Current status of stereotactic ablative body radiotherapy in the UK: six years of progress

Abstract

Objective: To update the 2012 UK stereotacticablative radiotherapy (SABR) Consortium survey and assess the development of SABR services across the UK over the past 6 years. Use the results to share practice and continue to drive forward technique development, aid standardization and by highlighting issues, improve access to SABR services and trials across the UK. Methods: In January 2018, an online questionnaire was sent by the UK SABR Consortium to 65 UK radiotherapy institutions covering current service provision and collecting data on immobilization, motion management, scanning protocols, target/OAR delineation, planning, image-guidance, quality assurance and future plans. Results: 50 (77%) institutions responded, 38 ( vs 15 in 2012) indicated they had an active SABR programme with the remaining 12 centres intending to develop a SABR programme Documented changes include the development of Linac delivered SABR to non-lung sites, an increase in centres using abdominal compression (14 vs 2) and the introduction of four-dimensional cone beam CBCT. Current practice is broadly in line with UK SABR Consortium and European guidelines. Conclusion: This 2018 survey shows a welcome increase in SABR provision, surpassing 2012 projections. However, it is clear that the UK SABR program needs to continue to expand to ensure that patients with oligometastatic disease have access and SABR for early stage lung cancer is available in all centres. Updated guidance that addresses variability in target delineation, image guidance and reduces patient specific quality assurance is warranted. Advances in knowledge: Documented progress of UK SABR across all treatment sites over the last six years, barriers to implementation and future plans.

Technical Note: Small field dose correction factors for radiochromic film in lung phantoms

“…41,42,46 Measurements in lung phantoms, particularly of small fields, are becoming increasingly important as more departments attempt to commission or validate treatment planning system calculations for stereotactic ablative radiotherapy treatments of small lung lesions. 21,26,27 Film measurements in lung phantoms should be corrected using values in Tables I--III, as shown in Eq. (1).…”

“…For example, between 2012 and 2018 the number of radiotherapy departments in the UK utilizing lung SBRT increased from 31% to 76 % (with the remaining 24% planning to implement SBRT within 2 yr). 21 In another recent example, 84% of radiotherapy departments in New South Wales, Australia are treating patients with lung SBRT. 22 Lung tumor sizes being treated can be as small as 3 mm in diameter, 23 and advancing imaging techniques and motion management strategies are allowing margins to be reduced, sparing more healthy lung tissue.…”

“…Accurate measurement in lower density materials is becoming increasingly important, due to the increased popularity of stereotactic body radiation therapy (SBRT) of the lung. For example, between 2012 and 2018 the number of radiotherapy departments in the UK utilizing lung SBRT increased from 31% to 76 % (with the remaining 24% planning to implement SBRT within 2 yr) 21 . In another recent example, 84% of radiotherapy departments in New South Wales, Australia are treating patients with lung SBRT 22 .…”

Lung Cancer in the United Kingdom

“…Conventional radiotherapy is associated with inferior outcomes compared with SBRT for peripheral lesions, and limited access to SBRT across the United Kingdom was likely a contributing factor with only approximately 40% of centers offering lung SBRT in 2018. 10 For stage III NSCLC, 60% of patients received only either active palliative treatment or best supportive care. Of the approximate 30% receiving radical-intent treatment, only 18% received multimodality treatment, with sequential chemoradiotherapy being offered approximately twice as often as concurrent.…”

Curative Radiotherapy for Non-small Cell Lung Cancer: Practice Changing and Changing Practice?

“…The paper by Phillips et al [2] reports that the percentage of patients undergoing SABR in England has increased from 64% in 2015 to 73% in 2016. Importantly, the 2018 updated UK SABR Consortium Audit [9] documents an increase in SABR provision, with the number of centres commissioned to deliver SABR rising from 12 in 2012 to 38. However, the 2018 survey also showed that SABR is not currently offered in around 40% of UK radiotherapy centres, a finding that highlights that the concerns raised by Phillips et al [2] from the 2015e2016 data are still present.…”