Stereotactic Body Radiotherapy (SBRT)

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What is stereotactic body radiotherapy? Stereotactic body radiotherapy (SBRT) is a cancer treatment that delivers extremely precise, very intense doses of radiation to cancer cells while minimizing damage to healthy tissues. Another name for it is “stereotactic ablative radiotherapy” (SABR).   Picture Courtesy: Consultqd How does Stereotactic radiotherapy work? This procedure utilizes many precisely focused radiation […] Read More

Top Doctors For Stereotactic Body Radiotherapy (SBRT) Treatments

Top Hospitals For Stereotactic Body Radiotherapy (SBRT) Treatments

Stereotactic Body Radiotherapy (SBRT)

What is stereotactic body radiotherapy?

Stereotactic body radiotherapy (SBRT) is a cancer treatment that delivers extremely precise, very intense doses of radiation to cancer cells while minimizing damage to healthy tissues. Another name for it is “stereotactic ablative radiotherapy” (SABR).   Stereotactic Body Radiotherapy SBRT Picture Courtesy: Consultqd How does Stereotactic radiotherapy work? This procedure utilizes many precisely focused radiation beams to treat cancers and other issues throughout the body. The beam meets at the tumor. Radiation is given to the tumor and its surrounding tissue at a high dose. Stereotactic body radioactive treatment, also known as “stereotactic ablative radiotherapy,” is only limited to the body. Stereotactic radiotherapy to the brain might be called stereotactic radiosurgery (SRS) and is usually a single treatment. If you have more than one treatment for the brain, this is usually called stereotactic treatment. Stereotactic body radioactive therapy treats tumors in the lungs, spine, liver, neck, lymph node, or other soft tissues. SBRT is not a traditional type of surgery because there is no incision. It uses 3D imaging to target high doses of radiation in the affected area.

What are the benefits of Stereotactic body radiotherapy?

The benefits OF SBRT are: SBRT can be applied in the treatment of very small cancers developing in the
      • Liver
      • Lungs
      • Prostrate
      • Lymph nodes
      • Spinal cord
      • Abdomen
SBRT delivers highly focused high-dose radiation over a short time and directs tumors directly. SBRT can lead to a better outcome with fewer side effects than conventional radiation therapy.

What are the risk factors associated with Stereotactic body radiotherapy?

Risks associated with stereotactic body radiotherapy are: Stereotactic radiotherapy does not involve an incision, so it is generally less risky than traditional surgery. The risk of complications with anesthesia, bleeding, and infections are avoided. Early complications or side effects, if at all evident, are temporary. They may include:
      1. Fatigue and tiredness.
      2. Nausea or vomiting. 
This happens when the radiation tumor is located near the liver or bowel.
      • Swelling.
Swelling at or near treatment sites may cause a temporary increase in pain. Anti-inflammatory medication (corticosteroid medication) may end the symptoms. Late side effects or potential risks, which are usually rare, may include:
      1. Changes in the lungs. 
      2. Weakened bones.
      3. Changes affecting the bowel.
      4. Changes in the spinal cord.
      5. Swollen arms and legs (lymphedema).
      6. Development of new cancer (secondary cancer).
 

How SBRT Works

      • All types of stereotactic radiotherapy and radiosurgery work in a similar manner. The specialized equipment focuses a high radiation dose on tumors or other targets. Each beam has a minor effect on the tissue it passes through, but a targeted dose of radiation is released to the site where all the beams interact.
      • The high dose of radiation delivered to the affected area shrinks the tumors and blood vessels to close off over time following treatment. This, therefore, stops the blood supply to the tumor.
      • There is minimal damage to the healthy surrounding tissues.
What are the steps to prepare for SBRT? Preparing for SBRT Picture Courtesy: researchgate

Preparing for SBRT

While preparing for SBRT, the patient has to get involved in the following steps: Food and Medications.
      • The patient may be asked not to eat or drink anything after midnight or the night before the procedure.
      • The patient should ask the doctor if they can take their regular medications the night before or the morning of the procedure.
Clothing And Personal Items Wear comfortable, loose-fitting clothing, preferably pajamas. Avoid wearing the following items during the SRT of the spinal cord:
      • Jewelry.
      • Contact lenses or eyeglasses. 
      • Dentures. 
      • Makeup, including nail polish.
      • Wigs or hairpieces.
Precautions regarding medications and allergies. Notify the doctor if the patient :
      1. Have any implanted medical devices in the body, such as pacemakers, aneurysm clips, artificial heart valves, stents, or neurostimulators.
      2. Carry any of the current medications to the treatment center.
      3. Consult the doctor regarding the medications on the day of the procedures.

The Stereotactic Body Radiotherapy Techniques 

Stereotactic body radiotherapy is most commonly done on an outpatient basis. Duration: 30 to 60 minutes per session for 1-5 sessions. Specialist: SBRT is performed jointly by Radiation oncologists and medical physicists. The doctor will advise the patient to come with a family member or friend for the treatment.

Before the Procedure

Preparation for SBRT involves several steps, including:
      • Marking. The marking procedure is usually done as an outpatient procedure before SRS treatment. But this step is not needed for most CT-guided technology.
      • Simulation. A radiation oncologist will conduct a simulation. This step ensures the best placement of the body to align it with the radiation beams. An immobilization device will hold the body very tight and still (the patient should inform the doctor if they have claustrophobia). 
The doctor will take an imaging scan. A 4DCT scan will be performed on the patient to capture how the tumor moves when the patient is breathing. The patient may sometimes be asked to hold their breath for 10 to 30 seconds during the treatment to reduce the movement of the tumor. The doctor may send the patient home before the next stage.
      • With imaging scans and specialized soft waves, the treatment team will arrive at the best combination of radiation beams to target the tumor or other abnormalities.

During the Procedure,

      • Children are usually given anesthesia for imaging tests and during radiosurgery. Adults are usually awake and may take a mild sedative to calm anxiety.
      • The LINAC machine, during the treatment, delivers radiation beams from different angles to the target. The treatment takes less than 30 – 60 minutes.
      • SBRT can be described as having an X-ray. During the procedure, the patient will not feel the radiation, and the patient will be able to talk with the doctor through a microphone.

After the Procedure,

      • After the procedure, the doctor will prescribe appropriate medications if the patient complains of any pain or nausea. The patient will be able to eat and drink after the procedure.
      • The patient can return home the same day of the procedure.
      • Patient can resume normal activities within one to two days.

Results

Any medical effect after treatment of SBRT occurs gradually depending on the condition being treated:
      • Benign Tumors (including vestibular schwannoma).
The tumor may shrink over 18 to 24 months, but treating benign tumors aims to prevent their future growth.
      • Malignant Tumors
Cancer does shrink more rapidly, always within a few months. The patient will receive instructions from the doctor on appropriate follow-up examinations to monitor further development.  

FAQ

  • How long does it take for Stereotactic radiation to work?

Although the effect of SRS on tumor tissues can be seen a few weeks after the procedure, it may take up to 2 years to see the effect of SRS on an AVM. When SRS is used to treat an AVM, an angiogram is obtained to improve the accuracy of targeting the lesion’s critical portions. 

 

  • What is the success rate of Stereotactic radiosurgery?

SBRT has shown dramatically better outcomes than conventional radiation therapy. Whereas two-year success rates for conventional treatment range from 30 -40 percent, the success rates of SBRT range from 80 – 90 percent, comparable to those of resection surgery but with far fewer risks. 

 

  • How much does Stereotactic radiation therapy cost? 

The median cost of SBRT was $27,145 compared to $17185 for brachytherapy, $37,090 for IMRT, and $54,706 for proton beam therapy (p<0.001).

 

  • How effective is Stereotactic radiosurgery?

Following Stereotactic radiotherapy, the tumor may shrink over 18 – 24 months, but the main goal of the treatment for benign tumors is to prevent any further tumor growth. Malignant tumors may shrink more rapidly, often within a few months.

 

  • How long does fatigue last after SBRT?

The patient may develop fatigue 4-6 weeks after the treatment. The fatigue can range from mild to severe. It may last for several months after the treatment ends.  

 

  • What are the types of Stereotactic radiosurgery? 

There are two types of stereotactic radiosurgery the doctor uses to deliver radiations. They are:

1. Linear accelerator (LINAC)- LINAC machines use x-rays to treat cancerous and non-cancerous abnormalities in the brain and other body parts.  

Linear accelerator (LINAC)

Picture Courtesy: mayoclinic

 

2. Proton beam (charged particle) is the newest type of stereotactic radiotherapy found in only a few research centers in the USA. It can use fractionated stereotactic radiotherapy to treat body tumors over several sessions. 

Proton beam (charged particle)

Picture Courtesy: Onco.com