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Jeanette Keil

April 15, 2018

Dos 711 – Research Methodology I

Identifying Future Research Projects and Literature Gaps Exercise

Article 1 – SBRT to adrenal metastases provides high local control with minimal toxicity1

The first article that I reviewed looks at SBRT treatment of the adrenal glands. The
authors describe how the adrenal glands are a very common site for metastases due to a rich
blood supply and that these metastases were previously most commonly treated with
chemotherapy. Treating these metastases with external beam radiotherapy was very rare but now
it is becoming more common to see these treated with SBRT. The authors did a retrospective
study of 10 patients treated with SBRT at their institution and came to the conclusions that SBRT
provided high local control with minimal acute toxicity. The authors concluded that there should
be larger scale studies on patients who have received adrenal SBRT to determine dose
parameters for minimal toxicity and high local control in patients with these tumors.1

Article 2 – Plan Comparison of volumetric arc therapy (RapidArc) and conventional

intensity-modulated radiation therapy (IMRT) in anal cancer2

This article’s main objective is to compare RapidArc plans and IMRT plans in anal
cancers. The authors choose 10 patients that were previously treated for anal cancer with static
IMRT fields and created 2 new RapidArc plans to compare which technique provided a better
plan. The RapidArc plans consisted of a single modulated arc and a double modulated arc.
Once the plans were created and compared, the authors saw that the IMRT and Rapid Arc plans
provided similar dose coverage but the RapidArc plans provided a plan with better mean dose to
the organs at risk, especially the utilizing two arcs. This article also mentioned using a decrease
of the X-jaw with the RapidArc plans to provide better modulation but did not site a source for
this information. This led me to think that there has to be some more literature or research done
on the topic to show what X-jaw limitation is best for optimization.2

Article 3 – Critical appraisal of the role of volumetric modulated arc therapy in the
radiation therapy management of breast cancer3
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This article addressed a topic that is still very controversial in my clinic when it comes to
breast cancer treatment. The authors of this study set out to review publications regarding
volumetric modulated arc therapy (VMAT) and breast cancer to review the current use of this
treatment method. The authors did a great job at explaining all the criteria a publication needed
to meet to be involved in this appraisal and had a total of 67 publications for review. These
publications consisted of treatment planning studies and clinical studies and provided a lot of
information on technical implications and patient data. The authors concluded that there was
sufficient evidence to show that using the VMAT technique can provide better results for
patients with nodal involvement. They did, however, point out a few disadvantages of using this
technique such as secondary cancer risks and a higher chance of cardiac toxicity when compared
to conventional tangential radiotherapy. The authors point out a need for more clinical reports to
prove the benefits of VMAT breast planning that are being demonstrated dosimetrically in the
planning investigations.3

Article 4 - Age is not a limiting factor in interventional radiotherapy (brachytherapy) for

patients with localized cancer4

This article highlights many benefits of using interventional radiotherapy (IRT) for the
treatment of certain cancers in the elderly population. Lancellotta et al. describe how age can no
longer be considered a counter-indication for brachytherapy considering that many elderly
patients are not candidates for surgery because of other health problems.4 The authors searched
for publication with the keywords “brachytherapy” and “elderly” and reviewed a total of 39
reports. This review showed that many elderly patients were being treated with IRT as a boost to
external beam radiation therapy and showed that the results of these treatments did not differ
when compared to when compared to the younger population. In conclusion, this review showed
that treatment of elderly patients must be multidisciplinary and take into consideration their
quality of life. They suggested additional research into IRT on the elderly population to
strengthen the evidence of for it use.4

Article 5 – Stereotactic body radiation therapy (SBRT) in the management of non-small-

cell lung cancer: Clinical impact and patient perspectives5

The final article that I chose to review discusses the advantages and disadvantages of
using SBRT in the treatment of non-small-cell lung cancer (NSCLC) and which patients should
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and should not be considered for this treatment. SBRT has been a great alternative therapy for
patients who are not surgical candidates by increasing the overall survival (OS) and the quality
of life (QOL) in patients when compared to no treatment. There is also an advantage to SBRT
compared to conventional radiotherapy by providing a shorter course of treatment and less acute
toxicity. During this review, the authors did identify some possible contraindications for using
SBRT for the treatment of NSCLC such as a patient having severe chronic obstructive
pulmonary disease (COPD) or them being in the elderly population. They also learned that
tumors in the central or apical regions should be approached with caution because of the
proximity to major organs at risk. One of the biggest concerns mention in this review in treating
patients with interstitial lung disease (ISL). There are over 200 types of ILD and display a
multitude of complications in patients with this disease. Having IDL is not a contraindication to
SBRT but must be treated with caution because of the higher risk of lung toxicity in these
patients. The authors report a need for further research into the QOL and toxicity for patients
treated with SBRT who also have ISL.5
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References

1. Plichta K, Camden N, Furqan M, et al. SBRT to adrenal metastases provides high local
control with minimal toxicity. Advances in radiation oncology. 2017;2(4):581-587.
https://doi.org/10.1016/j.adro.2017.07.011
2. Vieillot S, Azria D, Lemanski C, et al. Plan comparison of volumetric-modulated arc
therapy (RapidArc) and conventional intensity-modulated radiation therapy (IMRT) in
anal canal cancer. Radiation Oncology. 2010;5(1):92. https://doi.org/10.1186/1748-
717X-5-92
3. Cozzi L, Lohr F, Fogliata A, et al. Critical appraisal of the role of volumetric modulated
arc therapy in the radiation therapy management of breast cancer. Radiation Oncology.
2017;12(1):200. https://doi.org/10.1186/s13014-017-0935-4
4. Lancellotta V, Kovács G, Tagliaferri L, et al. Age Is Not a Limiting Factor in
Interventional Radiotherapy (Brachytherapy) for Patients with Localized Cancer. BioMed
Research International. 2018;2018. https://doi.org/10.1155/2018/2178469
5. Donovan EK, Swaminath A. Stereotactic body radiation therapy (SBRT) in the
management of non-small-cell lung cancer: Clinical impact and patient perspectives.
Lung Cancer: Targets and Therapy. 2018;9:13. http://doi.org/10.2147/LCTT.S129833