Stereotactic radiotherapy: An educational narrative review

Abstract

Stereotactic radiotherapy is a term collectively used to describe the radiation treatment techniques that allow for the delivery of highly precise ionizing radiation. It is usually a high dose per session in single or few fractions. This treatment approach has been in medical use for over six decades and has primarily evolved in the last two decades. Many patients benefit from this unique non-conventional radiotherapy approach. Its indications include various malignant, benign and functional problems in cranial and body sites. This technique is not widespread in developing countries compared to developed countries. This work is an educational narrative review for learners in radiation oncology. We aim to share the knowledge of this practice to improve precision radiation oncology globally. This review summarizes the basics of stereotactic radiotherapy, the technical prerequisites, the clinical considerations, the practical recommendations and the learning points from each site-specific region.

Keywords

Stereotactic radiotherapy / SRS / SABR / SRT / SBRT

References

[1] BarnettGH, Linskey ME, AdlerJR, et al. Stereotactic radiosurgery—an organized neurosurgery-sanctioned definition. J Neurosurg. 2007;106(1):1–5.

[2] LasakJM, Gorecki JP. The history of stereotactic radiosurgery and radiotherapy. Otolaryngol Clin North Am. 2009;42(4):593–599.

[3] ChangBK, Timmerman RD. Stereotactic body radiation therapy: a comprehensive review. Am J Clin Oncol. 2007;30(6):637–644.

[4] VermaV, Mcmillan MT, GroverS, SimoneCB. Stereotactic body radiation therapy and the influence of chemotherapy on overall survival for large (≥ 5 centimeter) non-small cell lung cancer. IJROBP. 2017;97(1):146–154.

[5] FooteM, BaileyM, SmithL, et al. Guidelines for safe practice of stereotactic body (ablative) radiation therapy. J Med Imaging Radiat Oncol. 2015;59(5):646–653.

[6] LoSS, Slotman BJ, LockM, et al. The development of stereotactic body radiotherapy in the past decade: a global perspective. Future Oncol. 2015;11(19):2721–2733.

[7] PathakRS, Tibdewal A, KinhikarR, et al. Practice Patterns and Perspectives on Stereotactic Body Radiation Therapy for the Metastatic Spine From Lower-and Middle-Income Countries. JCO Global Oncol. 2022;8:e2200167.

[8] BuckleyL, BachaB, GaudetM, et al. Development of a Curriculum for the Implementation of Stereotactic Radiation Therapy Programs in Middle-Income Countries. JCO Global Oncol. 2022;8:e2100389.

[9] Mula-HussainL, Wadi-Ramahi S, LiB, AhmedS, de Moraes FY. Specialty portfolio in radiation oncology: a global certification roadmap for trainers and trainees (Handbook–Logbook). 2021; Qatar University Press.

[10] VapiwalaN, Steinberg M, GrossC. The Accreditation Council for Graduate Medical Education's Recent Changes to Radiation Oncology Training Program Standards: Raising the Bar for Postgraduate Training Quality to Better Reflect Our Specialty and Better Serve Our Patients. Int J Radiat Oncol Biol Phys. 2023;115(2):285–287.

[11] HarrowS, PalmaDA, OlsonR, et al. Stereotactic radiation for the comprehensive treatment of oligometastases (SABR-COMET): extended long-term outcomes. IJROBP. 2022;114(4):611–616.

[12] AbelS, LeeS, LudmirEB, Verma V. Principles and applications of stereotactic radiosurgery and stereotactic body radiation therapy. Hematol/Oncol Clin. 2019;33(6):977–987.

[13] ChetvertkovM, MonroeJI, BoparaiJ, et al. NRG oncology survey on practice and technology use in SRT and SBRT delivery. Front Oncol. 2020;10:602607.

[14] SongCW, Glatstein E, MarksLB, et al. Biological principles of stereotactic body radiation therapy (SBRT) and stereotactic radiation surgery (SRS): indirect cell death. IJROBP. 2021;110(1):21–34.

[15] ParkHJ, Griffin RJ, HuiS, LevittSH, SongCW. Radiation-induced vascular damage in tumors: implications of vascular damage in ablative hypofractionated radiotherapy (SBRT and SRS). Radiat Res. 2012;177(3):311–327.

[16] SolbergTD, BalterJM, BenedictSH, et al. Quality and safety considerations in stereotactic radiosurgery and stereotactic body radiation therapy: Executive summary. Pract Radiat Oncol. 2012;2(1):2–9.

[17] HuangB, YangF, YinM, MoX, ZhongC. A review of multimodal medical image fusion techniques. Comput Math Methods Med. 2020;2020.

[18] BernsteinD, TaylorA, NillS, Oelfke U. New target volume delineation and PTV strategies to further personalise radiotherapy. Phys Med Biol. 2021;66(5):055024.

[19] Quiñones-HinojosaA, McDermottMW. Angled screw holes for anterior posts and a frame-positioning device for gamma knife radiosurgery: allowing for better targeting of intracranial lesions. Neurosurgery. 2007;60(4):339–344.

[20] BennionNR, Malouff T, VermaV, et al. A comparison of clinical and radiologic outcomes between frame-based and frameless stereotactic radiosurgery for brain metastases. Pract Radiat Oncol. 2016;6(6):e283-e290.

[21] CailletV, BoothJT, KeallP. IGRT and motion management during lung SBRT delivery. Physica Med. 2017;44:113–122.

[22] RiouO, LlacerMoscardo C, FenogliettoP, et al. SBRT planning for liver metastases: A focus on immobilization, motion management and planning imaging techniques. Rep Pract Oncol Radiother. 2017;(2):103–110.

[23] MaC-MC. Physics and Dosimetric Principles of SRS and SBRT. Mathews J Cancer Sci. 2019;4(2):1–16.

[24] BentzenSM. Steepness of the radiation dose-response curve for dose-per-fraction escalation keeping the number of fractions fixed. Acta Oncol (Madr). 2005;44(8):825–828.

[25] PatelG, MandalA, ChoudharyS, Mishra R, ShendeR. Plan evaluation indices: a journey of evolution. Rep Pract Oncol Radiother. 2020;25(3):336–344.

[26] BezjakA, et al. Radiation Therapy Oncology Group RTOG 0813 seamless Phase I/II study of stereotactic lung radiotherapy (SBRT) For early stage, centrally located, non‑small cell lung cancer (NSCLC) in medically inoperable patients. Update. 2009.

[27] FreisledererP, Batista V, ÖllersM, et al. ESTRO-ACROP guideline on surface guided radiation therapy. Radiother Oncol. 2022;173:188–196.

[28] LewisBC, SnyderWJ, KimS, KimT. Monitoring frequency of intra-fraction patient motion using the ExacTrac system for LINAC-based SRS treatments. J Appl Clin Med Phys. 2018;19(3):58–63.

[29] HoAK, FuD, CotrutzC, et al. A study of the accuracy of cyberknife spinal radiosurgery using skeletal structure tracking. Operative Neurosurg. 2007;60(suppl_2):ONS-147-ONS-156.

[30] ScherN, BolletM, BouilholG, et al. Safety and efficacy of fiducial marker implantation for robotic stereotactic body radiation therapy with fiducial tracking. Radiat Oncol. 2019;14(1):1–8.

[31] YamazakiH, OgitaM, HimeiK, et al. Reirradiation using robotic image-guided stereotactic radiotherapy of recurrent head and neck cancer. J Radiat Res (Tokyo). 2016;57(3):288–293.

[32] LartigauEF, TreschE, ThariatJ, et al. Multi institutional phase II study of concomitant stereotactic reirradiation and cetuximab for recurrent head and neck cancer. Radiother Oncol. 2013;109(2):281–285.

[33] BaligaS, Kabarriti R, OhriN, et al. Stereotactic body radiotherapy for recurrent head and neck cancer: a critical review. Head Neck. 2017;39(3):595–601.

[34] IqbalMS, WestN, RichmondN, et al. A systematic review and practical considerations of stereotactic body radiotherapy in the treatment of head and neck cancer. Br J Radiol. 2021;94(1117):20200332.

[35] CombsSE, Baumert BG, BendszusM, et al. ESTRO ACROP guideline for target volume delineation of skull base tumors. Radiother Oncol. 2021;156:80–94.

[36] BrunnerTB, Haustermans K, HuguetF, et al. ESTRO ACROP guidelines for target volume definition in pancreatic cancer. Radiother Oncol. 2021;154:60–69.

[37] SperdutoW, Oyekunle T, NiedzwieckiD, et al. Toxicity and Dosimetric Parameters of Ablative Radiation Therapy in the Management of Patients with Child-Pugh B/C Liver Function and Unresectable Hepatocellular Carcinoma (HCC). Int J Radiat Oncol Biol Phys. 2021;111(3):e78.

[38] HuY, ZhaoC, JiR, et al. The role of stereotactic body radiotherapy in hepatocellular carcinoma: guidelines and evidences. J Natl Cancer Cent. 2022.

[39] TimmermanRD, HuC, MichalskiJ, et al. Long-term results of RTOG 0236: a phase II trial of stereotactic body radiation therapy (SBRT) in the treatment of patients with medically inoperable stage I non-small cell lung cancer. Int J Radiat Oncol Biol Phys. 2014;90(1):S30.

[40] ShampSJ, SheikhS, ChangT, et al. Stereotactic body radiotherapy (SBRT) for T2N0 (>3 cm) non-small cell lung cancer: outcomes and failure patterns. J Radiosurg SBRT. 2021;7(4):271.

[41] VasudevanHN, Raleigh DR, JohnsonJ, et al. Management of chordoma and chondrosarcoma with fractionated stereotactic radiotherapy. Front Sur. 2017;4:35.

[42] BaligaS, MatsuiJK, KlamerB, et al. Clinical Outcomes and Efficacy of Stereotactic Body Radiation Therapy in Metastatic Pediatric Solid Tumors. Int J Radiat Oncol Biol Phys. 2021;111(3):e179-e180.

[43] BaligaS, MatsuiJ, KlamerB, et al. Clinical outcomes and efficacy of stereotactic body radiation therapy in children, adolescents, and young adults with metastatic solid tumors. Br J Radiol. 2022;95(1133):20211088.

[44] LeeC-C, YangH-C, ChenC-J, et al. Gamma Knife surgery for craniopharyngioma: report on a 20-year experience. J Neurosurg. 2014;121(Suppl_2):167–178.

[45] NapieralskaA, BekmanB, BlamekS. Craniopharyngioma in Children and Adults–Does the Age Matter?Int J Radiat Oncol Biol Phys. 2022;114(3):e46-e47.

[46] JacksonWC, SilvaJ, HartmanHE, et al. Stereotactic body radiation therapy for localized prostate cancer: a systematic review and meta-analysis of over 6,000 patients treated on prospective studies. IJROBP. 2019;104(4):778–789.

[47] RühleA, Andratschke N, SivaS, GuckenbergerM. Is there a role for stereotactic radiotherapy in the treatment of renal cell carcinoma?Clin Transl Radiat Oncol. 2019;18:104–112.

[48] ShawE, ScottC, SouhamiL, et al. Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: final report of RTOG protocol 90-05. IJROBP. 2000;47(2):291–298.

[49] MahajanA, AhmedS, McaleerMF, et al. Post-operative stereotactic radiosurgery versus observation for completely resected brain metastases: a single-centre, randomised, controlled, phase 3 trial. Lancet Oncol. 2017;18(8):1040–1048.

[50] TerakedisBE, JensenRL, BoucherK, Shrieve DC. Tumor control and incidence of radiation necrosis after reirradiation with stereotactic radiosurgery for brain metastases. J Radiosurg SBRT. 2014;3(1):21.

[51] SoltysSG, GrimmJ, MilanoMT, et al. Stereotactic body radiation therapy for spinal metastases: tumor control probability analyses and recommended reporting standards. IJROBP. 2021;110(1):112–123.

[52] SolimanH, Ringash J, JiangH, et al. Phase II trial of palliative radiotherapy for hepatocellular carcinoma and liver metastases. J Clin Oncol. 2013;31(31):3980–3986.

[53] BydderS, SpryNa, ChristieD, et al. A prospective trial of short-fractionation radiotherapy for the palliation of liver metastases. Australas Radiol. 2003;47(3):284–288.

[54] GutiérrezE, Sánchez I, DíazO, et al. Current evidence for stereotactic body radiotherapy in lung metastases. Curr Oncol. 2021;28(4):2560–2578.

[55] IlyasA, ChenC-J, AbecassisIJ, et al. Stereotactic Radiosurgery for A Randomized Trial of Unruptured Brain Arteriovenous Malformations-Eligible Patients: A Meta-Analysis. Neurosurgery. 2022;91(5):684–692.

[56] OngV, Bourcier AJ, FlorenceTJ, et al. Stereotactic Radiosurgery for Glomus Jugulare Tumors: Systematic Review and Meta-Analysis. World Neurosurg. 2022.

[57] SahyouniR, Mahboubi H, MoshtaghiO, et al. Radiosurgery of glomus tumors of temporal bone: a meta-analysis. Otol Neurotol. 2018;39(4):488–493.

[58] KotechaR, SahgalA, RubensM, et al. Stereotactic radiosurgery for non-functioning pituitary adenomas: meta-analysis and International Stereotactic Radiosurgery Society practice opinion. Neuro-oncol. 2020;22(3):318–332.

[59] PokhrelD, SoodS, McclintonC, et al. Linac-based stereotactic radiosurgery (SRS) in the treatment of refractory trigeminal neuralgia: detailed description of SRS procedure and reported clinical outcomes. J Appl Clin Med Phys. 2017;18(2):136–143.

[60] NarayanasamyG, Morrill S, CousinsD, et al. Radiosurgery for mesial temporal lobe epilepsy following ROSE trial guidelines—A planning comparison between Gamma Knife, Eclipse, and Brainlab. J Appl Clin Med Phys. 2019;20(10):134–141.

[61] GrimmJ, MarksLB, JacksonA, Kavanagh BD, XueJ, YorkeE. High dose per fraction, hypofractionated treatment effects in the clinic (HyTEC): an overview. Int J Radiat Oncol Biol Phys. 2021;110(1):1–10.

[62] Moreno-JiménezS, Álvarez-Guevara D, Moscardini-MartelliJ, et al. A Survey on Prophylactic Corticosteroids Use in Stereotactic Radiosurgery Treatments From Ibero and Latin America Centers. Cureus. 2023;15(1):e34060.

[63] SawlaniV, DaviesN, PatelM, et al. Evaluation of response to stereotactic radiosurgery in brain metastases using multiparametric magnetic resonance imaging and a review of the literature. Clin Oncol. 2019;31(1):41–49.

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