Stereotactic body radiotherapy: A critical review for nonradiation oncologists

Abstract

Stereotactic body radiotherapy (SBRT) involves the treatment of extracranial primary tumors or metastases with a few, high doses of ionizing radiation. In SBRT, tumor kill is maximized and dose to surrounding tissue is minimized, by precise and accurate delivery of multiple radiation beams to the target. This is particularly challenging, because extracranial lesions often move with respiration and are irregular in shape, requiring careful treatment planning and continual management of this motion and patient position during irradiation. This review presents the rationale, process workflow, and technology for the safe and effective administration of SBRT, as well as the indications, outcome, and limitations for this technique in the treatment of lung cancer, liver cancer, and metastatic disease. Cancer 2014;120:942-54.

CyberKnife Robotic Radiosurgery of Three Pancreatic Metastases of Renal Cell Cancer in One Treatment Session

“…Saito, et al have published results on four patients with pancreatic metastasis of renal cell carcinoma who were successfully treated with conventional radiation therapy (50 Gy, 2 fx/day) [13]. Stereotactic radiosurgery with the capabilities to apply a very high dose of radiation to a limited tumor volume has been shown to achieve this goal in different regions of the body [14]. Also, experience on the local efficacy of SRS for primary pancreatic tumors have been published [15].…”

Irradiation and immunotherapy: From concept to the clinic

“…Application of these technologies now allows for the delivery of a few, large, intracranial and extracranial RT doses that directly target tumors while excluding surrounding nontumor tissues. Commonly termed stereotactic radiosurgery when delivered to intracranial targets and stereotactic body RT (SBRT) or stereotactic ablative radiation (SABR) when delivered to extracranial targets, these treatments have generally led to promising treated tumor control rates with limited toxicity, 5 potentially engaging additional antitumor pathways. [6][7][8] Historically regarded as immunosuppressive, it is increasingly evident that RT has several immunomodulatory effects that potentially sensitize tumors, making them more responsive locally and systemically to therapy.…”

Stereotactic body radiotherapy for oligoprogressive cancer

“…Given the convenience and high therapeutic ratio of SBRT in treating tumours in almost every body site, there has been increasing interest in using SBRT to treat metastatic tumours in certain clinical scenarios. 11,12 Figure 1 illustrates a SBRT dose distribution used to treat a pulmonary metastasis.…”