Stereotactic Body Radiation Therapy (SBRT) or Alternative Fractionation Schedules
The use of hypofractionated regimens for the treatment of tumors with radiation has come full circle. After the discovery of X-rays and their utilization for cancer treatment, the initial fractionation schemes were primarily hypofractionated in nature. Ho
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Stereotactic Body Radiation Therapy (SBRT) or Alternative Fractionation Schedules Aaron M. Laine, Zabi Wardak, Michael R. Folkert, and Robert D. Timmerman
Abstract The use of hypofractionated regimens for the treatment of tumors with radiation has come full circle. After the discovery of X-rays and their utilization for cancer treatment, the initial fractionation schemes were primarily hypofractionated in nature. However, due to technical limitations and associated toxicities, more protracted fractionated regimens eventually became the foundation for modern radiation therapy. With the advance of imaging and radiation delivery systems, interest in more hypofractionated approaches was revived. Stereotactic ablative radiation therapy (SABR; also referred as stereotactic body radiation therapy, SBRT) is the most abbreviated form of hypofractionation, typically utilizing 1–5 fractions for treatment. Its strengths include high rates of tumor control via a convenient, noninvasive outpatient procedure. Toxicities related to high, ablative radiation doses still are a potential concern; however, recent clinical trials for a variety of tumor sites have shown good outcomes in properly selected patients. This chapter will discuss the potential for SBRT/SABR to improve the therapeutic response. The use of SBRT/SABR regimens to treat lesions within the lung, liver, spine, and prostate will be reviewed. Due to more mature data in regard to the safety and efficacy, costeffectiveness of the treatment, and potential for immunomodulatory effects, SBRT/ SABR has become more wildly utilized in cancer treatment.
A.M. Laine • Z. Wardak • M.R. Folkert Department of Radiation Oncology, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75235, USA e-mail: [email protected]; [email protected]; [email protected] R.D. Timmerman (*) Department of Radiation Oncology, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75235, USA Departments of Radiation Oncology and Neurological Surgery, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75235, USA e-mail: [email protected] © Springer International Publishing Switzerland 2017 P.J. Tofilon, K. Camphausen (eds.), Increasing the Therapeutic Ratio of Radiotherapy, Cancer Drug Discovery and Development, DOI 10.1007/978-3-319-40854-5_8
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Keywords Stereotactic radiation • Stereotactic ablative therapy • SABR • SBRT • Therapeutic ratio • Lung radiation • Liver radiation • Spine radiation • Prostate radiation
Stereotactic Body Radiation Therapy (SBRT) or Stereotactic Ablative Body Radiosurgery (SABR) Introduction After the discovery of X-rays in 1895 and radioactivity in 1896, initial radiation cancer treatments were mostly hypofractionated. Treatments were limited in giving higher doses to the skin and superficial structures than to a deeper tumor target. Quality
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