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Organs at Risk (OAR) Tolerance in Hypofractionated Radiosurgery

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CyberKnife NeuroRadiosurgery

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Abstract

For CyberKnife radiosurgery, the precise interpretation of the normal probability of tissue complications (NTCP) is extremely important due to the reverse planning algorithm and the non-isocentric irradiation geometry adopted by the system, which requires the setting of dose constraints for any organ at risk (OAR). Despite eight decades of practice in radiation therapy, the current understanding of radiobiology remains fairly imprecise, especially the tolerance limits of OAR at hypofractionated schedules. Here, we provide an overview of the radiation tolerance limits of the optic pathway, spinal cord, brain, and other central nervous system OARs. Above all, we summarize the basic principles of radiobiology and describe how these can be used to aid decision making for hypofractionated treatments. Basically, we provide radiobiological bases to build models that can be used to safely and effectively extrapolate the doses to be delivered in hypofractioned schedules, starting from single fraction clinical data and conventionally fractionated radiotherapy. Although this approach has several limitations, it can provide some practical suggestions and help users to increase confidence with hypofractionated approaches.

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Author information

Authors and Affiliations

  1. Alma Mater Studiorum University of Bologna, Bologna, Italy

    Alfredo Conti

  2. IRCCS ISNB Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy

    Alfredo Conti

  3. Department of Neurosurgery, Charité Faculty of Medicine, Berlin, Germany

    Alfredo Conti

Authors
  1. Alfredo Conti
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Correspondence to Alfredo Conti .

Editor information

Editors and Affiliations

  1. Associate Professor of Neurosurgery, Alma Mater Studiorum University of Bologna, Bologna, Italy

    Alfredo Conti

  2. Scientific Director, AB Medica, Milano, Italy

    Pantaleo Romanelli

  3. Assistant Professor, Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Evangelos Pantelis

  4. Associate Professor, Department of Radiation Oncology, Stanford University Cancer Center, Stanford, CA, USA

    Scott G. Soltys

  5. Associate Professor, Department of Neurosurgery and Radiosurgery Center, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea (Republic of)

    Young Hyun Cho

  6. Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Michael Lim

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Conti, A. (2020). Organs at Risk (OAR) Tolerance in Hypofractionated Radiosurgery. In: Conti, A., Romanelli, P., Pantelis, E., Soltys, S., Cho, Y., Lim, M. (eds) CyberKnife NeuroRadiosurgery . Springer, Cham. https://doi.org/10.1007/978-3-030-50668-1_13

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