Stereotactic body radiotherapy (SBRT) has become a standard treatment option for early stage, node negative non-small cell lung cancer (NSCLC) in patients who are either medically inoperable or refuse surgical resection. SBRT has high local control rates and a favorable toxicity profile relative to other surgical and non-surgical approaches. Given the excellent tumor control rates and increasing utilization of SBRT, recent efforts have focused on limiting toxicity while expanding treatment to increasingly complex patients. We review toxicities from SBRT for lung cancer, including central airway, esophageal, vascular (e.g., aorta), lung parenchyma (e.g., radiation pneumonitis), and chest wall toxicities, as well as radiation-induced neuropathies (e.g., brachial plexus, vagus nerve and recurrent laryngeal nerve). We summarize patient-related, tumor-related, dosimetric characteristics of these toxicities, review published dose constraints, and propose strategies to reduce such complications.

With the expansion in cross-sectional imaging over the past few decades, there has been an increase in the number of incidentally detected renal masses and an increase in the incidence of renal cel...

Radiation therapy with stereotactic radiosurgery (SRS) or whole brain radiation therapy is a mainstay of treatment for patients with brain metastases. The use of SRS in the management of brain metastases is becoming increasingly common and provides excellent local control. Cerebral radiation necrosis (RN) is a late complication of radiation treatment that can be seen months to years following treatment and is often indistinguishable from tumor progression on conventional imaging. In this review article, we explore risk factors associated with the development of radiation necrosis, advanced imaging modalities used to aid in diagnosis, and potential treatment strategies to manage side effects.

BACKGROUND: The objectives of this study were to investigate outcome prediction by measuring absolute tumor volume and regression ratios using serial magnetic resonance imaging (MRI) during radiation therapy (RT) for cervical cancer and to develop algorithms capable of identifying patients at risk of a poor therapeutic outcome. METHODS: Eighty patients with stage IB2 through IVA cervical cancer underwent 4 MRI scans: before RT (MRI1), during RT at 2 to 2.5 weeks (MRI2) at 4 to 5 weeks (MRI3), and 1 to 2 months after RT (MRI4). The median follow‐up was 6.2 years (range, 0.2‐9.4 years). Tumor volumes at MRI1, MRI2, MRI3, and MRI4 (V₁, V₂, V₃, and V₄, respectively) and tumor regression ratios (V₂/V₁, V₃/V₁, and V₄/V₁) were measured by 3‐dimensional volumetry. Predictive metrics based on tumor volume/regression parameters were correlated with ultimate clinical outcomes, including tumor local recurrence (LR) and dying of disease (DOD). Predictive power was evaluated using the Mann‐Whitney test, sensitivity/specificity analyses, and Kaplan‐Meier analyses. RESULTS: Both tumor volume and regression ratio were strongly correlated with LR (P = .06, P = 5 × 10⁻⁴, P = 1 × 10⁻⁶, and P = 2 × 10⁻⁸ for V₁, V₂, V₃, and V₄, respectively; and P = 7 × 10⁻⁵, P = 1 × 10⁻⁶, and P = 1 × 10⁻⁸ for V₂/V₁, V₃/V₁, and V₄/V₁, respectively) and DOD (P = .015, P = .004, P = .001, and P = 3 × 10⁻⁴ for V₁, V₂, V₃, and V₄, respectively; and P = .03, P = .009, and P = 3 × 10⁻⁴ for V₂/V₁, V₃/V₁, and V₄/V₁, respectively). Algorithms that combined tumor volumes and regression ratios improved predictive power (sensitivity, 61%‐89%; specificity, 79%‐100%). The strongest predictor, pre‐RT volume and regression ratio at MRI3 (V₁ > 40 cm³ and V₃/V₁ > 20%, respectively), achieved 89% sensitivity, 87% specificity, and 88% accuracy for LR and achieved 54% sensitivity, 83% specificity, and 73% accuracy for DOD. CONCLUSIONS: The current results suggested that tumor volume/regression parameters obtained during primary therapy are useful in predicting LR and DOD. Both tumor volume and regression ratio provided important information as early outcome predictors that may guide early intervention for patients with cervical cancer who are at high risk of treatment failure. Cancer 2010. © 2010 American Cancer Society.