Stereotactic body radiation therapy for primary and metastatic lung tumors
- Josh H Heinzerling, MD
Josh H Heinzerling, MD
- Radiation Oncologist
- Southeast Radiation Oncology
- Charlotte, North Carolina
- Robert D Timmerman, MD
Robert D Timmerman, MD
- Professor of Radiation Oncology and Neurosurgery
- University of Texas Southwestern
- Section Editors
- James R Jett, MD
James R Jett, MD
- Section Editor — Lung Cancer
- Professor of Medicine Emeritus
- National Jewish Health
- Joseph S Friedberg, MD
Joseph S Friedberg, MD
- Section Editor — Thoracic Surgery
- Charles Reid Edwards Professor of Surgery
- University of Maryland
- Rogerio C Lilenbaum, MD, FACP
Rogerio C Lilenbaum, MD, FACP
- Section Editor — Lung Cancer
- Yale Cancer Center
- Steven E Schild, MD
Steven E Schild, MD
- Section Editor — Radiation Therapy
- Professor of Radiation Oncology
- Mayo Clinic College of Medicine
Stereotactic body radiation therapy (SBRT) is a technique that utilizes precisely targeted radiation to a tumor while minimizing radiation to adjacent normal tissue. This targeting allows treatment of small- or moderate-sized tumors in either a single or limited number of dose fractions. (See "Radiation therapy techniques in cancer treatment".)
Stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) initially were used successfully for intracranial, orbital, and base of skull tumors, as well as benign conditions in which the skull could be used as a reference system. (See "Stereotactic cranial radiosurgery".)
The success of SRS for intracranial indications led to the development of techniques to extend this approach to extracranial targets. Stereotactic radiation therapy for extracranial sites has required significant technical advances including tumor imaging to guide radiation administration, patient immobilization, and conformal radiation delivery techniques.
SBRT has been defined by the American College of Radiology (ACR) and American Society for Radiation Oncology (ASTRO) as the use of very large doses of radiation, defined as >6 Gy/fraction given over few (five or fewer) fractions . SBRT has unique radiobiological characteristics, which can cause dramatic tumor response, leading to the associated term "ablative" radiotherapy.
The rationale for SBRT in treating both primary non-small cell lung cancer (NSCLC) and metastatic lung tumors, specific techniques, and early results with this technique will be reviewed here.
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- TECHNIQUES FOR LUNG TUMORS
- Patient positioning and immobilization
- Image-guided treatment
- Tumor motion control
- Treatment planning
- PRIMARY NSCLC
- Nonsurgical candidates
- SBRT in surgical candidates
- Randomized trials of SBRT versus surgery
- LUNG METASTASES
- Peripheral and apical lesions
- Proximal lesions
- Lung metastases
- SUMMARY AND RECOMMENDATIONS
- Primary non-small cell lung cancer
- Lung metastases