Is SBRT Ready for Widespread Use in Cancer Treatment

Stereotactic Body Radiation Therapy: Is It Ready For Primetime? Joseph Herman MD, MSc Department of Radiation Oncology

SBRT Overview ,[object Object],[object Object],[object Object],[object Object]

Radiation Delivery ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Radiation: Fractionation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Treatment Planning Liver Planning Target Volume Target Volumes

Target Volumes Gross Tumor Volume Planning Target Volume

Pre-radiation 6 months post-radiation Radiographic Response

Survival as a Function of Dose Dawson et. al., J Clin. Onc . 18:2210, 2000 ; Ben-Josef et al 2006 Time (years)

IMRT Plan to Deliver High Dose to Potential Resection Margin Vineberg and Ten Haken, 2004

Eliminating Organ Motion and Set-up Error ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Image Alignment: AP Radiographs Reference Image Treatment Image Hepatic microcoil

Active Breathing Control Mouthpiece and filter Flow sensor Valve (air bladder) ,[object Object]

Breath Hold at Normal Exhale Pressure Volume Flow Valve closed, Breath held Valve open

Synchrony ™ camera Treatment couch Linear accelerator Manipulator Image detectors X-ray sources Targeting System Robotic Delivery System Cyberknife

Patient Setup ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Photo courtesy of Naples Community Hospital

CyberKnife ® Conformality ,[object Object],[object Object],[object Object]

SRS Axial View GTV 60% 50% Koong et al. Stanford; IJROBP 2004

SRS Coronal View GTV 60% 50% Koong et al. Stanford; IJROBP 2004

SRS Toxicity ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Results of a phase I dose-escalation study using single-fraction stereotactic radiotherapy for lung tumors. Le et al. 2006 (Stanford) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

SRS: Questions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Is SBRT Ready for Widespread Use in Cancer Treatment

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