Translating SBRT From Academic to Community Practice

Abstract

Purpose/Objective(s): Similar to stereotactic radiosurgery (SRS) used for decades in treatment of intra-cranial metastasis, stereotactic body radiation therapy (SBRT) is becoming an established, efficient, and effective means in achieving high rates of local tumor control. The institution is one of the largest cancer care delivery systems in the United States, In 2008 and 2009, it expanded its radiosurgical practice to two of its large communitybased practices. Materials/Methods: We adapted the practice of SRS and SBRT utilizing LINAC-based radiosurgical techniques that include cone-based, 3D conformal, IMRT/IMRS, VMAT, and gated-VMAT techniques employing the clinical and research foundation established at our academic hub. With centralized training, clinical guidance, and routine oversight, the two clinical programs were established separately. Centralized treatment planning and review was essential in establishing treatment guidelines. Results: Two hundred thirty patients treated from May 2008 and Dec 2011 were analyzed, most with metastatic or recurrent neoplasms. Separate data bases were established to document and summarize: (1) various treatment sites, (2) dose-fractionation schemes, (3) response, (4) toxicity, (5) survival, (6) demographics, and several other endpoints. A collaborative effort was established to combine the databases. An additional and more in depth analysis of patients with oligometastases, lung cancer, and the special population of the elderly were performed and will be summarized in separate manuscripts. The well-described efficacy and toxicity profiles have been replicated in this setting as well as achieving a high rate of local control, palliation and, in some settings, improved survival. Acute side effects are relatively minor and significantly less compared to standard fractionated radiation therapy. Conclusions: Utilizing a team-based approach and following standardized guidelines for dose-fractionation and normal tissue protection, SBRT can become a standard part of practice of an experienced comprehensive community-based cancer center. Special attention to appropriate imaging, target delineation, patient immobilization, quality assurance and patient safety may allow this modality to become the next major improvement in treatment options demonstrating better disease control and less toxicity for many situations. Our analysis validates previous observations of a potential cost savings for our healthcare system, greater access to treatment secondary to increased patient convenience, fewer treatments, and increased quality of life for patients. Author Disclosure: R.B. Wynn: None. A. Mihai: None. P. Thiron: None. J. Westrup: None. M. Krebs: None. J. Armstrong: None. L.A. Rock: None. G. Fagan: None. R. Bhatnagar: None. D.E. Heron: None.