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Stereotactic Radiotherapy in Tumor Ablation (Volume II)
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Stereotactic Radiotherapy in Tumor Ablation (Volume II)

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: 31 July 2025 | Viewed by 7420

Special Issue Editors

Dr. Rémy Kinj

E-Mail Website
Guest Editor
Service of Radiation Oncology, Department of Oncology, Lausanne University Hospital, 1010 Lausanne, Switzerland
Interests: stereotactic body radiotherapy; re-irradiation; lattice radiotherapy; thoracic radiotherapy
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Jean Bourhis

E-Mail Website
Guest Editor
Department of Radiation Oncology, Lausanne University Hospital, CH-1205 Lausanne, Switzerland
Interests: head and neck radiotherapy; flash radiotherapy; stereotactic body radiotherapy
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

We would like to cordially invite you to contribute to the collection of articles related to "Stereotactic Radiotherapy in Tumor Ablation".

In the last decade, we have seen a growing interest in oncology for stereotactic body radiotherapy (SBRT), which appears as a highly effective, non-invasive, and safe tumor ablative treatment.

SBRT is building on major improvements in delivery achieved by intensity-modulated and image-guided radiotherapy, which now permit safe ablative doses of radiation to be delivered. SBRT is increasingly being used to treat a variety of cancers, including primary tumors as well as metastases in a wide range of locations (brain, bone, lung, prostate, liver, etc.).

Accumulated clinical evidence is growing over time, with efficacy and safety having being demonstrated in randomized clinical trials.

This collection of articles aims to provide a comprehensive and broad overview of the use of SBRT in the central nervous system, head and neck, thorax, abdomen, and pelvis, as well as its use in re-irradiation or metastatic and oligometastatic settings. Discussions on the technical evolutions, biological background, new developments, and potential limitations are encouraged. The remarkable complementarity of SBRT with systemic treatments is also important to emphasize.

Our goal is to create a reliable and updated source of information for all physicians and oncologists and improve cancer care through the use of this cutting-edge technology.

We look forward to receiving your contributions to this Special Issue of the journal Cancers.

Dr. Rémy Kinj
Prof. Dr. Jean Bourhis
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • SBRT
  • stereotactic body radiotherapy
  • SABR
  • stereotactic ablative radiotherapy
  • re-irradiation
  • oligometastasis
  • local therapy

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Published Papers (6 papers)

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Research

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17 pages, 4333 KiB  
Article
Intrafractional Motion in Online-Adaptive Magnetic Resonance-Guided Radiotherapy of Adrenal Metastases Leads to Reduced Target Volume Coverage and Elevated Organ-at-Risk Doses
by Philipp Hoegen-Saßmannshausen, Tobias P. Hartschuh, Claudia Katharina Renkamp, Carolin Buchele, Fabian Schlüter, Elisabetta Sandrini, Fabian Weykamp, Sebastian Regnery, Eva Meixner, Laila König, Jürgen Debus, Sebastian Klüter and Juliane Hörner-Rieber
Cancers 2025, 17(9), 1533; https://doi.org/10.3390/cancers17091533 - 30 Apr 2025
Viewed by 205
Abstract
Background/Objectives: Stereotactic body radiotherapy is frequently used in patients with adrenal metastases. Motion of adherent radiosensitive organs at risk (OARs) and tumors influence OAR toxicity and tumor control. Online-adaptive Magnetic Resonance-guided radiotherapy (MRgRT) can address and mitigate interfractional changes. However, the impact of [...] Read more.
Background/Objectives: Stereotactic body radiotherapy is frequently used in patients with adrenal metastases. Motion of adherent radiosensitive organs at risk (OARs) and tumors influence OAR toxicity and tumor control. Online-adaptive Magnetic Resonance-guided radiotherapy (MRgRT) can address and mitigate interfractional changes. However, the impact of intrafractional variations in adrenal MRgRT is unknown. Methods: A total of 23 patients with 24 adrenal metastases were treated with MRgRT. After daily plan adaptation and before beam application, an additional (preRT) 3d MRI was acquired. PreRT target volumes and OARs were retrospectively recontoured in 200 fractions. The delivered, online-adapted treatment plans, as well as non-adapted baseline plans, were calculated on these re-contoured structures to quantify the dosimetric impact of intrafractional variations on target volume coverage and OAR doses with and without online adaptation. Normal tissue complication probabilities (NTCPs) were calculated. Results: The median time between the two MRIs was 56.4 min. GTV and PTV coverage (dose to 95% of the PTV, D95%, and volume covered by 100% of the prescription dose, V100%) were significantly inferior in the preRT plans. GTV Dmean was significantly impaired in left-sided metastases, but not in right-sided metastases. Compared to non-adapted preRT plans, adapted preRT plans were still significantly superior for all GTV and PTV metrics. Intrafractional violations of OAR constraints were frequent. D0.5cc and the volume exposed to the near-maximum dose constraint were significantly higher in the preRT plans. The volume exposed to the D0.5cc constraints in single fractions escalated up to 1.5 cc for the esophagus, 3.2 cc for the stomach, 5.3 cc for the duodenum and 7.3 cc for the bowel. This led to significantly elevated NTCPs for the stomach, bowel and duodenum. Neither PTV D95%, nor gastrointestinal OAR maximum doses were significantly impaired by longer fraction duration. Conclusions: Intrafractional motion in adrenal MRgRT caused significant impairment of target volume coverage (D95% and V100%), potentially undermining local control. Frequent violation of gastrointestinal OAR constraints led to elevated NTCP. Compared to non-adaptive treatment, online adaptation still highly improved GTV and PTV coverage. Full article
(This article belongs to the Special Issue Stereotactic Radiotherapy in Tumor Ablation (Volume II))
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12 pages, 908 KiB  
Article
Precision in Motion Management: Long-Term Local Control and Prognostic Insights in SBRT for Oligometastatic Lung and Liver Metastases
by Silke Dirkx, Sven Van Laere, Thierry Gevaert and Mark De Ridder
Cancers 2025, 17(2), 296; https://doi.org/10.3390/cancers17020296 - 17 Jan 2025
Viewed by 755
Abstract
Background/Objectives: Inadequate dosing and respiratory motion contribute to local recurrence for oligometastatic disease (OMD). While short-term LC rates are well-documented, data on long-term LC remain limited. This study investigated long-term LC after stereotactic body radiotherapy (SBRT), using respiratory motion management techniques. Methods: [...] Read more.
Background/Objectives: Inadequate dosing and respiratory motion contribute to local recurrence for oligometastatic disease (OMD). While short-term LC rates are well-documented, data on long-term LC remain limited. This study investigated long-term LC after stereotactic body radiotherapy (SBRT), using respiratory motion management techniques. Methods: This retrospective study took place at UZ Brussel with follow-up until Oct 2024. It analyzed oligometastatic patients treated with SBRT between Jul 2012 and Feb 2017. Treatment involved delivering 50 Gy in 10 fractions on the 80% isodose line, building on data from a prior prospective study. Lesion movement was managed using internal target volume (ITV) or dynamic tumor tracking (DTT) with marker. The primary endpoint of the study was long-term LC and identifying variables associated with it using a Cox proportional hazards model. Results: A total of 100 patients were treated for a total of 211 metastatic lesions. Lesions were predominantly in the lungs (74%) and treated using ITV (88%). LC rates at 1, 3, 5, and 10 years were 76.5%, 53.8%, 38.1%, and 36.3%, respectively. Improved LC was observed in locations other than lung and liver (HR: 0.309; p = 0.024) and with increasing age (HR: 0.975; p < 0.010). Worse LC was seen in liver lesions (HR: 1.808; p = 0.103) and systemic therapy post-radiotherapy (HR: 3.726; p < 0.001). No significant associations were found with tumor size or tumor motion, nor between the two motion management strategies used (DTT and ITV). Conclusions: Appropriate motion management is key in LC for OMD. No significant difference in LC was found between both techniques. Lesion location, patient age, and systemic therapy post-radiotherapy were prognostic factors for LC. Full article
(This article belongs to the Special Issue Stereotactic Radiotherapy in Tumor Ablation (Volume II))
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14 pages, 1166 KiB  
Article
Dosimetric and Clinical Prognostic Factors in Single-Isocenter Linac-Based Stereotactic Radiotherapy for Brain Metastases
by Valeria Faccenda, Riccardo Ray Colciago, Sofia Paola Bianchi, Elena De Ponti, Denis Panizza and Stefano Arcangeli
Cancers 2024, 16(18), 3243; https://doi.org/10.3390/cancers16183243 - 23 Sep 2024
Cited by 1 | Viewed by 1335
Abstract
Background/Objectives: To report on predictive factors in Linac-based SRT for single and multiple BM. Methods: Consecutive patients receiving either one or three fractions of single-isocenter coplanar VMAT SRT were retrospectively included. The GTV-PTV margin was 1–2 mm. The delivered target dose was estimated [...] Read more.
Background/Objectives: To report on predictive factors in Linac-based SRT for single and multiple BM. Methods: Consecutive patients receiving either one or three fractions of single-isocenter coplanar VMAT SRT were retrospectively included. The GTV-PTV margin was 1–2 mm. The delivered target dose was estimated by recalculating the original plans on roto-translated CT according to errors recorded by post-treatment CBCT. The Kaplan–Meier method estimated local progression-free survival (LPFS), intracranial progression-free survival (IPFS), and overall survival (OS). Log-rank and Wilcoxon–Mann–Whitney tests evaluated inter-group differences, whereas Cox regression analysis assessed prognostic factors. Results: Fifty females and fifty males, with a median age of 69 years, received 107 SRTs. A total of 213 BM (range, 1–10 per treatment) with a median volume of 0.22 cc were irradiated with a median minimum BED of 59.5 Gy. The median delivered GTV D95 reduction was −0.3%. The median follow-up was 11 months. Nineteen LP events and a 1-year LC rate of 90.1% were observed. The GTV coverage did not correlate with LC, while the GTV volume was a risk factor for LP, with the 1-year rate dropping to 73% for volumes ≥ 0.88 cc. The median LPFS, IPFS, and OS were 6, 5, and 7 months, respectively. Multivariate analysis showed that patients with melanoma histology and those receiving a second or subsequent systemic therapy line had the worst outcomes, whereas patients with adenocarcinoma histology and mutations showed better results. Conclusions: The accuracy and efficacy of the Linac-based SRT approach for BM were confirmed, but the dose distribution alone failed to predict the treatment response, suggesting that other factors must be considered to maximize SRT outcomes. Full article
(This article belongs to the Special Issue Stereotactic Radiotherapy in Tumor Ablation (Volume II))
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13 pages, 1000 KiB  
Article
Long-Term Results of Stereotactic Radiotherapy in Patients with at Least 10 Brain Metastases at Diagnosis
by Rémy Kinj, Andreas Felix Hottinger, Till Tobias Böhlen, Mahmut Ozsahin, Véronique Vallet, Vincent Dunet, Hasna Bouchaab, Solange Peters, Constantin Tuleasca, Jean Bourhis and Luis Schiappacasse
Cancers 2024, 16(9), 1742; https://doi.org/10.3390/cancers16091742 - 29 Apr 2024
Cited by 1 | Viewed by 1773
Abstract
Purpose: to evaluate an SRT approach in patients with at least 10 lesions at the time of BM initial diagnosis. Methods: This is a monocentric prospective cohort of patients treated by SRT, followed by a brain MRI every two months. Subsequent SRT could [...] Read more.
Purpose: to evaluate an SRT approach in patients with at least 10 lesions at the time of BM initial diagnosis. Methods: This is a monocentric prospective cohort of patients treated by SRT, followed by a brain MRI every two months. Subsequent SRT could be delivered in cases of new BMs during follow-up. The main endpoints were local control rate (LCR), overall survival (OS), and strategy success rate (SSR). Acute and late toxicity were evaluated. Results: Seventy patients were included from October 2014 to January 2019, and the most frequent primary diagnosis was non-small-cell lung cancer (N = 36, 51.4%). A total of 1174 BMs were treated at first treatment, corresponding to a median number of 14 BMs per patient. Most of the patients (N = 51, 72.6%) received a single fraction of 20–24 Gy. At 1 year, OS was 62.3%, with a median OS of 19.2 months, and SSR was 77.8%. A cumulative number of 1537 BM were treated over time, corresponding to a median cumulative number of 16 BM per patient. At 1-year, the LCR was 97.3%, with a cumulative incidence of radio-necrosis of 2.1% per lesion. Three patients (4.3%) presented Grade 2 toxicity, and there was no Grade ≥ 3 toxicity. The number of treated BMs and the treatment volume did not influence OS or SSR (p > 0.05). Conclusions: SRT was highly efficient in controlling the BM, with minimal side effects. In this setting, an SRT treatment should be proposed even in patients with ≥10 BMs at diagnosis. Full article
(This article belongs to the Special Issue Stereotactic Radiotherapy in Tumor Ablation (Volume II))
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Review

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17 pages, 941 KiB  
Review
Stereotactic Lung Re-Irradiation After a First Course of Stereotactic Radiotherapy with In-Field Relapse: A Valuable Option to Be Considered
by Assim Sahin, Edouard Romano, Alessio Casutt, Raphaël Moeckli, Véronique Vallet, Shaïma El Chammah, Mahmut Ozsahin and Rémy Kinj
Cancers 2025, 17(3), 366; https://doi.org/10.3390/cancers17030366 - 23 Jan 2025
Viewed by 1164
Abstract
Background/Objectives: Stereotactic body radiation therapy (SBRT) has demonstrated high local control rates for inoperable early-stage lung cancers. However, 5–15% of patients experience local relapse within the irradiated volume after treatment, with limited curative salvage options. The aim of this review is to clarify [...] Read more.
Background/Objectives: Stereotactic body radiation therapy (SBRT) has demonstrated high local control rates for inoperable early-stage lung cancers. However, 5–15% of patients experience local relapse within the irradiated volume after treatment, with limited curative salvage options. The aim of this review is to clarify the modalities and outcomes after a second course of SBRT in patients with local relapse after a previous lung SBRT. Methods: An exhaustive literature review was conducted to identify, analyse and summarise the results of 21 main studies. Results: Local repeat lung SBRT after a first course of SBRT showed a favourable local control at 1 and 2 years, ranging from 70 to 90% and 45 to 80%, respectively. Good overall survival rates were also observed at 1 and 2 years reaching up to 95% and 85%, respectively. Toxicity was rare but could be severe, with cases of Grade 4 and 5 toxicities (≈5%). An important dose relationship was observed between re-irradiation dose levels and local control, highlighting the importance of precise dosing. The cumulative doses impacting organs at risk were similarly associated with increased radiation-induced toxicity. Central lung lesions presented a higher risk for severe side effects compared to peripheral ones. Conclusions: In conclusion, repeat lung SBRT after a first course of SBRT represents a feasible treatment option in cases of local recurrence. In order to limit severe toxicity, patients must be carefully selected, and particular attention should be given to cumulative doses to organs at risk, as well as tumour location. Thus, further investigations are still needed to refine the optimal parameters for SBRT lung re-irradiation. Full article
(This article belongs to the Special Issue Stereotactic Radiotherapy in Tumor Ablation (Volume II))
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27 pages, 1321 KiB  
Review
Recent Advances and Current Challenges in Stereotactic Body Radiotherapy for Ultra-Central Lung Tumors
by Viola Salvestrini, Andrea Lastrucci, Marco Banini, Mauro Loi, Maria Grazia Carnevale, Emanuela Olmetto, Pietro Garlatti, Gabriele Simontacchi, Giulio Francolini, Pierluigi Bonomo, Yannick Wandael, Isacco Desideri, Renzo Ricci, Daniele Giansanti, Vieri Scotti and Lorenzo Livi
Cancers 2024, 16(24), 4135; https://doi.org/10.3390/cancers16244135 - 11 Dec 2024
Viewed by 1503
Abstract
Stereotactic body radiotherapy has been established as a viable treatment option for inoperable early-stage non-small cell lung cancer or secondary lesions mainly in oligoprogressive/oligometastatic scenarios. Treating lesions in the so-called “no flight zone” has always been challenging and conflicting data never cleared how [...] Read more.
Stereotactic body radiotherapy has been established as a viable treatment option for inoperable early-stage non-small cell lung cancer or secondary lesions mainly in oligoprogressive/oligometastatic scenarios. Treating lesions in the so-called “no flight zone” has always been challenging and conflicting data never cleared how to safely treat these lesions. This is truer considering ultra-central lesions, i.e., directly abutting or whose PTV is overlapping critical mediastinal organs. While historical retrospective data are abundant but mostly heterogenous in terms of the definition of ultra-central lesions, dosing regimens and outcomes, prospective data remain scarce, even though recently published studies have given new encouraging results for such delicate treatment scenarios. For this reason, we aimed to review and summarize current knowledge on stereotactic radiation treatment for ultra-central thoracic lesions, highlighting the most recent advances and the messages that can be taken from them. Lastly, we propose a workflow of the necessary steps to identify and treat such patients, therefore helping in elucidating the advantages and caveats of such treatment options. Full article
(This article belongs to the Special Issue Stereotactic Radiotherapy in Tumor Ablation (Volume II))
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