Table 2.
Treatment planning and dosimetric information for SBRT studies included in liver toxicity dose-volume analysis (all studies prescribed to PTV)
| Investigator | Fractions (n) | Total dose range (Gy) | Imaging modalities | Target margins | Prescription definition | Motion management | Liver planning guidelines |
|---|---|---|---|---|---|---|---|
| Barney et al (24), 2012 | 3, 5 | 45–60 | CT, MRI | GTV = CTV; ITV = CTV + motion margin using 4DCT; PTV = ITV + nonuniform 5-mm margin | Isodose line covers PTV based on tumor volume and proximity of OARs | Gating, abdominal compression | ≥700 cm3 to ≤21 Gy |
| Tse et al (13), 2008 | 6 | 24–54 | kV fluoroscopy, CT, MRI | CTV = GTV + 8 mm within liver; PTV = CTV + individualized margin (minimum 5 mm) | Isodose line covers PTV based on limiting RILD risk | Breath hold, abdominal compression | Based on Veff |
| Vautravers-Dewas et al (25), 2011 | 3, 4 | 40, 45 | CT, MRI | CTV = GTV + 5 mm; PTV = CTV + 3 mm | 80% Isodose line covers PTV | CyberKnife respiratory tracking system with fiducial markers | V21Gy <33% |
| Huang et al (22), 2012 | 4, 5 | 25–48 | CT | With fiducial markers: PTV = GTV + 0– 8 mm (increased to 8–20 mm in caudocephalad direction if no fiducial markers) | 70%–83% Isodose line covers PTV | CyberKnife respiratory tracking system with fiducial markers, abdominal compression | ≥700 cm3 to ≤15 Gy |
| Kang et al (21), 2012 | 3 | 42–60 | CT | ITV = GTV + motion margin using slow CT; PTV = ITV + 4 mm in longitudinal direction and 2 mm in all other directions | SBRT doses prescribed at isodose line (70%–80% of maximum dose) covering ≥97% of PTV | Abdominal compression, CyberKnife respiratory tracking system with fiducial markers | ≥700 cm3 to ≤17 Gy |
| Goodman et al (10), 2010 | 1 | 18–30 | CT, MRI, PET/CT | ITV = GTV + motion margin using 4DCT; PTV = ITV + 3–5 mm for patients with 4DCT; PTV = ITV + 5–10 mm for patients with no 4DCT | 65%-90% isodose covering PTV | CyberKnife respiratory tracking system with fiducial markers | ≥700 cm3 to ≤15 Gy |
| Lee et al (11), 2009 | 6 | 27.7–60 | kV fluoroscopy, CT, MRI | CTV = GTV + 8 mm within liver; PTV = nonuniform expansion around GTV and CTV based on individual patient tumor motion and reproducibility of immobilization (≥5 mm) | Isodose line covering PTV based on limiting RILD risk (maximum dose of 140% within target) | Active breathing control, abdominal compression | Based on Veff |
| Andolino et al (14), 2011 | 3, 5 | CP: A, 44 (30–48); B, 40 (24–48) | Dual-phase CT | PTV = GTV + 5 mm radially and + 10 mm superoinferiorly | 80% Isodose line covering PTV | Abdominal compression | CP A: 1/3 to ≤10 Gy and ≥500 cm3 to <7 Gy; CP B: 1/3 to ≤18 Gy and ≥500 cm3 to <12 Gy |
| Bujold et al (12), 2013 | 6 | 24–54 | CT, MRI | CTV = GTV + 5–8 mm within liver; PTV = nonuniform expansion around CTV based on individual patient tumor motion and reproducibility of immobilization (≥5 mm) | Isodose line covering PTV based on limiting RILD risk | Active breathing control, abdominal compression | Based on Veff |
| Son et al (20), | 3 | 30–39 | CT | PTV = GTV + 3–5 mm | PTV enclosed by 70%–85% isodose line | Breath hold + CyberKnife respiratory tracking system with fiducial markers | V20Gy ≤50% |
| Barney et al (26), 2013 | 1, 3, 5 | 28–60 | CT, PET/CT | ITV = GTV + motion margin using 4DCT; PTV = ITV + 5 mm | 95% coverage of PTV with prescription isodose line | NA | NA |
| Bae et al (23), 2013 | 3, 4, 5 | 30–60 | CT, MRI, PET/CT | GTV = CTV; PTV = CTV + 4 mm in longitudinal direction and 2 mm in all other directions | 56%–83% Isodose line of maximum dose in CyberKnife and 91%–100% in RapidArc to cover ≥95% of PTVs | NA | ≥700 cm3 to ≤17 Gy |
Abbreviations: CT = computed tomography; CTV = clinical target volume; GTV = gross tumor volume; ITV = internal target volume; MRI = magnetic resonance imaging; NA = not available; PET = positron emission tomography; PTV = planning target volume.