Status Of Stereotactic Body Radiotherapy Research Articles

Current status of stereotactic body radiotherapy for the treatment of hepatocellular carcinoma.

Stereotactic body radiotherapy (SBRT) is an advanced form of radiotherapy (RT) with a growing interest on its application in the treatment of hepatocellular carcinoma (HCC). It can deliver ablative radiation doses to tumors in a few fractions without excessive doses to normal tissues, with the help of advanced modern RT and imaging technologies. Currently, SBRT is recommended as an alternative to curative treatments, such as surgery and radiofrequency ablation. This review discusses the current status of SBRT to aid in the decision making on how it is incorporated into the HCC management.

A Survey of Stereotactic Body Radiotherapy in Korea.

PurposeThe purpose of this study is to investigate the current status of stereotactic body radiotherapy (SBRT) in Korea. A nationwide survey was conducted by the Korean Stereotactic Radiosurgery Group of the Korean Society for Radiation Oncology (KROG 13-13).Materials and MethodsSBRT was defined as radiotherapy with delivery of a high dose of radiation to an extracranial lesion in ≤ 4 fractions. A 16-questionnaire survey was sent by e-mail to the chief of radiation oncology at 85 institutions in June 2013.ResultsAll institutions (100%) responded to this survey. Of these, 38 institutions (45%) have used SBRT and 47 institutions (55%) have not used SBRT. Regarding the treatment site, the lung (92%) and liver (76%) were the two most common sites. The most common schedules were 60 Gy/4 fractions for non-small cell lung cancer, 48 Gy/4 fractions for lung metastases, 60 Gy/3 fractions for hepatocellular carcinoma, and 45 Gy/3 fractions or 40 Gy/4 fractions for liver metastases. Four-dimensional computed tomography (CT) was the most common method for planning CT (74%). During planning CT, the most common method of immobilization was the use of an alpha cradle/vacuum-lock (42%).ConclusionBased on this survey, conduct of further prospective studies will be needed in order to determine the appropriate prescribed doses and to standardize the practice of SBRT.

Survey of Stereotactic Body Radiation Oncology for Early Staged Non-Small Cell Lung Cancer in China

Purpose: To evaluate the current status of stereotactic body radiotherapy (SBRT) for early staged non-small cell lung cancer (NSCLC) at main cancer hospitals in China. Methods and Materials: The questionnaire was sent by mail and email to 21 hospitals, which include the patient enrollment, treatment technique, dose and fractionation, quality control, disease control and side effects. Results: Nineteen hospitals responded. It was found that SBRT has been used for early staged NSCLC in most of the hospitals participating in the survey. The patient characteristics and techniques were relatively consistent, but there were many controversies regarding dose fractionation and quality control. Conclusions: SBRT for early staged NSCLC has been applied at main cancer hospitals in China. However, considerable variation exists. The establishment of clinical guidelines and standardized quality control are crucial for further improvement.

What is the current status of Stereotactic body radiotherapy for stage I non-small cell lung cancer?

Non-small cell lung cancer, if detected at early stage, is a disease with high probability for cure. However, the treatment in clinical practice is highly dependent on the co-morbidities of the patient, the performance status and age. A relevant proportion especially of the elderly patient population remains untreated despite the dismal prognosis of untreated stage I NSCLC with 5 year cancer specific survival (CSS) of only 16% (1,2). Conventionally fractionated radiotherapy has been the treatment of choice for medically inoperable patients: however, outcome is suboptimal with 5 year CSS ranging between 13% and 39% (3); most importantly, local disease recurrence is the most frequent site of failure, not systemic metastases (4). CSS is excellent after lobectomy ranging between 100% and 57.6% depending on the size of the primary tumor (5). Despite a randomized trial demonstrated inferior outcome of sublobar resection compared to lobectomy (6), sublobar resection is practiced especially in high-risk patients aiming at preservation of pulmonary function (7). Wedge resection seems to be insufficient even for small tumors whereas segmentectomy results in promising CSS if the tumor size is below 3cm (5,8).

Survey of Stereotactic Body Radiation Therapy in Japan by the Japan 3-D Conformal External Beam Radiotherapy Group

To recognize the current status of stereotactic body radiotherapy (SBRT) in Japan, using a nationwide survey conducted by the Japan 3-D Conformal External Beam Radiotherapy Group. The questionnaire was sent by mail to 117 institutions. Ninety-four institutions (80%) responded by the end of November 2005. Fifty-three institutions indicated that they have already started SBRT, and 38 institutions had been reimbursed by insurance. A total of 1111 patients with histologically confirmed lung cancer were treated. Among these patients, 637 had T1N0M0 and 272 had T2N0M0 lung cancer. Metastatic lung cancer was found in 702 and histologically unconfirmed lung tumor in 291 patients. Primary liver cancer was found in 207 and metastatic liver cancer in 76 patients. The most frequent schedule used for primary lung cancer was 48 Gy in 4 fractions at 22 institutions (52%), followed by 50 Gy in 5 fractions at 11 institutions (26%) and 60 Gy in 8 fractions at 4 institutions (10%). The tendency was the same for metastatic lung cancer. The average number of personnel involved in SBRT was 1.8 radiation oncologists, including 1.1 certified radiation oncologists, 2.8 technologists, 0.7 nurses, and 0.6 certified quality assurance personnel and 0.3 physicists. The most frequent amount of time for treatment planning was 61-120 min, for quality assurance was 50-60 min, and for treatment was 30 min. There were 14 (0.6% of all cases) reported Grade 5 complications: 11 cases of radiation pneumonitis, 2 cases of hemoptysis, and 1 case of radiation esophagitis. The current status of SBRT in Japan was surveyed.

Current status of stereotactic body radiotherapy for lung cancer

Stereotactic radiotherapy (SRT) for extracranial tumors has been recently performed to treat lung and liver cancers, and has subsequently been named stereotactic body radiotherapy (SBRT). The advantages of hypofractionated radiotherapy for treating lung tumors are a shortened treatment course that requires fewer trips to the clinic than a conventional program, and the adoption of a smaller irradiated volume allowed by greater setup precision. This treatment is possible because the lung and liver are considered parallel organs at risk. The preliminary clinical results, mostly reported on lung cancer, have been very promising, including a local control rate of more than 90%, and a relatively low complication rate. The final results of a few clinical trials are awaited. SBRT may be useful for the treatment of stage I lung tumors.