An Overview of Hypofractionation and Introduction to This Issue of Seminars in Radiation Oncology
Section snippets
The Early Use of Hypofractionation
At the onset of using radiation to treat cancer soon after the discovery of x-rays in 1895 and radioactivity in 1896, treatments were mostly hypofractionated. Many of the early practitioners of radiation therapy for cancer were surgeons who were accustomed to single-session interventions. Treatments were technologically crude giving more dose to skin and superficial structures than to a deep-seated target. There were few standards to ensure dose deposition was accurately quantified or
Intraoperative Radiotherapy and Investigations of Dose Tolerance From Hypofractionated Radiotherapy
Although never in widespread use because mostly of its logistic challenges, intraoperative radiotherapy has played an important role as a weapon in the arsenal of cancer treatments. The treatment has been particularly useful for selected patients with gastrointestinal tumors in which radial margins are often close as compared with the margins at the anastomosis. In these circumstances, the region at risk is well identified at the time of surgery, even without clips or other indirect guideposts
Degrees of Hypofractionation
The main objective of therapeutic radiation is to disrupt clonogenicity. Clonogenicity is the ability of cells to form colonies by cellular division. Cellular division is a very complicated process regulated by a multitude of genes. Because damage to any one of these genes can disrupt the process, the entire process can be stymied by a relatively modest dose of radiation. In contrast, cellular function, like the secretion of a hormone, is usually only coded for by 1 gene or a few genes.
This Issue of Seminars in Radiation Oncology
Only 10 to 15 years ago, a review of the topic of hypofractionation would be limited to IORT, SRS, and the more moderate hypofractionated regimens associated with breast and prostate cancer. With the increasing use of SBRT to treat a number of cancers, the topic has dramatically broadened with dose per fraction of over 30 Gy. Implementing hypofractionation within any daily dose beyond conventional for curable patients constitutes an extremely contentious topic. Clinical practice may be ahead of
References (57)
- et al.
Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial
Lancet
(2004) - et al.
Intraoperative and external radiotherapy in resected gastric cancer: Updated report of a phase II trial
Int J Radiat Oncol Biol Phys
(1992) - et al.
Treatment of cancer of the pancreas by precision high dose (PHD) external photon beam and intraoperative electron beam therapy (IOEBT)
Int J Radiat Oncol Biol Phys
(1989) - et al.
Local control and survival in locally advanced gastrointestinal cancer
Int J Radiat Oncol Biol Phys
(1986) - et al.
Intraoperative radiotherapy for unresectable cholangiocarcinoma—The Mayo Clinic experience
Surg Oncol
(1992) - et al.
High-dose-rate intraoperative radiation therapy (HDR-IORT) for retroperitoneal sarcomas
Int J Radiat Oncol Biol Phys
(2000) - et al.
Surgery with intraoperative radiotherapy for sarcomas of the pelvic girdle: A pilot experience
Int J Radiat Oncol Biol Phys
(1988) - et al.
Hemipelvectomy and intraoperative radiotherapy for bone and soft tissue sarcomas of the pelvic girdle
Radiother Oncol
(1995) - et al.
Survival and repair of potentially lethal radiation damage in confluent vascular smooth muscle cell cultures
Radiother Oncol
(1986) - et al.
Tolerance of normal tissue to therapeutic irradiation
Int J Radiat Biol Phys
(1991)
Tolerance of canine anastomoses to intraoperative radiation therapy
Int J Radiat Oncol Biol Phys
Tolerance of the canine bladder to intraoperative radiation therapy: An experimental study
Int J Radiat Oncol Biol Phys
Bone necrosis and tumor induction following experimental intraoperative irradiation
Int J Radiat Oncol Biol Phys
Response of canine esophagus to intraoperative electron beam radiotherapy
Int J Radiat Oncol Biol Phys
Response of the mediastinal and thoracic viscera of the dog to intraoperative radiation therapy (IORT)
Int J Radiat Biol Phys
Response of the mediastinal and thoracic viscera of the dog to intraoperative radiation therapy (IORT)
Int J Radiat Oncol Biol Phys
Response of aorta and branch arteries to experimental intraoperative irradiation
Int J Radiat Oncol Biol Phys
Ureteral injury following experimental intraoperative radiation
Int J Radiat Oncol Biol Phys
Treatment of certain forms of cancer by the x-rays
JAMA
The use of x-rays in the treatment of diseases of the skin, of new growth, of the glandular system and of other diseases and as a means of relief of pain
Trans Assoc Am Physicians
Ueber die Einwirkung der Rötgenstrahlen auf innere Organe
Münch Med Wochenschr
Quelques observations de radiumtherapie de tumerurs cancereuses
Arch d'Electr Med Exper et Cliniques
Beiträge zur Bestrahlung tiefliegender Prozesse
Med Klin
My studies on the special foundations of deep therapy treatment
AJR Am J Roentgenol
Actions des rayons X sur les diverses generations de la lignee spermatique: Extreme sensibilite des spermatogonies a ces rayons
Compt Rend Soc de Biol
Interpretation de quelques resultats de la radiotherapie et essai de fixaation d'une technique rationelle
Compt Rend Acad Sci Paris
Unsere Methode der Rontgen-Tiefentheapie und ihre Erfolge
Die gengenwartigen Methoden und Erfolge de Krebsbestrahlung mit verteilten Dosen
Strahlentherapie
Cited by (378)
Hypofractionated Stereotactic Radiation Therapy Dosimetric Tolerances for the Inferior Aspect of the Brachial Plexus: A Systematic Review
2024, International Journal of Radiation Oncology Biology PhysicsStereotactic Body Radiation Therapy to the Foot for Bone Metastasis
2024, Advances in Radiation OncologyAchievable Dosimetric Constraints in Stereotactic Reirradiation for Recurrent Prostate Cancer
2023, Practical Radiation OncologyVertebral compression fracture after stereotactic ablative radiotherapy in patients with oligometastatic bone lesions from hepatocellular carcinoma
2023, Clinical and Translational Radiation OncologyLimits of dose constraint definition for organs at risk specific to stereotactic radiotherapy
2023, Cancer/Radiotherapie