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Stereotactic Body Radiotherapy: A Practical Guide by Andrew Gaya, Anand Mahadevan

By Andrew Gaya, Anand Mahadevan

This is a unmarried, accomplished guide for scientific oncology trainees and experts, masking the fundamental elements of stereotactic radiotherapy platforms and treatment.

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1 Introduction As an emerging radiotherapy procedure, SBRT (Stereotactic Body Radiation Therapy) is in rapid development. In the previous decade, various radiotherapy techniques and systems for SBRT have been developed and SBRT has become an increasingly common practice. SBRT’s two major features define the requirements for the systems. First, SBRT aims to reproduce physical and biologic aspects of the successful SRS and SRT (intracranial stereotactic radiosurgery and radiotherapy) experience. Since it delivers large doses in a few fractions, it is critical that the high doses to the target are precise and conformal; meanwhile there must be rapid dose fall off away from target to minimize toxicity to normal tissues and critical organs at risk.

3 Commercially Available Systems By integrating different techniques described in the last section, various systems that can treat both SBRT and SRS/SRT have been developed. Here we briefly list the main systems currently available commercially or currently being developed. 1. Major manufactures of conventional radiation therapy linacs have developed their new products, aiming for a seamless transition from conventional therapy to SBRT: Varian’s latest product for SBRT is the TrueBeam STx. In addition to X-ray imaging, CBCT (cone beam CT) imaging and RPM (Real-Time Position Management TM) gating for respiratory treatment, its new IMR (intra-fraction motion review), or “triggered imaging” system, triggers the low-dose X-ray imager at a specific point in the patient’s respiratory cycle, which enables visual verification that a tumor is being properly targeted (refer to Sect.

4 Radiobiological Rationale and Its Impact on SBRT Techniques The crucial question that arises in SBRT is the rationale for its effectiveness. Taking into account that radiobiology is not an exact science, we cannot answer these questions with absolute certainty. However, convincing heuristic advice is possible and should address speculative doubts about the technique. First it is easy to convince radiation oncologists that 54 Gy in three fractions should be a potentially ablative dose. This statement is sustained by radiobiological modeling.

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