Abstract
Recently, there has been increased interest worldwide in the use of conventional linear accelerator (linac)-based systems for delivery of stereotactic radiosurgery/radiotherapy (SRS/SRT) contrasting with historical delivery in specialised clinics with dedicated equipment. In order to gain an understanding and define the current status of SRS/SRT delivery in Australia and New Zealand (ANZ) we conducted surveys and provided a single-day workshop. Prior to the workshop ANZ medical physicists were invited to complete two surveys: a departmental survey regarding SRS/SRT practises and equipment; and an individual survey regarding opinions on current and future SRS/SRT practices. At the workshop conclusion, attendees completed a second opinion-based survey. Workshop discussion and survey data were utilised to identify areas of consensus, and areas where a community consensus was unclear. The workshop was held on the 8th Sept 2020 virtually due to pandemic-related travel restrictions and was attended by 238 radiation oncology medical physicists from 39 departments. The departmental survey received 32 responses; a further 89 and 142 responses were received to the pre-workshop and post-workshop surveys respectively. Workshop discussion indicated a consensus that for a department to offer an SRS/SRT service, a minimum case load should be considered depending on availability of training, peer-review, resources and equipment. It was suggested this service may be limited to brain metastases only, with less common indications reserved for departments with comprehensive SRS/SRT programs. Whilst most centres showed consensus with treatment delivery techniques and image guidance, opinions varied on the minimum target diameter and treatment margin that should be applied.
Highlights
For many years radiation therapy for small tumours and surgical cavities within the brain was confined to a limited number of treatment centres with specialized equipment [1,2,3]
The motivation of this study was to obtain an understanding of the current status of stereotactic radiosurgery (SRS)/stereotactic radiotherapy (SRT) in ANZ in a one day workshop attended by radiation oncology medical physicists around ANZ, in conjunction with departmental and workshop attendee opinion-based surveys
This service may be limited to brain metastases only, with less common indications requiring more specialised equipment reserved for departments with a more comprehensive SRS/SRT program
Summary
For many years radiation therapy for small tumours and surgical cavities within the brain was confined to a limited number of treatment centres with specialized equipment [1,2,3]. With the growth of extra-cranial stereotactic ablative radiotherapy (SABR) in Australia and worldwide [7,8,9,10,11,12,13], there has been an increased interest in using a conventional linac and associated radiotherapy equipment for linac-based stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT). Physical and Engineering Sciences in Medicine have the ability to plan highly conformal treatments of single as well as multiple lesions either individually or simultaneously in single-isocentre multiple-target (SIMT) SRS [14]. In addition to recognising that conventional technology could potentially be adapted for use with cranial SRS or SRT, there has been a change in referral patterns favouring a stereotactic approach for multiple brain lesions over standard whole-brain radiotherapy treatments in an effort to improve quality of life in patients with an extended life expectancy [15, 16]
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