Stereotactic body radiotherapy: a review.

Stereotactic body radiotherapy (SBRT) combines the challenge of meeting the stringent dosimetric requirements of stereotactic radiosurgery with that of accounting for the physiological movement of tumour and normal tissue. Here we present an overview of the history and development of SBRT and discuss the radiobiological rationale upon which it is based. The published results of SBRT for lung, liver, pancreas, kidney, prostate and spinal lesions are reviewed and summarised. The current evidence base is appraised and important ongoing trials are identified.

[1]  Joe Y. Chang,et al.  Stereotactic body radiation therapy in centrally and superiorly located stage I or isolated recurrent non-small-cell lung cancer. , 2008, International journal of radiation oncology, biology, physics.

[2]  H. Keen,et al.  ORAL HYPOGLYCÆMICS IN DIABETES MELLITUS , 1975, The Lancet.

[3]  Matthias Guckenberger,et al.  Pulmonary injury and tumor response after stereotactic body radiotherapy (SBRT): results of a serial follow-up CT study. , 2007, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[4]  P. Weinstein,et al.  Spinal Cord and Intradural-Extraparenchymal Spinal Tumors: Current Best Care Practices and Strategies , 2004, Journal of Neuro-Oncology.

[5]  I. Lax,et al.  The role of radiotherapy in treatment of stage I non-small cell lung cancer. , 2003, Lung cancer.

[6]  X Allen Li,et al.  Extending the linear-quadratic model for large fraction doses pertinent to stereotactic radiotherapy. , 2004, Physics in medicine and biology.

[7]  J. Fowler,et al.  Lung Metastases Treated by CyberKnife® Image-Guided Robotic Stereotactic Radiosurgery at 41 Months , 2008, Southern medical journal.

[8]  J. Fowler.  The linear-quadratic formula and progress in fractionated radiotherapy. , 1989, The British journal of radiology.

[9]  G. Sibley.  Radiotherapy for patients with medically inoperable stage I nonsmall cell lung carcinoma , 1998, Cancer.

[10]  C. Cox,et al.  Image-guided helical Tomotherapy for treatment of spine tumors , 2008, Clinical Neurology and Neurosurgery.

[11]  Mohammed Mohiuddin,et al.  Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial , 2005, The Lancet.

[12]  Robert D Timmerman,et al.  A phase I trial of stereotactic body radiation therapy (SBRT) for liver metastases. , 2005, International journal of radiation oncology, biology, physics.

[13]  C. Moertel,et al.  Combined 5-fluorouracil and supervoltage radiation therapy of locally unresectable gastrointestinal cancer. , 1969, Lancet.

[14]  A. Muacevic,et al.  CyberKnife Radiosurgery for Malignant Spinal Tumors: Characterization of Well-Suited Patients , 2008, Spine.

[15]  G. Gagnon,et al.  TREATMENT OF CHORDOMAS WITH CYBERKNIFE: GEORGETOWN UNIVERSITY EXPERIENCE AND TREATMENT RECOMMENDATIONS , 2009, Neurosurgery.

[16]  Daniel T Chang,et al.  Stereotactic radiotherapy for unresectable adenocarcinoma of the pancreas , 2009, Cancer.

[17]  A. Benson,et al.  A randomized phase III study of gemcitabine in combination with radiation therapy versus gemcitabine alone in patients with localized, unresectable pancreatic cancer: E4201 , 2008 .

[18]  A Daşu,et al.  Is the alpha/beta value for prostate tumours low enough to be safely used in clinical trials? , 2007, Clinical oncology (Royal College of Radiologists (Great Britain)).

[19]  H. Jang,et al.  Fractionated stereotactic radiotherapy in patients with primary hepatocellular carcinoma. , 2006, Japanese journal of clinical oncology.

[20]  Masahiro Hiraoka,et al.  Stereotactic body radiotherapy for oligometastatic lung tumors. , 2008, International journal of radiation oncology, biology, physics.

[21]  J. Rock,et al.  Partial volume tolerance of the spinal cord and complications of single‐dose radiosurgery , 2007, Cancer.

[22]  Albert C Koong,et al.  Phase I study of stereotactic radiosurgery in patients with locally advanced pancreatic cancer. , 2004, International journal of radiation oncology, biology, physics.

[23]  H. von der Maase,et al.  Phase-II study on stereotactic radiotherapy of locally advanced pancreatic carcinoma. , 2005, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[24]  Sten Nilsson,et al.  Extracranial stereotactic radiotherapy for primary and metastatic renal cell carcinoma. , 2005, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[25]  R. Komaki,et al.  A comparison of misonidazole sensitized radiation therapy to radiation therapy alone for the palliation of hepatic metastases: results of a Radiation Therapy Oncology Group randomized prospective trial. , 1987, International journal of radiation oncology, biology, physics.

[26]  Lech Papiez,et al.  Excessive toxicity when treating central tumors in a phase II study of stereotactic body radiation therapy for medically inoperable early-stage lung cancer. , 2006, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[27]  J. Fowler,et al.  CyberKnife radiosurgery for stage I lung cancer: results at 36 months. , 2007, Clinical lung cancer.

[28]  L. Leksell.  The stereotaxic method and radiosurgery of the brain. , 1951, Acta chirurgica Scandinavica.

[29]  E. Spiegel,et al.  Stereotaxic Apparatus for Operations on the Human Brain. , 1947, Science.

[30]  John C. Flickinger,et al.  The use of radiation in the management of spinal metastases , 2005, Journal of Neuro-Oncology.

[31]  Meic H. Schmidt,et al.  Treatment of metastatic spinal epidural disease: a review of the literature. , 2003, Neurosurgical focus.

[32]  P. Gerszten,et al.  Single‐fraction radiosurgery for the treatment of spinal breast metastases , 2005, Cancer.

[33]  E. Maranzano,et al.  Effectiveness of radiation therapy without surgery in metastatic spinal cord compression: final results from a prospective trial. , 1995, International journal of radiation oncology, biology, physics.

[34]  D. Gouma,et al.  Feasibility and efficacy of high dose conformal radiotherapy for patients with locally advanced pancreatic carcinoma , 2000, Cancer.

[35]  D. Brenner,et al.  Direct evidence that prostate tumors show high sensitivity to fractionation (low α/β ratio), similar to late-responding normal tissue , 2002 .

[36]  C. Cleeland,et al.  Phase I/II study of stereotactic body radiotherapy for spinal metastasis and its pattern of failure. , 2007, Journal of neurosurgery. Spine.

[37]  Steven D Chang,et al.  FORAMINAL NERVE SHEATH TUMORS: INTERMEDIATE FOLLOW‐UP AFTER CYBERKNIFE RADIOSURGERY , 2009, Neurosurgery.

[38]  M. Goitein,et al.  Tolerance of normal tissue to therapeutic irradiation. , 1991, International journal of radiation oncology, biology, physics.

[39]  G Morton,et al.  Phase I/II study of a five-fraction hypofractionated accelerated radiotherapy treatment for low-risk localised prostate cancer: early results of pHART3. , 2008, Clinical oncology (Royal College of Radiologists (Great Britain)).

[40]  P. Gerszten,et al.  RADIOSURGERY FOR BENIGN INTRADURAL SPINAL TUMORS , 2008, Neurosurgery.

[41]  Quynh-Thu Le,et al.  Phase II study to assess the efficacy of conventionally fractionated radiotherapy followed by a stereotactic radiosurgery boost in patients with locally advanced pancreatic cancer. , 2005, International journal of radiation oncology, biology, physics.

[42]  J. Barkin,et al.  Therapy of locally unresectable pancreatic carcinoma: A randomized comparison of high dose (6000 rads) radiation alone, moderate dose radiation (4000 rads + 5‐fluorouracil), and high dose radiation + 5‐fluorouracil. The gastrointestinal tumor study group , 1981, Cancer.

[43]  B. Chauffert,et al.  Phase III trial comparing initial chemoradiotherapy (intermittent cisplatin and infusional 5-FU) followed by gemcitabine vs. gemcitabine alone in patients with locally advanced non metastatic pancreatic cancer: A FFCD-SFRO study. , 2006, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[44]  A. Muacevic,et al.  Stereotactic radiosurgery without radiation therapy providing high local tumor control of multiple brain metastases from renal cell carcinoma. , 2004, Minimally invasive neurosurgery : MIN.

[45]  H. Blomgren,et al.  A prospective Phase II trial of using extracranial stereotactic radiotherapy in primary and metastatic renal cell carcinoma , 2006, Acta oncologica.

[46]  H. Geinitz,et al.  Stereotactic hypofractionated radiotherapy in stage I (T1-2 N0 M0) non-small-cell lung cancer (NSCLC) , 2006, Acta oncologica.

[47]  Fang-Fang Yin,et al.  Stereotactic body radiotherapy for lesions of the spine and paraspinal regions. , 2009, International journal of radiation oncology, biology, physics.

[48]  K. Badiozamani,et al.  Comparison of rectal dose volume histograms for definitive prostate radiotherapy among stereotactic radiotherapy, IMRT, and 3D-CRT techniques , 2004 .

[49]  Seung Do Ahn,et al.  Stereotactic body frame based fractionated radiosurgery on consecutive days for primary or metastatic tumors in the lung. , 2003, Lung cancer.

[50]  Jan Nyman,et al.  Outcome in a prospective phase II trial of medically inoperable stage I non-small-cell lung cancer patients treated with stereotactic body radiotherapy. , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[51]  J. Fowler,et al.  Stereotactic hypofractionated accurate radiotherapy of the prostate (SHARP), 33.5 Gy in five fractions for localized disease: first clinical trial results. , 2007, International journal of radiation oncology, biology, physics.

[52]  R. Marcus,et al.  The incidence of myelitis after irradiation of the cervical spinal cord. , 1990, International journal of radiation oncology, biology, physics.

[53]  G. Lockwood,et al.  Phase I study of individualized stereotactic body radiotherapy of liver metastases. , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[54]  A. Hamilton,et al.  Preliminary clinical experience with linear accelerator-based spinal stereotactic radiosurgery. , 1995, Neurosurgery.

[55]  P. Gerszten,et al.  DELAYED RADIATION‐INDUCED MYELOPATHY AFTER SPINAL RADIOSURGERY , 2009, Neurosurgery.

[56]  Jan Nyman,et al.  Factors important for efficacy of stereotactic body radiotherapy of medically inoperable stage I lung cancer. A retrospective analysis of patients treated in the Nordic countries , 2006, Acta oncologica.

[57]  J. Beitler,et al.  Definitive, High-Dose-Per-Fraction, Conformal, Stereotactic External Radiation for Renal Cell Carcinoma , 2004, American journal of clinical oncology.

[58]  L. Schour,et al.  High-dose-rate intensity-modulated brachytherapy with external beam radiotherapy for prostate cancer: California endocurietherapy's 10-year results. , 2005, International journal of radiation oncology, biology, physics.

[59]  Haoran Jin,et al.  Virtual HDR CyberKnife treatment for localized prostatic carcinoma: dosimetry comparison with HDR brachytherapy and preliminary clinical observations. , 2008, International journal of radiation oncology, biology, physics.

[60]  H. Jang,et al.  Stereotactic body radiation therapy with or without transarterial chemoembolization for patients with primary hepatocellular carcinoma: preliminary analysis , 2008, BMC Cancer.

[61]  T. Solberg,et al.  Spinal lesions treated with Novalis shaped beam intensity-modulated radiosurgery and stereotactic radiotherapy. , 2004, Journal of neurosurgery.

[62]  H. Withers,et al.  Four R's of radiotherapy , 1975 .

[63]  G. Gustafson,et al.  High dose rate brachytherapy as prostate cancer monotherapy reduces toxicity compared to low dose rate palladium seeds. , 2004, The Journal of urology.

[64]  G. Gagnon,et al.  TREATMENT OF SPINAL TUMORS USING CYBERKNIFE FRACTIONATED STEREOTACTIC RADIOSURGERY: PAIN AND QUALITY‐OF‐LIFE ASSESSMENT AFTER TREATMENT IN 200 PATIENTS , 2009, Neurosurgery.

[65]  Steven D Chang,et al.  CyberKnife Radiosurgery for Benign Intradural Extramedullary Spinal Tumors , 2006, Neurosurgery.

[66]  Guy Marchal,et al.  Radiofrequency Ablation versus Resection for Resectable Colorectal Liver Metastases: Time for a Randomized Trial? , 2009, Digestive Surgery.

[67]  William C Welch,et al.  Radiosurgery for Spinal Metastases: Clinical Experience in 500 Cases From a Single Institution , 2007, Spine.

[68]  A. Levine,et al.  STEREOTACTIC RADIOSURGERY FOR THE TREATMENT OF PRIMARY SARCOMAS AND SARCOMA METASTASES OF THE SPINE , 2009, Neurosurgery.

[69]  L H Blumgart,et al.  Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. , 1999, Annals of surgery.

[70]  George Starkschall,et al.  Prostate cancer radiation dose response: results of the M. D. Anderson phase III randomized trial. , 2002, International journal of radiation oncology, biology, physics.

[71]  L. Way,et al.  Prognostic indicators for survival after resection of pancreatic adenocarcinoma. , 1993, American journal of surgery.

[72]  I. Lax,et al.  Stereotactic high dose fraction radiation therapy of extracranial tumors using an accelerator. Clinical experience of the first thirty-one patients. , 1995, Acta oncologica.

[73]  Quynh-Thu Le,et al.  Results of a Phase I Dose-Escalation Study Using Single-Fraction Stereotactic Radiotherapy for Lung Tumors , 2006, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[74]  R. V. van Klaveren,et al.  Stereotactic radiotherapy with real-time tumor tracking for non-small cell lung cancer: clinical outcome. , 2009, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[75]  B. Davis,et al.  External radiation of brain metastases from renal carcinoma: A retrospective study of 119 patients from the M. D. Anderson Cancer Center , 1997 .

[76]  J. Fowler,et al.  Selective boosting of tumor subvolumes. , 2000, International journal of radiation oncology, biology, physics.

[77]  Lech Papiez,et al.  Stereotactic body radiation therapy of early-stage non-small-cell lung carcinoma: phase I study. , 2005, International journal of radiation oncology, biology, physics.

[78]  Lijun Ma,et al.  Image-Guided Robotic Stereotactic Body Radiotherapy for Benign Spinal Tumors: The University of California San Francisco Preliminary Experience , 2007, Technology in cancer research & treatment.

[79]  J. Rock,et al.  Patterns of failure after single-dose radiosurgery for spinal metastasis , 2004 .

[80]  Steven D Chang,et al.  Multisession CyberKnife Radiosurgery for Intramedullary Spinal Cord Arteriovenous Malformations , 2006, Neurosurgery.

[81]  D. Kondziolka,et al.  Radiosurgery in patients with renal cell carcinoma metastasis to the brain: long-term outcomes and prognostic factors influencing survival and local tumor control. , 2003, Journal of neurosurgery.

[82]  E. Kunieda,et al.  Hypofractionated stereotactic radiotherapy with and without transarterial chemoembolization for small hepatocellular carcinoma not eligible for other ablation therapies: Preliminary results for efficacy and toxicity , 2008, Hepatology research : the official journal of the Japan Society of Hepatology.

[83]  P. Gerszten,et al.  Radiosurgery for the treatment of spinal lung metastases , 2006, Cancer.

[84]  S. Kalnicki,et al.  CyberKnife Frameless Radiosurgery for the Treatment of Extracranial Benign Tumors , 2005, Technology in cancer research & treatment.

[85]  M. Wannenmacher,et al.  [Value of local radiotherapy in treatment of osseous metastases, pathological fractures and spinal cord compression]. , 1995, Der Radiologe.

[86]  R. H. Clarke,et al.  THE STRUCTURE AND FUNCTIONS OF THE CEREBELLUM EXAMINED BY A NEW METHOD. , 1908 .

[87]  M. Parmar,et al.  Escalated-dose versus standard-dose conformal radiotherapy in prostate cancer: first results from the MRC RT01 randomised controlled trial. , 2007, The Lancet. Oncology.

[88]  P. Gerszten,et al.  Stereotactic radiosurgery for spinal metastases from renal cell carcinoma. , 2005, Journal of neurosurgery. Spine.

[89]  Maria Hawkins,et al.  Phase I study of individualized stereotactic body radiotherapy for hepatocellular carcinoma and intrahepatic cholangiocarcinoma. , 2008, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[90]  O. Alfthan,et al.  Preoperative irradiation in the treatment of renal adenocarcinoma. , 1977, Scandinavian journal of urology and nephrology.

[91]  Patrick A Kupelian,et al.  Implantation and stability of metallic fiducials within pulmonary lesions. , 2007, International journal of radiation oncology, biology, physics.

[92]  Bernhard Heck,et al.  Accuracy and stability of positioning in radiosurgery: long-term results of the Gamma Knife system. , 2007, Medical physics.

[93]  P. Engstrom,et al.  Treatment of locally unresectable cancer of the stomach and pancreas: a randomized comparison of 5-fluorouracil alone with radiation plus concurrent and maintenance 5-fluorouracil--an Eastern Cooperative Oncology Group study. , 1985, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[94]  J. Roth,et al.  Survival in early-stage non-small cell lung cancer. , 1995, The Annals of thoracic surgery.

[95]  S Richardson,et al.  The treatment of primary and metastatic renal cell carcinoma (RCC) with image-guided stereotactic body radiation therapy (SBRT) , 2007, Biomedical imaging and intervention journal.

[96]  P. Gerszten,et al.  Radiosurgery for the Treatment of Spinal Melanoma Metastases , 2006, Stereotactic and Functional Neurosurgery.

[97]  I. Lax,et al.  Stereotactic radiotherapy of malignancies in the abdomen. Methodological aspects. , 1994, Acta oncologica.

[98]  Hiroki Shirato,et al.  STEREOTACTIC RADIATION THERAPY WORKSHOP Hypofractionated Stereotactic Radiotherapy (HypoFXSRT) for Stage I Non-small Cell Lung Cancer: Updated Results of 257 Patients in a Japanese Multi-institutional Study , 2007 .

[99]  J. Brooks,et al.  Stereotactic body radiotherapy for localized prostate cancer: interim results of a prospective phase II clinical trial. , 2009, International journal of radiation oncology, biology, physics.

[100]  I. Lax,et al.  Stereotactic body radiotherapy of primary and metastatic renal lesions for patients with only one functioning kidney , 2008, Acta oncologica.

[101]  Ping Li,et al.  Promising clinical outcome of stereotactic body radiation therapy for patients with inoperable Stage I/II non-small-cell lung cancer. , 2006, International journal of radiation oncology, biology, physics.

[102]  L. Gaspar,et al.  Multi-institutional phase I/II trial of stereotactic body radiation therapy for lung metastases. , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[103]  M Buyse,et al.  Long-term results of lung metastasectomy: prognostic analyses based on 5206 cases. , 1997, The Journal of thoracic and cardiovascular surgery.

[104]  Angelika Hoess,et al.  Stereotactic single‐dose radiotherapy (radiosurgery) of early stage nonsmall‐cell lung cancer (NSCLC) , 2007, Cancer.

[105]  F. Lohr,et al.  Stereotactic single-dose radiation therapy of liver tumors: results of a phase I/II trial. , 2001, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[106]  M. Schell,et al.  Hypofractionated stereotactic body radiation therapy (SBRT) for limited hepatic metastases. , 2007, International journal of radiation oncology, biology, physics.

[107]  Philip H. Gutin,et al.  Intensity-modulated Stereotactic Radiotherapy of Paraspinal Tumors: A Preliminary Report , 2004, Neurosurgery.

[108]  I. Sarikaya,et al.  Radical cyberknife radiosurgery with tumor tracking: an effective treatment for inoperable small peripheral stage I non-small cell lung cancer , 2009, Journal of hematology & oncology.

[109]  Peter C Levendag,et al.  Stereotactic body radiation therapy for primary and metastatic liver tumors: A single institution phase i-ii study , 2006, Acta oncologica.

[110]  Michael Flentje,et al.  Stereotactic radiotherapy for primary lung cancer and pulmonary metastases: a noninvasive treatment approach in medically inoperable patients. , 2004, International journal of radiation oncology, biology, physics.

[111]  W. Mühlnickel,et al.  Stereotactic, single-dose irradiation of stage I non-small cell lung cancer and lung metastases , 2006, Radiation oncology.