RapidArc SBRT

Palliative SBRT for multiply recurrent H&N cancer (BGS)

81 y/o female 1-year after partial mandibulectomy and postoperative IMRT with cetuximab for locally recurrent squamous cell carcinoma of the retromolar trigone who developed a painful and rapidly progressive second isolated local recurrence in the prior 59.4 Gy volume. The unresectable tumor was was treated with RapidArc SBRT to 30 Gy in 5 fractions of 6 Gy and planned using cone-beam CT and Novalis Tx ExacTrac guidance. CI achieved was 1.07. Beam-on and total treatment times were 4 and 15 minutes respectively.

Spine

Metastatic Spine Disease from Thyroid Cancer (CTSI)

80 y/o female with spine metastasis to C6-T1 from advanced thyroid cancer with previous treatment to this region. RapidArc SBRT was planned and treated based on this preplanning CT. Dose delivered was 27 Gy in 3 – 9 Gy fractions. Prior to treatment the patient had significant pain radiating down the left arm. There was immediate pain relief by the third fraction and complete pain relief with no requirement for narcotics within 1-month.

Thorax

RapidArc SBRT for Inoperable Right Lung (BGS)

63 year old female with a past medical history of a left lung cancer 10 years ago status post pneumonectomy. Patient presented with biopsy proven right upper lung cancer with SBRT as the first treatment option. 60 Gy was delivered in 3 fractions of 20 Gy each using a non-coplaner rapid arc SBRT treatment platform to minimize low dose to nomal lung. This plan was superior in meeting the dose constraints to normal tissue when compared to static IMRT and single arc treatment plans.

Lung Metastasis from Esophageal Cancer (CTSI)

59 y/o male with right lung metastasis from advanced esophageal cancer was planned and treated based on a fused PET/CT. The SBRT plan was 50 Gy in 4 – 12.5 Gy fractions prescribed to the 90.5% isodose (blue line). A 3-month follow-up PET/CT (right) shows the original PTV (red line) that was treated with RapidArc SBRT indicating obliteration of the lung metastasis with surrounding inflammatory changes consistent with normal radiation response.

T2N0 Central Lung Cancer with Spine Avoidance (VUMC)

T2N0 NSCLC (left) near the spinal cord treated with 60 Gy (prescribed to the encompassing 80% isodose) in 8 fractions using 2 full RapidArc arcs.

T2N0 Non Small-Cell Lung Cancer (VUMC)

T2N0 NSCLC in the lower lobe (200 cc) treated with 60 Gy (prescribed to the encompassing 80 % isodose) in eight 7.5 Gy fractions using two partial RapidArc SBRT arcs

Recurrent stage I-A NSCLC of the left lung (MIMA)

77 y/o male with recurrent non-small cell lung cancer, CTV was 27cc, PTV was 52cc and dose was 30 Gy in 4 fractions. This case demonstrates multiarc, multiangle, partial arc technique. Collimator= 20 & 320 deg; Yaw = 15 & 345 degrees; and arcs +/- 20 degrees. Each 7.5 Gy fraction was delivered in 3 min.

Abdomen

SBRT for locally-recurrent inoperable T3N0 hepatocellular carcinoma (BGS)

67 yo man had prior transarterial chemoembolizations (TACEs) and consolidative fractionated radiotherapy to 50 Gy. One-year later he suffered isolated local progression in the dominant tumor mass that was not amenable to percutaneous ablation. RapidArc SBRT at 30 Gy in five fractions was given to the 85% isodose line. Image guidance with Novalis Tx ExacTrac and cone-beam CT on the embolized lipiodol was employed. The conformity index was 1.5. Daily beam-on & total-treatment times were 6 and 25-30 minutes respectively.

Adrenal Metastasis from Esophageal Cancer (CTSI)

A 59 y/o male with adrenal metastasis from advanced esophageal cancer was planned and treated (left) based on a fused PET/CT. The SBRT plan was 40 Gy in 5 – 8 Gy fractions. A 3-month follow-up PET/CT (right) shows the original PTV (red line) that was treated with RapidArc SBRT. Absence of PET uptake indicates complete local control of the adrenal metastasis.

Pelvis

Recurrent renal urothelial (transitional cell) carcinoma of the renal pelvis (MIMA)

Multiangle 360 degree RapidArc to current renal urothelial carcinoma of the renal pelvis.