Virtual SBRT and SRS Remote Training Session 4: Liver/Pancreas

Department of Radiation Oncology at Baylor College of Medicine is organizing virtual SRBT /SRS training sessions for radiation oncologists, medical physicists, dosimetrists and therapists in low- and middle-income countries.
Summary
This training session, the fourth in a series on SBRT and SRT, focused on the application of SPRT for liver and pancreas cancers. The session featured two expert speakers from Baylor College of Medicine: Dr. Hanania, a medical director with expertise in radiation oncology, and Dr. Lafratta, a medical physicist specializing in radiation therapy technology and quality assurance. The training covered both clinical and technical aspects of delivering high-dose, ablative radiation treatments to these challenging abdominal tumors.

Dr. Hanania began by discussing the role of radiation in treating pancreatic cancer, emphasizing the importance of local control despite the high likelihood of early metastatic spread. He highlighted the limitations of conventional radiation doses and the emerging paradigm shift towards dose escalation in well-selected patients, often using advanced imaging and planning techniques such as simultaneous integrated boost (SIB). He demonstrated how radiation plans focus on delivering ablative doses to the tumor core, especially the tumor-vessel interface, while sparing nearby critical structures like the duodenum and bowel. Various fractionation regimens were explained, including typical SBRT doses (e.g., 50 Gy in 5 fractions) and more fractionated approaches (e.g., 15 or 25 fractions) that allow safer delivery where anatomy or motion constraints exist.

He then presented clinical cases illustrating the practical application of these techniques in pancreatic and liver cancers, including hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma. He underscored the necessity of careful patient selection, careful contouring of targets and organs at risk, and the critical importance of motion management and image guidance to deliver ablative doses safely.

Following this, Dr. Lafratta delivered a detailed overview of the physics and technical requirements underlying liver and pancreas SBRT. She stressed the importance of patient immobilization, respiratory motion control, and precise image guidance—including the use of 4D CT, fiducial markers, cone beam CT (CBCT), and respiratory gating—to achieve tight treatment margins and steep dose gradients. She described immobilization devices, motion management strategies (compression belts, breath holds, gating), and the workflow for treatment planning including image fusion, contouring, and margin generation (ITV, PTV). She also detailed quality assurance procedures, including machine commissioning, daily verification, patient-specific QA with phantoms and portal dosimetry, and the importance of multidisciplinary training and coordination.

The session concluded with a Q&A addressing practical concerns such as the feasibility of treating multifocal liver lesions, the accuracy of CBCT and motion tracking versus MR-guided radiation, and the implementation of quality assurance processes.

Overall, the training provided a comprehensive, state-of-the-art perspective on the clinical rationale, treatment planning, delivery, and quality assurance for ablative radiation therapy of liver and pancreas cancers using SBRT techniques.

Видео Virtual SBRT and SRS Remote Training Session 4: Liver/Pancreas канала Baozhou Sun