Abstract
PurposeTo assess stereotactic radiotherapy (SRT)/stereotactic body radiotherapy (SBRT) practices by polling clinics participating in multi-institutional clinical trials.MethodsThe NRG Oncology Medical Physics Subcommittee distributed a survey consisting of 23 questions, which covered general technologies, policies, and procedures used in the Radiation Oncology field for the delivery of SRT/SBRT (9 questions), and site-specific questions for brain SRT, lung SBRT, and prostate SBRT (14 questions). Surveys were distributed to 1,996 radiotherapy institutions included on the membership rosters of the five National Clinical Trials Network (NCTN) groups. Patient setup, motion management, target localization, prescriptions, and treatment delivery technique data were reported back by 568 institutions (28%).Results97.5% of respondents treat lung SBRT patients, 77.0% perform brain SRT, and 29.1% deliver prostate SBRT. 48.8% of clinics require a physicist present for every fraction of SBRT, 18.5% require a physicist present for the initial SBRT fraction only, and 14.9% require a physicist present for the entire first fraction, including set-up approval for all subsequent fractions. 55.3% require physician approval for all fractions, and 86.7% do not reposition without x-ray imaging. For brain SRT, most institutions (83.9%) use a planning target volume (PTV) margin of 2 mm or less. Lung SBRT PTV margins of 3 mm or more are used in 80.6% of clinics. Volumetric modulated arc therapy (VMAT) is the dominant delivery method in 62.8% of SRT treatments, 70.9% of lung SBRT, and 68.3% of prostate SBRT.ConclusionThis report characterizes SRT/SBRT practices in radiotherapy clinics participating in clinical trials. Data made available here allows the radiotherapy community to compare their practice with that of other clinics, determine what is achievable, and assess areas for improvement.
Highlights
Stereotactic radiation therapy (SRT) and stereotactic body radiation therapy (SBRT) are external beam techniques that deliver high doses (2,400 cGy to 6,000 cGy) in a small number of fractions, resulting in a high biological effective dose (BED) to intracranial (SRT) or extracranial (SBRT) targets
This report characterizes SRT/SBRT practices in radiotherapy clinics participating in clinical trials
The survey was conducted October 2018. It was electronically distributed by the Imaging and Radiation Oncology Core (IROC) Houston Quality Assurance center to the 1,996 radiation therapy institutions that participate in National Clinical Trials Network (NCTN) clinical trials
Summary
Stereotactic radiation therapy (SRT) and stereotactic body radiation therapy (SBRT) are external beam techniques that deliver high doses (2,400 cGy to 6,000 cGy) in a small number of fractions (one fraction, up to five fractions), resulting in a high biological effective dose (BED) to intracranial (SRT) or extracranial (SBRT) targets. Published in 2010, the American Association of Physicists in Medicine Task Group 101 (AAPM TG-101) (1) report provides comprehensive guidance to SBRT treatment delivery as well as recommendations on clinical implementation, quality assurance, quality improvement, and patient safety. The United Kingdom Stereotactic Ablative Body Radiation Therapy (SABR) Consortium report (5) is a comprehensive overview of the SBRT program recommendations including safety and quality assurance and treatments for the different sites, and Canadian Association of Radiation Oncology scope of practice guidelines (6) is a concise overview of the principles, roles, technologies, practices and safety, and quality assurance in SBRT. There is an ACR-AAPM technical standard for medical physics performance monitoring of SBRT (8)
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