Cancer Res Treat.  2011 Jun;43(2):75-82.

The Role of Stereotactic Ablative Radiotherapy for Early-Stage and Oligometastatic Non-small Cell Lung Cancer: Evidence for Changing Paradigms

Affiliations
  • 1Department of Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands. s.senan@vumc.nl

Abstract

A compelling body of non-randomized evidence has established stereotactic ablative lung radiotherapy (SABR) as a standard of care for medically inoperable patients with peripheral early-stage non-small cell lung cancer (NSCLC). This convenient outpatient therapy, which is typically delivered in 3-8 fractions, is also well tolerated by elderly and frail patients, makes efficient use of resources and is feasible using standard commercial equipment. The introduction of lung SABR into large populations has led to an increased utilization of radiotherapy, a reduction in the proportion of untreated patients and an increase in overall survival. In selected patients, the same ablative technology can now achieve durable local control of NSCLC metastases in a variety of common locations including the adrenal glands, bone, brain, and liver. At the same time as this, advances in prognostic molecular markers and targeted systemic therapies mean that there is now a subgroup of patients with stage IV NSCLC and a median survival of around 2 years. This creates opportunities for new trials that incorporate SABR and patient-specific systemic strategies. This selective mini-review focuses on the emerging role of SABR in patients with early-stage and oligometastatic NSCLC.

Keyword

Non-small-cell lung carcinoma; Radiosurgery; Stereotactic body radiotherapy; Clinical trial design

MeSH Terms

Adrenal Glands
Aged
Brain
Carcinoma, Non-Small-Cell Lung
Humans
Liver
Lung
Neoplasm Metastasis
Outpatients
Radiosurgery
Standard of Care

Figure

  • Fig. 1 This peripheral stage I lung tumor (left) was treated using 3 fractions of 18 Gy. The panel on the right side shows the colorwash representing high-dose regions within the planning target volume (red contour).

  • Fig. 2 This patient had initially undergone resection of a T2N0 primary non-small cell lung cancer and single fraction stereotactic radiosurgery for 2 synchronous brain metastases. Eleven mo later, after radiosurgery to 2 more brain metastases, they developed a solitary metastasis in the right adrenal gland measuring 5.3 cm in diameter (left, arrow), which was treated with stereotactic ablative lung radiotherapy to a dose of 60 Gy in 8 fractions. The 60 Gy dose (colored area, middle panel) tightly covers the treatment volume. A computed tomography scan 4 mo later shows a reduction in diameter to 3.3 cm (right, arrow).

  • Fig. 3 This patient had previously undergone a single fraction of palliative radiotherapy for a painful vertebral metastasis, and subsequently developed progressive local pain. A magnetic resonance imaging scan (left) revealed progressive vertebral destruction and thecal sac/spinal cord compression. Whilst respecting the tolerance of the spinal cord, stereotactic re-irradiation delivering a minimum dose of 8 Gy per fraction to most of the tumor volume (colorwash) was possible. The patient received 2 fractions, and the maximum point dose in the tumor was 13 Gy per fraction.


Reference

1. Loo BW, Chang JY, Dawson LA, Kavanagh BD, Koong AC, Senan S, et al. Stereotactic ablative radiotherapy: whats in a name? Pract Radiat Oncol. 2011; 1:38–39.
Article
2. Palma D, Senan S. Stereotactic radiation therapy: changing treatment paradigms for stage I nonsmall cell lung cancer. Curr Opin Oncol. 2011; 23:133–139. PMID: 21107257.
Article
3. Hurkmans CW, Cuijpers JP, Lagerwaard FJ, Widder J, van der Heide UA, Schuring D, et al. Recommendations for implementing stereotactic radiotherapy in peripheral stage IA non-small cell lung cancer: report from the Quality Assurance Working Party of the randomised phase III ROSEL study. Radiat Oncol. 2009; 4:1. PMID: 19138400.
Article
4. Verbakel WF, Senan S, Cuijpers JP, Slotman BJ, Lagerwaard FJ. Rapid delivery of stereotactic radiotherapy for peripheral lung tumors using volumetric intensity-modulated arcs. Radiother Oncol. 2009; 93:122–124. PMID: 19552979.
Article
5. Timmerman R, Paulus R, Galvin J, Michalski J, Straube W, Bradley J, et al. Stereotactic body radiation therapy for inoperable early stage lung cancer. JAMA. 2010; 303:1070–1076. PMID: 20233825.
Article
6. Lagerwaard FJ, Haasbeek CJ, Smit EF, Slotman BJ, Senan S. Outcomes of risk-adapted fractionated stereotactic radiotherapy for stage I non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2008; 70:685–692. PMID: 18164849.
Article
7. van Sörnsen de Koste JR, Lagerwaard FJ, Nijssen-Visser MR, Graveland WJ, Senan S. Tumor location cannot predict the mobility of lung tumors: a 3D analysis of data generated from multiple CT scans. Int J Radiat Oncol Biol Phys. 2003; 56:348–354. PMID: 12738308.
Article
8. Underberg RW, Lagerwaard FJ, Cuijpers JP, Slotman BJ, van Sörnsen de Koste JR, Senan S. Four-dimensional CT scans for treatment planning in stereotactic radiotherapy for stage I lung cancer. Int J Radiat Oncol Biol Phys. 2004; 60:1283–1290. PMID: 15519801.
Article
9. Lagerwaard FJ, Senan S, van Meerbeeck JP, Graveland WJ. Rotterdam Oncological Thoracic Study Group. Has 3-D conformal radiotherapy (3D CRT) improved the local tumour control for stage I non-small cell lung cancer. Radiother Oncol. 2002; 63:151–157. PMID: 12063004.
Article
10. Cheung PC, Yeung LT, Basrur V, Ung YC, Balogh J, Danjoux CE. Accelerated hypofractionation for early-stage non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2002; 54:1014–1023. PMID: 12419427.
Article
11. Palma D, Visser O, Lagerwaard FJ, Belderbos J, Slotman BJ, Senan S. Impact of introducing stereotactic lung radiotherapy for elderly patients with stage I non-small-cell lung cancer: a population-based time-trend analysis. J Clin Oncol. 2010; 28:5153–5159. PMID: 21041709.
Article
12. Nagata Y, Hiraoka M, Mizowaki T, Narita Y, Matsuo Y, Norihisa Y, et al. Survey of stereotactic body radiation therapy in Japan by the Japan 3-D Conformal External Beam Radiotherapy Group. Int J Radiat Oncol Biol Phys. 2009; 75:343–347. PMID: 19735861.
Article
13. Grutters JP, Kessels AG, Pijls-Johannesma M, De Ruysscher D, Joore MA, Lambin P. Comparison of the effectiveness of radiotherapy with photons, protons and carbonions for non-small cell lung cancer: a meta-analysis. Radiother Oncol. 2010; 95:32–40. PMID: 19733410.
Article
14. Haasbeek CJ, Lagerwaard FJ, Antonisse ME, Slotman BJ, Senan S. Stage I nonsmall cell lung cancer in patients aged > or =75 years: outcomes after stereotactic radiotherapy. Cancer. 2010; 116:406–414. PMID: 19950125.
15. Louie AV, Rodrigues G, Hannouf M, Lagerwaard FJ, Palma D, Zaric GS, et al. Withholding stereotactic radiotherapy in elderly patients with stage I non-small cell lung cancer and co-existing COPD is not justified: outcomes of a Markov Model analysis. Radiother Oncol. 2011; 99:161–165. PMID: 21620503.
Article
16. Palma D, Lagerwaard FJ, Rodrigues G, Haasbeek CJ, Senan S. Curative treatment of stage I non-small cell lung cancer in patients with severe COPD: stereotactic radiotherapy outcomes and systematic review. Int J Radiat Oncol Biol Phys. 2011; 6. 01. [Epub]. Doi: 10.1016/j.ijrobp.2011.03.005 .
17. Ball D. Extracranial stereotactic body radiotherapy for stage I non-small cell lung cancer: still investigational or standard of care? J Thorac Oncol. 2008; 3:1209–1210. PMID: 18978553.
Article
18. Soliman H, Cheung P, Yeung L, Poon I, Balogh J, Barbera L, et al. Accelerated hypofractionated radiotherapy for early-stage non-small-cell lung cancer: long-term results. Int J Radiat Oncol Biol Phys. 2011; 79:459–465. PMID: 20385455.
Article
19. Cooperberg MR, Broering JM, Carroll PR. Time trends and local variation in primary treatment of localized prostate cancer. J Clin Oncol. 2010; 28:1117–1123. PMID: 20124165.
Article
20. Mintz A, Perry J, Spithoff K, Chambers A, Laperriere N. Management of single brain metastasis: a practice guideline. Curr Oncol. 2007; 14:131–143. PMID: 17710205.
Article
21. Grossman J, Mackenzie FJ. The randomized controlled trial: gold standard, or merely standard? Perspect Biol Med. 2005; 48:516–534. PMID: 16227664.
Article
22. Bentzen SM. Radiation oncology health technology assessment: the best is the enemy of the good. Nat Clin Pract Oncol. 2008; 5:563. PMID: 18818689.
23. Weijer C, Shapiro SH, Cranley Glass K. For and against: clinical equipoise and not the uncertainty principle is the moral underpinning of the randomised controlled trial. BMJ. 2000; 321:756–758. PMID: 10999914.
24. Wisnivesky JP, Halm E, Bonomi M, Powell C, Bagiella E. Effectiveness of radiation therapy for elderly patients with unresected stage I and II non-small cell lung cancer. Am J Respir Crit Care Med. 2010; 181:264–269. PMID: 19892859.
Article
25. Hurkmans CW, van Lieshout M, Schuring D, van Heumen MJ, Cuijpers JP, Lagerwaard FJ, et al. Quality assurance of 4D-CT scan techniques in multicenter phase III trial of surgery versus stereotactic radiotherapy (radiosurgery or surgery for operable early stage (Stage 1A) non-small-cell lung cancer [ROSEL] study). Int J Radiat Oncol Biol Phys. 2011; 80:918–927. PMID: 20950961.
Article
26. Pan H, Simpson DR, Mell LK, Mundt AJ, Lawson JD. A survey of stereotactic body radiotherapy use in the United States. Cancer. 2011; 3. 15. [Epub]. Doi: 10.1002/cncr.26067 .
Article
27. Dahele M, Senan S. Radiation oncology: overview and recent advances. J R Coll Physicians Edinb. 2010; 40:136–143. PMID: 21125059.
Article
28. Onishi H, Shirato H, Nagata Y, Hiraoka M, Fujino M, Gomi K, et al. Hypofractionated stereotactic radiotherapy (HypoFXSRT) for stage I non-small cell lung cancer: updated results of 257 patients in a Japanese multi-institutional study. J Thorac Oncol. 2007; 2(7 Suppl 3):S94–S100. PMID: 17603311.
Article
29. Park C, Papiez L, Zhang S, Story M, Timmerman RD. Universal survival curve and single fraction equivalent dose: useful tools in understanding potency of ablative radiotherapy. Int J Radiat Oncol Biol Phys. 2008; 70:847–852. PMID: 18262098.
Article
30. Olsen JR, Robinson CG, El Naqa I, Creach KM, Drzymala RE, Bloch C, et al. Dose-response for stereotactic body radiotherapy in early-stage non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2011; 4. 06. [Epub]. Doi: 10.1016/j.ijrobp.2011.01.038 .
Article
31. Chi A, Liao Z, Nguyen NP, Xu J, Stea B, Komaki R. Systemic review of the patterns of failure following stereotactic body radiation therapy in early-stage non-small-cell lung cancer: clinical implications. Radiother Oncol. 2010; 94:1–11. PMID: 20074823.
Article
32. Milano MT, Constine LS, Okunieff P. Normal tissue toxicity after small field hypofractionated stereotactic body radiation. Radiat Oncol. 2008; 3:36. PMID: 18976463.
Article
33. Forquer JA, Fakiris AJ, Timmerman RD, Lo SS, Perkins SM, McGarry RC, et al. Brachial plexopathy from stereotactic body radiotherapy in early-stage NSCLC: dose-limiting toxicity in apical tumor sites. Radiother Oncol. 2009; 93:408–413. PMID: 19454366.
Article
34. Ong CL, Palma D, Verbakel WF, Slotman BJ, Senan S. Treatment of large stage I-II lung tumors using stereotactic body radiotherapy (SBRT): planning considerations and early toxicity. Radiother Oncol. 2010; 97:431–436. PMID: 20971523.
Article
35. Song SY, Choi W, Shin SS, Lee SW, Ahn SD, Kim JH, et al. Fractionated stereotactic body radiation therapy for medically inoperable stage I lung cancer adjacent to central large bronchus. Lung Cancer. 2009; 66:89–93. PMID: 19168260.
Article
36. Timmerman R, McGarry R, Yiannoutsos C, Papiez L, Tudor K, DeLuca J, et al. Excessive toxicity when treating central tumors in a phase II study of stereotactic body radiation therapy for medically inoperable early-stage lung cancer. J Clin Oncol. 2006; 24:4833–4839. PMID: 17050868.
Article
37. Haasbeek CJ, Senan S, Smit EF, Paul MA, Slotman BJ, Lagerwaard FJ. Critical review of nonsurgical treatment options for stage I non-small cell lung cancer. Oncologist. 2008; 13:309–319. PMID: 18378542.
Article
38. Timmerman RD. Surgery versus stereotactic body radiation therapy for early-stage lung cancer: who's down for the count? J Clin Oncol. 2010; 28:907–909. PMID: 20065172.
Article
39. Louie AV, Rodrigues G, Hannouf M, Zaric GS, Palma DA, Cao JQ, et al. Stereotactic body radiotherapy versus surgery for medically operable stage I non-small-cell lung cancer: a Markov Model-based decision analysis. Int J Radiat Oncol Biol Phys. 2010; 10. 05. [Epub]. Doi: 10.1016/j.ijrobp.2010.06.040 .
Article
40. Crabtree TD, Denlinger CE, Meyers BF, El Naqa I, Zoole J, Krupnick AS, et al. Stereotactic body radiation therapy versus surgical resection for stage I non-small cell lung cancer. J Thorac Cardiovasc Surg. 2010; 140:377–386. PMID: 20400121.
Article
41. Boyd JA, Hubbs JL, Kim DW, Hollis D, Marks LB, Kelsey CR. Timing of local and distant failure in resected lung cancer: implications for reported rates of local failure. J Thorac Oncol. 2010; 5:211–214. PMID: 19901853.
Article
42. Warren JL, Yabroff KR, Meekins A, Topor M, Lamont EB, Brown ML. Evaluation of trends in the cost of initial cancer treatment. J Natl Cancer Inst. 2008; 100:888–897. PMID: 18544740.
Article
43. Pepe C, Hasan B, Winton TL, Seymour L, Graham B, Livingston RB, et al. Adjuvant vinorelbine and cisplatin in elderly patients: National Cancer Institute of Canada and Intergroup Study JBR.10. J Clin Oncol. 2007; 25:1553–1561. PMID: 17442999.
Article
44. Felip E, Rosell R, Maestre JA, Rodríguez-Paniagua JM, Morán T, Astudillo J, et al. Preoperative chemotherapy plus surgery versus surgery plus adjuvant chemotherapy versus surgery alone in early-stage non-small-cell lung cancer. J Clin Oncol. 2010; 28:3138–3145. PMID: 20516435.
Article
45. Herder GJ, van Tinteren H, Golding RP, Kostense PJ, Comans EF, Smit EF, et al. Clinical prediction model to characterize pulmonary nodules: validation and added value of 18F-fluorodeoxyglucose positron emission tomography. Chest. 2005; 128:2490–2496. PMID: 16236914.
46. van Tinteren H, Hoekstra OS, Smit EF, van den Bergh JH, Schreurs AJ, Stallaert RA, et al. Effectiveness of positron emission tomography in the preoperative assessment of patients with suspected non-small-cell lung cancer: the PLUS multicentre randomised trial. Lancet. 2002; 359:1388–1393. PMID: 11978336.
Article
47. Herder GJ, Kramer H, Hoekstra OS, Smit EF, Pruim J, van Tinteren H, et al. Traditional versus up-front [18F] fluorodeoxyglucose-positron emission tomography staging of non-small-cell lung cancer: a Dutch cooperative randomized study. J Clin Oncol. 2006; 24:1800–1806. PMID: 16567772.
Article
48. Belgers EH, Siebenga J, Bosch AM, van Haren EH, Bollen EC. Complete video-assisted thoracoscopic surgery lobectomy and its learning curve: a single center study introducing the technique in The Netherlands. Interact Cardiovasc Thorac Surg. 2010; 10:176–180. PMID: 19850598.
Article
49. May BJ, Levsky JM, Godelman A, Jain VR, Little BP, Mahadevia PS, et al. Should CT play a greater role in preventing the resection of granulomas in the era of PET? AJR Am J Roentgenol. 2011; 196:795–800. PMID: 21427327.
Article
50. Dahele M, Palma D, Lagerwaard F, Slotman B, Senan S. Radiological changes following stereotactic radiotherapy for stage I lung cancer. J Thorac Oncol. 2011; 5. 26. [Epub]. Doi: 10.1097/JTO.0b013e318219aac5 .
51. Neri S, Takahashi Y, Terashi T, Hamakawa H, Tomii K, Katakami N, et al. Surgical treatment of local recurrence after stereotactic body radiotherapy for primary and metastatic lung cancers. J Thorac Oncol. 2010; 5:2003–2007. PMID: 21102262.
Article
52. Chen F, Matsuo Y, Yoshizawa A, Sato T, Sakai H, Bando T, et al. Salvage lung resection for non-small cell lung cancer after stereotactic body radiotherapy in initially operable patients. J Thorac Oncol. 2010; 5:1999–2002. PMID: 21102261.
Article
53. Allen MS, Darling GE, Pechet TT, Mitchell JD, Herndon JE 2nd, Landreneau RJ, et al. Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg. 2006; 81:1013–1019. PMID: 16488712.
Article
54. Kates M, Perez X, Gribetz J, Swanson SJ, McGinn T, Wisnivesky JP. Validation of a model to predict perioperative mortality from lung cancer resection in the elderly. Am J Respir Crit Care Med. 2009; 179:390–395. PMID: 19029001.
Article
55. O'Connor GT, Plume SK, Olmstead EM, Morton JR, Maloney CT, Nugent WC, et al. The Northern New England Cardiovascular Disease Study Group. A regional intervention to improve the hospital mortality associated with coronary artery bypass graft surgery. JAMA. 1996; 275:841–846. PMID: 8596221.
56. Finley CJ, Bendzsak A, Tomlinson G, Keshavjee S, Urbach DR, Darling GE. The effect of regionalization on outcome in pulmonary lobectomy: a Canadian national study. J Thorac Cardiovasc Surg. 2010; 140:757–763. PMID: 20850656.
57. Clinical practice guidelines for the treatment of unresectable non-small-cell lung cancer. Adopted on May 16, 1997 by the American Society of Clinical Oncology. J Clin Oncol. 1997; 15:2996–3018. PMID: 9256144.
58. Schiller JH, Harrington D, Belani CP, Langer C, Sandler A, Krook J, et al. Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. N Engl J Med. 2002; 346:92–98. PMID: 11784875.
Article
59. Burt M, Wronski M, Arbit E, Galicich JH. Resection of brain metastases from nonsmall-cell lung carcinoma. Results of therapy. Memorial Sloan-Kettering Cancer Center Thoracic Surgical Staff. J Thorac Cardiovasc Surg. 1992; 103:399–410. PMID: 1312184.
60. Luketich JD, Burt ME. Does resection of adrenal metastases from non-small cell lung cancer improve survival? Ann Thorac Surg. 1996; 62:1614–1616. PMID: 8957360.
Article
61. Lind JS, Lagerwaard FJ, Smit EF, Postmus PE, Slotman BJ, Senan S. Time for reappraisal of extracranial treatment options? Synchronous brain metastases from nonsmall cell lung cancer. Cancer. 2011; 117:597–605. PMID: 20872880.
62. Fairchild A, Harris K, Barnes E, Wong R, Lutz S, Bezjak A, et al. Palliative thoracic radiotherapy for lung cancer: a systematic review. J Clin Oncol. 2008; 26:4001–4011. PMID: 18711191.
Article
63. Rusthoven KE, Hammerman SF, Kavanagh BD, Birtwhistle MJ, Stares M, Camidge DR. Is there a role for consolidative stereotactic body radiation therapy following first-line systemic therapy for metastatic lung cancer? A patterns-of-failure analysis. Acta Oncol. 2009; 48:578–583. PMID: 19373699.
Article
64. Marks LB, Saynak M, Christodouleas JP. Stage III vs. stage IV lung cancer: "Crossing a Great Divide". Lung Cancer. 2010; 67:1–3. PMID: 19962209.
Article
65. Lim E, Baldwin D, Beckles M, Duffy J, Entwisle J, Faivre-Finn C, et al. Guidelines on the radical management of patients with lung cancer. Thorax. 2010; 65(Suppl 3):iii1–iii27. PMID: 20940263.
Article
66. Rusthoven KE, Kavanagh BD, Cardenes H, Stieber VW, Burri SH, Feigenberg SJ, et al. Multi-institutional phase I/II trial of stereotactic body radiation therapy for liver metastases. J Clin Oncol. 2009; 27:1572–1578. PMID: 19255321.
Article
67. Casamassima F, Livi L, Masciullo S, Menichelli C, Masi L, Meattini I, et al. Stereotactic radiotherapy for adrenal gland metastases: University of Florence experience. Int J Radiat Oncol Biol Phys. 2011; 2. 05. [Epub]. Doi: 10.1016/j.ijrobp.2010.11.060 .
Article
68. Rusthoven KE, Kavanagh BD, Burri SH, Chen C, Cardenes H, Chidel MA, et al. Multi-institutional phase I/II trial of stereotactic body radiation therapy for lung metastases. J Clin Oncol. 2009; 27:1579–1584. PMID: 19255320.
Article
69. Wegner RE, Olson AC, Kondziolka D, Niranjan A, Lundsford LD, Flickinger JC. Stereotactic radiosurgery for patients with brain metastases from small cell lung cancer. Int J Radiat Oncol Biol Phys. 2011; 2. 22. [Epub]. Doi: 10.1016/j.ijrobp.2011.01.001 .
Article
70. Lovelock DM, Zhang Z, Jackson A, Keam J, Bekelman J, Bilsky M, et al. Correlation of local failure with measures of dose insufficiency in the high-dose single-fraction treatment of bony metastases. Int J Radiat Oncol Biol Phys. 2010; 77:1282–1287. PMID: 20350795.
Article
71. Hellman S, Weichselbaum RR. Oligometastases. J Clin Oncol. 1995; 13:8–10. PMID: 7799047.
Article
72. Mehta N, Mauer AM, Hellman S, Haraf DJ, Cohen EE, Vokes EE, et al. Analysis of further disease progression in metastatic non-small cell lung cancer: implications for locoregional treatment. Int J Oncol. 2004; 25:1677–1683. PMID: 15547705.
Article
73. Rosell R, Moran T, Queralt C, Porta R, Cardenal F, Camps C, et al. Screening for epidermal growth factor receptor mutations in lung cancer. N Engl J Med. 2009; 361:958–967. PMID: 19692684.
Article
74. Mok TS, Wu YL, Thongprasert S, Yang CH, Chu DT, Saijo N, et al. Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma. N Engl J Med. 2009; 361:947–957. PMID: 19692680.
Article
75. Kwak EL, Bang YJ, Camidge DR, Shaw AT, Solomon B, Maki RG, et al. Anaplastic lymphoma kinase inhibition in non-small-cell lung cancer. N Engl J Med. 2010; 363:1693–1703. PMID: 20979469.
76. Sun Y, Ren Y, Fang Z, Li C, Fang R, Gao B, et al. Lung adenocarcinoma from East Asian never-smokers is a disease largely defined by targetable oncogenic mutant kinases. J Clin Oncol. 2010; 28:4616–4620. PMID: 20855837.
Article
77. Soria JC, Deutsch E. Hemorrhage caused by antiangiogenic therapy within previously irradiated areas: expected consequence of tumor shrinkage or a warning for antiangiogenic agents combined to radiotherapy? Ann Oncol. 2011; 22:1247–1249. PMID: 21382869.
Article
78. Senan S, Smit EF. Design of clinical trials of radiation combined with antiangiogenic therapy. Oncologist. 2007; 12:465–477. PMID: 17470689.
Article
79. Klein EE, Hanley J, Bayouth J, Yin FF, Simon W, Dresser S, et al. Task Group 142 report: quality assurance of medical accelerators. Med Phys. 2009; 36:4197–4212. PMID: 19810494.
80. Kuijper IT, Dahele M, Senan S, Verbakel WF. Volumetric modulated arc therapy versus conventional intensity modulated radiation therapy for stereotactic spine radiotherapy: a planning study and early clinical data. Radiother Oncol. 2010; 94:224–228. PMID: 20122745.
Article
81. Dahele M, Zindler JD, Sanchez E, Verbakel WF, Kuijer JP, Slotman BJ, et al. Imaging for stereotactic spine radiotherapy: clinical considerations. Int J Radiat Oncol Biol Phys. (in press).
Article
82. Woodington GF, Waugh JM. Results of resection of metastatic tumors of the liver. Am J Surg. 1963; 105:24–29. PMID: 14010473.
Article
83. Garden OJ, Rees M, Poston GJ, Mirza D, Saunders M, Ledermann J, et al. Guidelines for resection of colorectal cancer liver metastases. Gut. 2006; 55(Suppl 3):iii1–iii8. PMID: 16835351.
Article
Full Text Links
  • CRT
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr