title: The tolerance of gastrointestinal organs to stereotactic body radiation therapy: what do we know so far?
abstract: As stereotactic body radiation therapy (SBRT) for gastrointestinal (GI) gains popularity, there is a need to optimize doses and fractionation to minimize GI toxicity. GI organs that have classically developed radiation-induced toxicity include the liver & biliary system, small bowel, esophagus, and rectum. While the literature quantifies dose restrictions for these organs under standard fractionation, there is limited data regarding toxicity with the ablative dose schedules used in SBRT. We conducted a review of the literature to identify prospective and retrospective studies that detail GI toxicities when SBRT was employed. Based on the literature, the median SBRT dose for abdominal and thoracic tumors ranged from 24 to 60 Gy, at 5 to 25 Gy per fraction. The respective observed frequencies of grade 3 and 4 toxicities for the liver, biliary system, small bowel, and esophagus were variable among different studies. Typically, patients who suffered grade 3 and 4 toxicities were more likely to have had some form of systemic therapy as well. The effect of dose, fractionation, timing, and volume on GI toxicities has been described in the literature but more data is necessary to develop uniform treatment guidelines for SBRT.
authors: 1 Department of Radiation Oncology, Loyola University School of Medicine, Maywood, IL, USA ; 2 Department of Radiation Oncology Baltimore, Johns Hopkins University School of Medicine, MD, USA ; 3 London Regional Cancer Program, University of Western Ontario, London, ON, Canada ; 4 Department of Radiation Oncology, University of Washington, Seattle, WA, USA ; 5 Department of Radiation Oncology, Houston Methodist Hospital, Weill Cornell Medical College, Houston, TX, USA ; 6 Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA.
authors: Tarita O
authors: TO
authors: Thomas
authors: 1 Department of Radiation Oncology, Loyola University School of Medicine, Maywood, IL, USA ; 2 Department of Radiation Oncology Baltimore, Johns Hopkins University School of Medicine, MD, USA ; 3 London Regional Cancer Program, University of Western Ontario, London, ON, Canada ; 4 Department of Radiation Oncology, University of Washington, Seattle, WA, USA ; 5 Department of Radiation Oncology, Houston Methodist Hospital, Weill Cornell Medical College, Houston, TX, USA ; 6 Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA.
authors: Shaakir
authors: S
authors: Hasan
authors: 1 Department of Radiation Oncology, Loyola University School of Medicine, Maywood, IL, USA ; 2 Department of Radiation Oncology Baltimore, Johns Hopkins University School of Medicine, MD, USA ; 3 London Regional Cancer Program, University of Western Ontario, London, ON, Canada ; 4 Department of Radiation Oncology, University of Washington, Seattle, WA, USA ; 5 Department of Radiation Oncology, Houston Methodist Hospital, Weill Cornell Medical College, Houston, TX, USA ; 6 Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA.
authors: William
authors: W
authors: Small
authors: 1 Department of Radiation Oncology, Loyola University School of Medicine, Maywood, IL, USA ; 2 Department of Radiation Oncology Baltimore, Johns Hopkins University School of Medicine, MD, USA ; 3 London Regional Cancer Program, University of Western Ontario, London, ON, Canada ; 4 Department of Radiation Oncology, University of Washington, Seattle, WA, USA ; 5 Department of Radiation Oncology, Houston Methodist Hospital, Weill Cornell Medical College, Houston, TX, USA ; 6 Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA.
authors: Joseph M
authors: JM
authors: Herman
authors: 1 Department of Radiation Oncology, Loyola University School of Medicine, Maywood, IL, USA ; 2 Department of Radiation Oncology Baltimore, Johns Hopkins University School of Medicine, MD, USA ; 3 London Regional Cancer Program, University of Western Ontario, London, ON, Canada ; 4 Department of Radiation Oncology, University of Washington, Seattle, WA, USA ; 5 Department of Radiation Oncology, Houston Methodist Hospital, Weill Cornell Medical College, Houston, TX, USA ; 6 Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA.
authors: Michael
authors: M
authors: Lock
authors: 1 Department of Radiation Oncology, Loyola University School of Medicine, Maywood, IL, USA ; 2 Department of Radiation Oncology Baltimore, Johns Hopkins University School of Medicine, MD, USA ; 3 London Regional Cancer Program, University of Western Ontario, London, ON, Canada ; 4 Department of Radiation Oncology, University of Washington, Seattle, WA, USA ; 5 Department of Radiation Oncology, Houston Methodist Hospital, Weill Cornell Medical College, Houston, TX, USA ; 6 Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA.
authors: Edward Y
authors: EY
authors: Kim
authors: 1 Department of Radiation Oncology, Loyola University School of Medicine, Maywood, IL, USA ; 2 Department of Radiation Oncology Baltimore, Johns Hopkins University School of Medicine, MD, USA ; 3 London Regional Cancer Program, University of Western Ontario, London, ON, Canada ; 4 Department of Radiation Oncology, University of Washington, Seattle, WA, USA ; 5 Department of Radiation Oncology, Houston Methodist Hospital, Weill Cornell Medical College, Houston, TX, USA ; 6 Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA.
authors: Nina A
authors: NA
authors: Mayr
authors: 1 Department of Radiation Oncology, Loyola University School of Medicine, Maywood, IL, USA ; 2 Department of Radiation Oncology Baltimore, Johns Hopkins University School of Medicine, MD, USA ; 3 London Regional Cancer Program, University of Western Ontario, London, ON, Canada ; 4 Department of Radiation Oncology, University of Washington, Seattle, WA, USA ; 5 Department of Radiation Oncology, Houston Methodist Hospital, Weill Cornell Medical College, Houston, TX, USA ; 6 Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA.
authors: Bin S
authors: BS
authors: Teh
authors: 1 Department of Radiation Oncology, Loyola University School of Medicine, Maywood, IL, USA ; 2 Department of Radiation Oncology Baltimore, Johns Hopkins University School of Medicine, MD, USA ; 3 London Regional Cancer Program, University of Western Ontario, London, ON, Canada ; 4 Department of Radiation Oncology, University of Washington, Seattle, WA, USA ; 5 Department of Radiation Oncology, Houston Methodist Hospital, Weill Cornell Medical College, Houston, TX, USA ; 6 Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA.
authors: Simon S
authors: SS
authors: Lo
keywords: Stereotactic body radiation therapy (SBRT); gastrointestinal organs (GI organs); tolerance