Table Of ContentRajni A. Sethi · Igor J. Barani
David A. Larson · Mack Roach, III
Editors
Handbook of
Evidence-Based
Stereotactic
Radiosurgery and
Stereotactic Body
Radiotherapy
123
Handbook of Evidence-Based
Stereotactic Radiosurgery
and Stereotactic Body
Radiotherapy
Rajni A. Sethi (cid:129) Igor J. Barani
David A. Larson (cid:129) Mack Roach, III
Editors
Handbook of
Evidence- Based
Stereotactic
Radiosurgery
and Stereotactic Body
Radiotherapy
Editors
Rajni A. Sethi, MD Igor J. Barani, MD
Department of Radiation Departments of Radiation
Oncology Oncology and Neurological
University of California, Surgery
San Francisco University of California,
San Francisco , CA , USA San Francisco
San Francisco , CA , USA
David A. Larson, MD, PhD
Departments of Radiation Mack Roach, III, MD
Oncology and Neurological Department of Radiation
Surgery Oncology and Urology
University of California, U niversity of California,
San Francisco San Francisco
San Francisco , CA , USA San Francisco , CA , USA
ISBN 978-3-319-21896-0 ISBN 978-3-319-21897-7 (eBook)
DOI 10.1007/978-3-319-21897-7
Library of Congress Control Number: 2015945109
Springer Cham Heidelberg New York Dordrecht London
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Pref ace
Over the past decade, technical advancements in radiother-
apy such as image guidance, highly modulated beams,
improved patient immobilization, tumor tracking systems,
beam gating, and complex treatment planning systems have
enabled practitioners to accurately and precisely deliver
highly conformal, large doses of radiation. As these tech-
nologies are more widely adopted worldwide, extreme hypo-
fractionated and single fraction regimens using stereotactic
radiosurgery (SRS) and stereotactic body radiotherapy
(SBRT) are becoming more common. We developed this
handbook in order to concisely summarize the state of the
art including: (1) history of SRS and SBRT; (2) the biologic
rationale; (3) typical practices; and (4) the reported results.
In doing so, we hope that practitioners might be more aware
of what has been published and what might be expected
were they to similarly treat patients. However, we cannot
and do not vouch for the safety of any of treatment practices
reported. First, the follow-up in many cases is relatively
short. Second, as with any recipe, there may be details or
ingredients left out that may critically impact the results. In
all cases clinical judgment is required, particularly in cases
when dose- limiting structures are put at risk when adjacent
to very high doses of radiation.
W hile several textbooks focus on SRS and SBRT, we spe-
cifically wanted to create a practical handbook on these tech-
niques that could be referenced easily in the clinic. This
handbook can inform decisions regarding the a ppropriateness
v
vi Preface
of SRS or SBRT, guide treatment technique, and summarize
expected outcomes and toxicity.
W e have developed the Handbook of Evidence-Based
Stereotactic Radiosurgery and Stereotactic Body Radiotherapy
as a companion book to our institution’s prior publication,
Handbook of Evidence-Based Radiation Oncology . As such,
we have attempted not to replicate information between the
two books. General information on anatomy, staging, work-
up, and follow-up for each disease site can be referenced in
the latter. The current handbook focuses on specific uses of
SRS and SBRT, with chapters organized by disease site. We
include a description of treatment techniques and recom-
mended imaging. We also specifically address safety and
quality assurance issues, which are especially important with
extreme hypofractionation. In each chapter, we discuss toxic-
ity and management issues specific to SBRT. We have also
included chapters on the historical development of SRS and
SBRT, biologic rationale for these techniques, and treatment
delivery systems. Finally, in the appendix, we include a sum-
mary of normal tissue dose tolerances.
In order to maintain the nature of this publication as a
handbook, we limited the amount of information included in
each chapter. We encourage you to refer to original publica-
tions as listed in the reference section for more detailed infor-
mation on clinical protocols and previously published data.
I n many cases the contents of this book reflect the treat-
ment approach at the University of California at San
Francisco. We are privileged to employ a broad range of
treatment machines and expertise that enables the use of
SRS and SBRT in many settings. This book is meant to sum-
marize our own experience and that of our colleagues who
have reported separately in peer-reviewed journals and at
national and international meetings. Individual practitioners
must use their own clinical judgment and knowledge to guide
use of SRS and SBRT in their own practice. Specifically, we
caution against use of these highly skilled techniques in insti-
tutions without prior training or expertise.
Preface vii
We want to sincerely thank the contributing authors for
the excellent chapters they have produced. We also wanted to
specifically thank Keith Sharee for his stalwart and enthusi-
astic editorial review and for managing all of the references
and abbreviations. This handbook would not have been pos-
sible without their hours of hard work and dedication. We
want to acknowledge the pioneers in our field who have built
the body of work that we are presenting here today and
whose ingenuity and drive continues to move our field ahead
with the constant goal of improving outcomes for our
patients. And finally, we want to thank our patients, whose
courage continues to inspire us every day.
San Francisco, CA, USA Rajni A. Sethi, MD
Igor J. Barani, MD
David A. Larson, MD, PhD
Mack Roach, III, MD
Abbreviations
AAPM American Association of Physicists in Medicine
ABC Active breathing control
ACTH Adrenocorticotropic hormone
ADT Androgen deprivation therapy
AFP Alpha-fetoprotein (α-fetoprotein)
AMA American Medical Association
AP/PA Anteroposterior/posteroanterior
ASTRO American Society for Radiation Oncology
ATM Ataxia telangiectasia mutated
ATR ATM-Rad3-related
AVM Arterio-venous malformation
BED Biologically effective dose
bPFS Biochemical progression-free survival
BPL Batho power-law correction
BRCA Breast cancer risk genes BRCA1 and BRCA2
BUN Blood urea nitrogen
CAD Coronary artery disease
CBC Complete blood count
CBCT Cone beam computed tomography
CEA Carcinoembryonic antigen
CGE Cobalt gray equivalent
CHF Congestive heart failure
CK CyberKnife
Cm Centimeter
CMP Comprehensive metabolic panel
CMS Centers for Medicare and Medicaid Services
CN Cranial nerve
CNS Central nervous system
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