Emerging radiotherapy technology in a developing country: A single Brazilian institution assessment of stereotactic body radiotherapy application

Abstract

Objective: To provide a quantitative profile of the indications and use of stereotactic body radiotherapy (SBRT) in a developing country oncology-based institution. In addition, to describe the patients' and treatment characteristics, and to provide a temporal analysis. Method: SBRT patients treated from 2007 to 2015 were retrospectively evaluated by two independently investigators. Data were stratified and compared in two periods: first experience (FE) (May 2007 to April 2011), and following experience (FollowE) (May 2011 to April 2015). The following parameters were compared between the groups: total number of treated patients and lesions, treatment site, additional image fusion used, formal protocol adoption, and SBRT planning technique. Results: One hundred and seventy-six (176) patients with 191 lesions were treated: 34 (18%) lesions in the FE and 157 (82%) lesions in FollowE. The majority of lesions were metastases (60.3%), and lung (60.2%) was the most common treatment site, followed by spine (31%), and others (8.8%). An average of 1.4 (±0.6) additional imaging exams for delineation was performed. Conformal 3D radiotherapy planning technique was used in 64.4%, and intensity modulated radiotherapy (IMRT) or volumetric-modulated arc therapy (VMAT) in the remaining 35.6% (p=0.0001). Higher rates of curative treatments were observed in FE, as well as more lung lesions, patients ≥ 70 years, 3D conformal, number of additional images and ECOG 0, and all presented p<0.05. The global rate of protocol statement was 79%, lung treatment being the most stated. Conclusion: SBRT application is rapidly increasing in our setting. Treatment sites and planning techniques are becoming more diversified and complex.

Real-World Evidence of Health Outcomes Related to Lung Stereotactic Body Radiation Therapy in Brazil

“…There are a scarce number of studies generated in Latin America describing the feasibility of SBRT treatments in patients with lung lesions (either early-stage or oligometastatic). 9,[15][16][17][18] In LMICs, it is common that patients with early-stage NSCLC, who are not candidates for surgical treatment, receive conventional RT fractionations. 7 However, conventional RT for early NSCLC does not provide adequate control and is associated with higher rates of local and systemic failures.…”

Brazilian Landscape of Hepatocellular Carcinoma

“…Liver SBRT, however, is a more complex technique and has been reported in selected academic centers and private hospitals. 48 , 50 , 51 Minimum technical requirements for HCC SBRT include four-dimensional CT (4D-CT) simulation with triphasic contrast injection, 3D-conformal or intensity-modulated RT (IMRT) planning, and daily image verification (image-guided RT) with cone-beam CT (CBCT) or KV images plus fiducial markers. 52 Fiducial markers are not available in the SUS and are not reimbursed by insurance companies, which makes their use very limited in clinical practice.…”