Liver SBRT

Protocol paper for an Australian and Danish phase 2 trial of liver SBRT with kilovoltage intrafraction monitoring. Its supplementary tables (Additional file 1) give organ constraints for HCC (5 fractions) and for liver metastases (3 and 5 fractions), and liver limits — including an HCC liver-mean limit for each prescription and a minimum volume of liver kept below 15 Gy. The constraints were adapted from existing recommendations and trials including UK CORE, RTOG 1112 and NRG BR001. DoseLab read the supplementary tables.

UK consensus on dose–volume constraints for SABR of oligometastases, primary lung cancer and hepatocellular carcinoma. Citation checked against Crossref. DoseLab read the tables in the authors' accepted manuscript (UCL Discovery and White Rose Research Online): Table 6 (intracranial, 1, 3 and 5 fractions) for the brain pages, and Tables 2, 3 and 5 (thoracic, abdominal and spinal) for the liver SBRT page. Each table gives optimal and mandatory limits by fraction count; the liver limits apply to patients with, at worst, Child-Pugh A6 liver disease. The kidney limit is written as a "cold" constraint — at least 200 cc must receive no more than the stated dose.

The template NRG Oncology gives investigators for the radiation therapy section of a liver SBRT trial, based on NRG GI-003. It strongly recommends implanted fiducials, allows several motion-management techniques, and describes the multiphase contrast CT used for hepatocellular carcinoma: non-contrast, arterial phase (hypervascular tumor), portal venous phase (vascular thrombus) and delayed phase (washout). Contrast-enhanced MRI is recommended when contrast CT can't be done.

The QUANTEC overview paper, whose summary table gathers the approximate dose/volume/outcome data from each organ chapter. Its footnotes stress that the data are estimates from the literature, should be applied with caution, and largely do not reflect modern IMRT. DoseLab read the esophagus row (mean dose <34 Gy for grade ≥3 acute esophagitis, 5–20%, 3D-CRT) from the open-access manuscript, and the lung, heart, liver, kidney, stomach and small bowel rows used on the GI pages from the journal's full-text table.

Analysis of hepatobiliary toxicity after liver SBRT, using a central hepatobiliary tract structure defined as a 15 mm expansion of the portal vein. Citation checked against Europe PMC; DoseLab has not read the paper.

Sixty patients treated with 3–5 fraction SBRT for peripheral lung lesions. The chest wall volume receiving 30 Gy best predicted severe pain or rib fracture; the authors advise limiting it to under 30 cm³ where possible without compromising coverage. DoseLab read the abstract.

RTOG consensus guidelines and atlas for delineating upper abdominal normal organs. Citation checked against Europe PMC.

AAPM task group report describing best-practice guidelines for stereotactic body radiation therapy, including a table of normal-tissue dose constraints. Bibliographic details confirmed against the journal index; table map not yet checked.

AAPM task group report on respiratory motion in thoracic, abdominal and pelvic treatment. It groups management approaches into motion-encompassing methods, respiratory gating, breath-hold techniques, forced shallow breathing (such as abdominal compression) and respiration-synchronized (tracking) techniques. Read in the AAPM report PDF (Report No. 91, July 2006): using ICRU Report 62 nomenclature, the PTV adds margins to the CTV for respiratory (intrafraction) motion, interfraction motion and set-up error; without a respiratory management device the entire range of motion should be considered in the internal margin; and for lung tumors a maximum intensity projection (MIP) can give the motion-encompassing volume, provided there is no mediastinal involvement.

AAPM Task Group 132 report on image registration and fusion in radiotherapy. It reviews rigid and deformable registration, points out that every registration carries an uncertainty that should be understood and communicated, and gives recommendations for commissioning and quality assurance of registration software and for checking individual registrations. Citation checked against Europe PMC.

Endorsed eviQ protocol for stereotactic treatment of primary liver cancer (hepatocellular carcinoma or intrahepatic cholangiocarcinoma) in five fractions. It covers motion management (breath hold, free breathing with 4DCT, compression or gating), triple-phase contrast CT, fiducials (including lipiodol and surgical clips), contrast-enhanced MRI and rigid co-registration of MRI, PET and CT in the region of the liver. Its organ table draws on the LARK (TROG 17.03) trial protocol and the UK 2022 SABR consensus.

Endorsed eviQ protocol for stereotactic treatment of liver metastases in three or five fractions (three preferred when organ limits allow). Its organ table gives a separate column for each fraction count. Patients with cirrhosis are treated as for hepatocellular carcinoma under the companion primary-liver protocol.