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Stereotactic radiation surgery and stereotactic body radiation therapy
Stereotactic radiation surgery/ Stereotactic body radiation therapy (SRS/ SBRT) were first reviewed by the HTCC in 2012.
In 2017, a review of SRS/ SBRT medical literature was performed to determine if evidence published since the 2012 review was likely to change the original decision.
There is increasing use of SRS/ SBRT for a variety of cancers. The impact of this technology on patient-important outcomes compared to current conventional (coronal or standard) EBRT is unclear.
Primary criteria ranking
- Safety = Medium
- Efficacy = High
- Cost = High
Documents (2017 Update literature search)
Documents (2010 assessment)
- Draft key questions: Comment and response
- Final key questions - Updated
- Final evidence report
- Appendix B: Excluded references
- Appendix E: Summary of findings table by malignancy
- Appendix J: Peer review comments and disposition
- Appendix K: Public comments and disposition - Key questions
- Appendix L: Public comments and disposition - Draft report
- Final findings and decision
- Updated key questions published: June 18, 2012
- Updated public comment period: June 18 - July 2, 2012
- Draft report published: August 31, 2012
- Public comment period: August 31 - October 1, 2012
- Final report published: October 15, 2012
- HTCC public meeting: November 16, 2012
Current conventional or standard EBRT uses three-dimensional (3D) imaging technology from computed tomography (CT), positron-emission tomography (PET), and/or magnetic resonance imaging (MRI) for planning purposes and delivers photon beams of uniform intensity to the target tumor using a medical linear accelerator (linac). Conformal refers to the ability to precisely conform the delivery of the EBRT to the shape and size of the tumor, so current conventional EBRT is often referred to as 3D conformal radiation therapy (3DCRT).
Over the past ten years, significant advances have been made in the techniques available to deliver EBRT including stereotactic radiation surgery (SRS) limited to the central nervous system and a single dose, stereotactic body radiation therapy (SBRT), intensity modulated radiation therapy (IMRT), and proton or particle beam radiation therapy. For SRS and SBRT, the technical goals are to 1) improve the targeting of the radiation to the tumor to minimize damage of normal tissue and 2) increase the dose of radiation (fraction) delivered to improve outcomes and decrease the number of fractions (doses) and length of treatment. The patient-important outcomes of SRS and SBRT include: 1) improved survival in patients with inoperable cancer due to the location of the tumor or patient condition, 2) reduced acute and chronic radiation side-effects, and 3) improved convenience for patients since the course of treatment may be substantially shorter.
The focus of this report will be on SRS and SBRT. However, it should be noted that SBRT and IMRT are not mutually exclusive.