PURPOSE: To determine whether the accumulated dose using image guided radiation therapy is a stronger predictor of clinical outcomes than the planned dose in stereotactic body radiation therapy (SBRT) for liver @entity3 . METHODS AND MATERIALS: From 2003 to 2009, 81 @entity1 with 142 @entity3 were treated in institutional review board-approved SBRT studies (5-10 fractions). @entity1 were treated during free breathing (with or without abdominal compression) or with controlled exhale breath-holding. SBRT was planned on a static exhale computed tomography (CT) scan, and the minimum planning target volume dose to 0.5  cm(3) (minPTV) was recorded. The accumulated minimum dose to the 0.5  cm(3) gross @entity5 volume (accGTV) was calculated after performing dose accumulation from exported image guided radiation therapy data sets registered to the planning CT using rigid (2-dimensional MV/kV orthogonal) or deformable (3-dimensional/4-dimensional cone beam CT) image registration. Univariate and multivariate Cox regression models assessed the factors influencing the @entity2631 ( @entity2631 ). Hazard ratios for accGTV and minPTV were compared using model goodness-of-fit and bootstrapping. RESULTS: Overall, the accGTV dose exceeded the minPTV dose in 98% of the lesions. For 5 to 6 fractions, accGTV doses of >45  Gy were associated with 1-year local control of 86%. On univariate analysis, the @entity5 subtype (breast), smaller @entity5 volume, and increased dose were significant predictors for improved @entity2631 . The dose and volume were uncorrelated; the accGTV dose and minPTV dose were correlated and were tested separately on multivariate models. @entity0 subtype, accGTV dose (P<.001), and minPTV dose (P=.02) retained significance in the multivariate models. The univariate hazard ratio for @entity2631 for 5-Gy increases in accGTV versus minPTV was 0.67 versus 0.74 (all @entity1 ; 95% confidence interval of difference 0.03-0.14). Goodness-of-fit testing confirmed the accGTV dose as a stronger dose-response predictor than the minPTV dose. CONCLUSIONS: The accGTV dose is a better predictor of @entity2631 than the minPTV dose for liver @entity3 SBRT. The use of modern image guided radiation therapy in future analyses of dose-response outcomes should increase the concordance between the planned and delivered doses.

Accumulated Delivered Dose Response of  Stereotactic Body Radiation Therapy for  Liver  XXXX .

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients'] @entity0 :: ('MESH:D001943', 'Disease') :: ['Breast cancer'] @entity5 :: ('MESH:D009369', 'Disease') :: ['tumor', 'cancer'] @entity2631 :: ('MESH:D012594', 'Disease') :: ['time to local progression', 'TTLP'] @entity3 :: ('MESH:D009362', 'Disease') :: ['metastasis', 'metastases']
@entity3 :: (MESH:D009362,Disease) :: ['Metastases']
