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 2022, the HCA director selected SBRT for rereview based on newly available published evidence that could change the original coverage decision.

Status: Review in progress

Policy context

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

Assessment (2022)

Update literature search (2022)

Update literature search (2018)

Update literature search (2017)

Assessment (2012)

Assessment timeline TBD

  • Draft key questions published: July 27, 2022
  • Public comment period: July 27 to August 12, 2022
  • Final key questions published: September 21, 2022
  • Draft report published: TBD
  • Public comment period: TBD
  • Final report published: TBD
  • HTCC public meeting: TBD

Background

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.