This information brief is in response to a request from the Direction québécoise de cancérologie to evaluate the efficacy and efficiency of stereotactic body radiation therapy for the management of lung, abdominal and pelvic cancers. This highly conformal and precise, hypofractionated external-beam radiotherapy method, which is guided by imaging in order to follow the movements of the tumour in real time, consists in irradiating an extracranial target using a radical dose whose efficacy is biologically equivalent to conventional doses.
Most of the indications for SBRT are supported by low-level clinical evidence, usually noncontrolled with another treatment option.
The cost of SBRT treatment compares with that of 3D conformal radiotherapy and that of intensity-modulation radiotherapy using hypofractionated or conventional irradiation, according to the Belgian and Australian cost studies. Although the number of treatment sessions is lower, higher fractionated radiation doses make the administration of this treatment more complex.
In conclusion, the introduction of SBRT at radiotherapy facilities should be limited to the indications selected on the basis of the available SBRT efficacy and safety evidence according to the patient’s needs and the technology’s efficiency be used in clinical trials involving indications for which the efficacy and safety have not yet been sufficiently demonstrated, such as prostate cancer; be included in a comprehensive oncology quality assurance program; be avoided in units that treat fewer than 25 patients a year with this method. This standard should be validated for Québec; be centralized at university hospitals; be accessible for patients from facilities that do not have the necessary equipment.