Stereotactic ablative radiotherapy for lung cancer

Stereotactic ablative radiotherapy (SABR), which is also referred to as stereotactic body radiotherapy (SBRT), is defined as “the precise irradiation of an image defined extra-cranial lesion associated with the use of high radiation dose in a small number of fractions”. SABR is a relatively recent advance in the treatment of small peripheral non-small cell lung tumours. The concept of SABR was originally proposed in the early 1990s by the Karolinska Institute in Stockholm, and the underlying principles are those of intracranial radiosurgery, applied in an extra-cranial site.

Conventional radiotherapy for lung cancer usually involves 20 to 30 daily radiotherapy fractions, each delivering a dose of around 2 to 2.75Gy. Such a dose is designed to try to kill tumour cells without causing excessive damage to the surrounding normal cells of the lung and mediastinum. Unfortunately, because of the need to respect the surrounding normal tissues, the dose received by the tumour is insufficient to cure the vast majority of cases. In fact, a standard dose of 60Gy in 30 fractions is predicted to only control about 30% of lung cancers at three years.

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