Focused Issue of This Month Stereotactic Body Radiation Therapy Mi Sook Kim, MD Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences E mail : mskim@kcch.re.kr J Korean Med Assoc 2008; 51(1): 45-52 Abstract Stereotactic Body Radiation Therapy (SBRT) is extracranial stereotactic radiosurgery or stereotactic radiation therapy, a newly emerging radiotherapy treatment method to deliver a high dose of radiation to the target, utilizing either a single dose or a small number of fractions with a high degree of precision within the body. The ability to deliver a single or a few fractions of high dose ionizing radiation with a high targeting accuracy and rapid dose falloff gradients encompassing tumors with a patient provides the basis for the development of SBRT. A few fractions, the use of fiducial as a marker, image guidance and multiple radiation beam, and gating through a skin marker are unique technologies as compared to the conventional fractionated radiotherapy. The most common sites for these treatments are lung and liver, which are considered to parallel organs at risk. Recently, it was confirmed that prostate, spinal/paraspinal, head and neck, and pancreas tumors could be new candidates for these novel treatments. The preliminary reports show promising results with a relatively low complication rate. This article provides an overview of SBRT, the indication, descriptions of method including radiation dose and fraction size, the clinical data of lung and liver tumor, and discussions on potential areas of future investigations. Keywords : Sterotactic body radiation therapy (SBRT); Radiosurgery; Lung cancer; Hepatic tumor 45
Kim MS (A) (B) Figure 1. Real time tumor tracking system in SBRT using the detector (A) on the ceiling and sensors (B) of the chest wall enables detecting and correcting for tumors that move with respiration. The lung or liver tumor can be treated with smaller irradiated normal volume under the adoption of this system. 46
Stereotactic Body Radiation Therapy Figure 2. In SBRT, internal fiducial markers can be used for more accuracy during SBRT. Gold strict fiducial (A) and flexible helical coil markers (C). The fiducials could be placed in or around tumor under fluoroscopy (B), CT or sono. A B C 47
Kim MS A B C D Figure 3. This is example of a highly conformal plan in SBRT. Red line (A, B, C) represents the target volume. Green lines (D) mean the multi direction of radiation beams. The patient was malignant histiocytoma and treated with 26Gy in 2 fraction (equivalent to 83 Gy > in 2Gy per fraction). At 1 year after completion of SBRT, showing complete response and continued local control at 3 year. 48
Stereotactic Body Radiation Therapy A. Liver Metastasis from Rectal Cancer B. 10 Months after SBRT C. 21 Months after SBRT Figure 4. (A) is PET/CT images for a patient with liver metastasis from rectal cancer. (B) is showing small lesion on CT 10 months after SBRT, which is difficult to distinguish between residual tumor or radiation reaction. PET or PET/CT would be helpful for differential diagnosis. (C) is showing continued complete response on PET at 21 months. 49
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Kim MS Peer Reviewer Commentary 52