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The Radiobiological Rationale for Hypofractionation of Lung and Liver Tumors

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Treating Tumors that Move with Respiration

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Abstract

The radiobiological concepts of intrinsic radiation sensitivity, oxygenation, and dose-volume effects have been reasonably delineated in the context of conventional radiotherapy (RT). Yet, for circumstances in which large doses are delivered in single-fraction or hypofractionated regimens, these intrinsic radiobiological concepts are relatively poorly understood. Stereotactic radiosurgery (SRS) is a radical departure from the current RT approach in which large fields, cone downs, and protracted therapies are used for normal tissue preservation and to maximize the therapeutic ratio. SRS is the precise, highly focused delivery of radiation beams to lesions whereby only a fraction of the total dose is received by surrounding normal tissues. The usage of SRS is currently expanding well beyond its roots as an ablative tool for thalamotomies, arteriovenous malformations, and cranial vault tumors. Hence, widely believed dogmas concerning the tolerance of critical structures to conventionally fractionated doses, such as the dose-volume effect, total dose, and time (latency) dependency, have to be reevaluated for hypofractionated radiation therapy.

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Authors and Affiliations

  1. Department of Radiation Oncology, Montefiore Medical Center and the Albert Einstein College of Medicine, 111 East 210 Street, Bronx, NY, 10467, USA

    Alan Alfieri MSc (Clinical Associate Professor), Jill Rossinow MD (Resident), Madhur Garg MD (Clinical Director Assistant Professor), Shalom Kalnicki MD, FACR (Professor and Chairman) & Chandan Guha MD, PhD (Associate Professor Vice Chairman)

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  1. Alan Alfieri MSc
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  2. Jill Rossinow MD
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  3. Madhur Garg MD
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  4. Shalom Kalnicki MD, FACR
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  5. Chandan Guha MD, PhD
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Editors and Affiliations

  1. Research, Education and Clinical Excellence, Baylor University Medical Center, 1201 Barnett Tower 3600 Gaston Avenue, Dallas, TX, 75246, USA

    Harold C. Urschel Jr. MD (Chair of Cardiovascular and Thoracic Surgical) (Chair of Cardiovascular and Thoracic Surgical)

  2. Arizona Oncology Services at St. Joseph’s Hospital & Medical Center Department of Radiation Oncology CyberKnife Center Barrow Neurological Institute, Gamma Knife Center, 350 West Thomas Road, Phoenix, Arizona, 85013, USA

    John J. Kresl MD, PhD

  3. The Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh Medical Center, PUH, C-800, 200 Lothrop Street, Pittsburgh, PA, 15213, USA

    James D. Luketich MD (Sampson Family Endowed Professor of Surgery Chief) (Sampson Family Endowed Professor of Surgery Chief)

  4. Department of Radiation Oncology, University of Texas Southwestern Medical Center, 5801 Forest Park Road, Dallas, TX, 75390, USA

    Lech Papiez PhD (Associate Professor) & Robert D. Timmerman MD (Professor and Vice-Chairman Effie Marie Cain Distinguished Chair in Cancer Therapy Research) (Associate Professor) &  (Professor and Vice-Chairman Effie Marie Cain Distinguished Chair in Cancer Therapy Research)

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Alfieri, A., Rossinow, J., Garg, M., Kalnicki, S., Guha, C. (2007). The Radiobiological Rationale for Hypofractionation of Lung and Liver Tumors. In: Urschel, H.C., Kresl, J.J., Luketich, J.D., Papiez, L., Timmerman, R.D., Schulz, R.A. (eds) Treating Tumors that Move with Respiration. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-69886-9_4

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