Radiosurgery scope of practice in Canada: A report of the Canadian association of radiation oncology (CARO) radiosurgery advisory committee

A Phase II Multi-institutional Clinical Trial Assessing Fractionated Simultaneous In-Field Boost Radiotherapy for Brain Oligometastases

“…Given the current lack of a randomized phase III trial evaluating this form of treatment versus SRS, it is unlikely that this trial will shift clinical practice in centers with SRS clinical programs. However, from a broader perspective, SRS programs do not exist at all radiation treatment centers due to the specialized nature of this treatment requiring significant programmatic resources [21][22]. This clinical trial has demonstrated that an image-guided fSRT approach using suitable immobilization and highly conformal treatment delivery is associated with clinical outcomes comparable to those achieved with traditional radiosurgery approaches.…”

Technology Resource Planning in Radiation Oncology: Application of a Needs-Based Analytic Framework to Radiosurgery Planning in Ontario

“…4,10 At the Juravinski Cancer Centre in 2011, 67% of patients treated with radiosurgery had brain metastases. 10 The clearest evidence-based indication for radiosurgery is in the management of a single brain metastasis, 2,3 and we therefore focus the remainder of this discussion on resource planning for single brain metastases.…”

“…18 It has been hypothesized that a decrease in cancer-specific mortality, improvements in systemic therapy, and the relative protection of the brain from systemic therapy are responsible for the rising incidence of brain metastases. 3,4,18 We therefore hypothesize that the future epidemiologic need for radiosurgery for single brain metastases will increase over time [(H/P) tϩ10 Ͼ (H/P) t ].…”

“…Encouraging clinical trial results have been reported for the primary treatment of early-stage lung cancer, prostate cancer, liver metastases, bone metastases, and a number of benign tumors. 4 There are open clinical trials evaluating new indications for radiosurgery in Ontario as well. [5][6][7] Although the treatment of brain metastases is of palliative intent, aggressive local management with radiosurgery has led to both improved survival and quality of life.…”

“…However, with the publication of clinical efficacy trials, it is now known that selected patients with small lung tumors benefit from radiosurgery. 4 Therefore, whereas 10 years ago the planned amount of radiosurgery administered for small lung tumors was (Q/H) tϪ10 ϭ 0, there are now selected patients with small lung tumors for whom radiosurgery is the treatment of choice (Q/H) t Ͼ 0. The third term in the equation relates to productivity of a treatment modality.…”