSM with visual field before and 170 weeks after SRT
19 ONSM Patient 10 with planum meningioma invading both optic canals with visual fields before and 129 weeks after SRT
20 ONSM Patient 22 with planum meningioma invading both optic canals with visual fields before and 32 weeks after SRT
21 ONSM Patient 16 with right ONSM in only functioning ON with visual field before and 182 weeks after SRT
22 ONSM Patient 5 with left ONSM (NLP) and chiasm with visual field of functioning ON before and 175 weeks after SRT
23 ONSM Patient 24 with right sphenoid/ orbital apex with visual field of functioning ON before and 24 weeks after SRT
24 ONSM Patient 29 with planum/bilateral orbital apex tumor with visual field of only functioning ON before and 32 wks after SRT
25 ONSM Kaplan-Meier Cum. Survival Plot for vision comparing CF-SRT to observation 1 Probability of vision preservation CF-SRT observation p = Time (weeks)
26 ONSM: Novalis solution
27 Acoustic Neuromas
28 Acoustic Neuromas: tumor control Figure 5 Kaplan-Meier plot for probability of tumor control for all patients with follow-up of > 6 months 1 Probability of tumor control SRT (N = 36) SRS (N = 62) p = Time (weeks)
29 Acoustic Neuromas: Trigeminal nerve preservation Figure 6 Kaplan-Meier plot for probability of trigeminal nerve preservation for all patients with follow-up of > 6 months 1 Probability of V nerve preservation SRT (N = 40) SRS (N = 63) p = Time (weeks)
30 Acoustic Neuromas: Facial nerve preservation Figure 7 Kaplan-Meier plot for probability of facial nerve preservation for all patients with follow-up of > 6 months 1 Probability of VII nerve preservation SRT (N = 41) SRS (N = 56) p = Time (weeks)
31 Acoustic Neuromas: Hearing preservation Figure 8a Kaplan-Meier plot for probability of the same Gardner-Robertson hearing grade for all patients 1 Probability of same G-R grade SRT (N = 34) SRS (N = 17) p = a Time (weeks)
32 Acoustic Neuromas: Hearing preservation Figure 8b Kaplan-Meier plot for probability of maintaining serviceable hearing grade for all patients 1 Probability of serviceable hearing SRT (N = 21) SRS (N = 12) p = b Time (weeks)
33 Acoustic Neuromas: Hearing preservation Figure 8c Kaplan-Meier plot for probability of maintenance of serviceable hearing by pre-treatment G-R Grade 1 G-R I (N = 24) Probability of serviceable hearing p =.0105 G-R II (N = 10) 8c Time (weeks)
34 Acoustic Neuromas: Hearing preservation Figure 8d Kaplan-Meier plot for probability of maintenance of serviceable hearing in patients with pre-treatment G-R I hearing by treatment group 1 Probability of serviceable hearing SRT (N = 17) SRS (N = 7) p = d Time (weeks)
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36 What about observation? Kaplan-Meier Cum. Survival Plot for KM-hearing-1 Censor Variable: seviceable censored? Grouping Variable: Tx Mode Cum. Survival Cum. Survival (Gamma) Event Times (Gamma) Censor Times (Gamma) Cum. Survival (Linac) Event Times (Linac) Censor Times (Linac) Cum. Survival (Observe) Event Times (Observe) Censor Times (Observe) Time
37 Dose cohort 50.4 Gy audiometric data all measureable (71) serviceable (48) corrected for follow-up & initial SNHL 1 (27) Pre-treatment PTA (db) SDS (%) PTA Post-treatment PTA SDS SDS Gy audiometric data all measureable (29) serviceable (25) corrected for follow-up & initial SNHL 1 (14) a
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Description. Section: Therapy Effective Date: January 15, 2015 Subsection: Therapy Original Policy Date: September 13, 2012 Subject:
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List the tumours that may arise in CPA:
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