Objective: To ascertain the progress being made towards the implementation of stereotactic ablative body radiotherapy (SABR) treatment in the UK, to obtain details of current practice in centres with an active treatment programme and to assess the projected future provision. Methods: In August 2012, an online questionnaire was sent to all 65 UK radiotherapy institutions. The included questions covered the current number of patients being treated and the intended number of patients for each clinical site; immobilization and motion management methods; CT scanning protocols; target and organ-atrisk delineation; treatment planning; image-guidance and treatment protocols; and quality assurance methods.Results: 48/65 (74%) institutions responded by the end of November 2012, with 15 indicating an active SABR programme. A further four centres indicated that a SABR protocol had been established but was not yet in clinical use. 14 of the 29 remaining responses stated an intention to develop a SABR programme in the next 2 years. Conclusion: The survey responses confirm that SABR provision in the UK is increasing and that this should be expected to continue in the next 2 years. A projection of the future uptake would suggest that by the end of 2014, UK SABR provision will be broadly in line with international practice.Stereotactic ablative body radiotherapy (SABR) uses hypofractionated dose schedules (three to eight fractions) and high-precision treatment delivery to improve local control of disease. The radiobiological rationale for hypofractionation, that delivery of a few large fractions over a short overall treatment time will achieve a greater therapeutic ratio than delivery of standard treatment regimes of 20 or more fractions, is indicated in numerous studies for a range of clinical indications.1,2 This evidence is most robust in patients with non-small-cell lung cancer (NSCLC), where a recent systematic review found 2-year survival and local control rates after SABR of 70% and 91%, respectively.3 Despite the lack of randomized trial evidence, SABR is now a recognized standard of care for inoperable patients with early-stage peripheral lung tumours, 4 while a recent systematic review of the use of SABR for treatment of central lung tumours found local control rates .85% for biologically equivalent tumour doses .100 Gy, with low rates of treatmentrelated toxicity.5 These promising outcomes have led to suggestions that SABR could be an acceptable alternative to surgery in operable patients with NSCLC, potentially enabling a balance to be struck between the risk of morbidity and mortality of lobectomy, with the increased risk of locoregional recurrence from SABR. [6][7][8]

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Stereotactic ablative radiotherapy (SABR) has developed from the principles and techniques used in the stereotactic radiosurgery treatment of brain metastases. Advances in computer technology, imaging, planning and treatment delivery and evidence from retrospective analysis of single-and multi-institutional early-phase studies have established SABR in the treatment of medically inoperable early lung cancer. Effective multidisciplinary team working is crucial to safe delivery of SABR. The variation in patient selection, radiotherapy planning and delivery techniques has led to a collective approach to SABR implementation across the UK. Centres developing the technique are represented in the UK SABR Consortium, which is supported by the relevant UK professional bodies and represents a platform to develop extracranial SABR across the UK. The uptake of SABR in the UK has been slowed by workforce issues, but at least 15 centres are currently delivering treatment with over 500 patients treated using UK SABR Consortium guidance. A mentoring program is being piloted helping new centres to develop their programs, and over 30 UK centres are expected to be offering SABR treatment by the end of 2014. The use of consistent guidance for patient selection, treatment planning and delivery in the UK gives the opportunity to collect and audit toxicity and outcome across the centres, contributing to the internationally reported SABR experience. Having established this service in the UK, the development of SABR through clinical research is a priority, and with input from the Radiotherapy Trials Quality Assurance Group, the UK is developing a national study program that includes participation in international trials.

Commercial glass beads are utilized as low-cost novel TLDs for treatment-plan verification.

Objective: To update the 2012 UK stereotacticablative radiotherapy (SABR) Consortium survey and assess the development of SABR services across the UK over the past 6 years. Use the results to share practice and continue to drive forward technique development, aid standardization and by highlighting issues, improve access to SABR services and trials across the UK. Methods: In January 2018, an online questionnaire was sent by the UK SABR Consortium to 65 UK radiotherapy institutions covering current service provision and collecting data on immobilization, motion management, scanning protocols, target/OAR delineation, planning, image-guidance, quality assurance and future plans. Results: 50 (77%) institutions responded, 38 ( vs 15 in 2012) indicated they had an active SABR programme with the remaining 12 centres intending to develop a SABR programme Documented changes include the development of Linac delivered SABR to non-lung sites, an increase in centres using abdominal compression (14 vs 2) and the introduction of four-dimensional cone beam CBCT. Current practice is broadly in line with UK SABR Consortium and European guidelines. Conclusion: This 2018 survey shows a welcome increase in SABR provision, surpassing 2012 projections. However, it is clear that the UK SABR program needs to continue to expand to ensure that patients with oligometastatic disease have access and SABR for early stage lung cancer is available in all centres. Updated guidance that addresses variability in target delineation, image guidance and reduces patient specific quality assurance is warranted. Advances in knowledge: Documented progress of UK SABR across all treatment sites over the last six years, barriers to implementation and future plans.