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  • Review Article
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Stereotactic body radiotherapy treatment of extracranial metastases

Nature Reviews Clinical Oncology volume 9, pages 654–665 (2012)Cite this article

Subjects

Abstract

Radiotherapy is an integral treatment for patients with metastatic cancer, although it is usually reserved for palliation of pain, dyspnoea, oedema, bleeding and neurological symptoms. However, the administration of high-precision radiotherapy, termed stereotactic body radiotherapy (SBRT), has the potential to significantly affect the disease course for some patients with metastatic cancer by delivering high doses of radiation to the secondary tumours with limited high-dose delivery to adjacent healthy tissues. Indeed, such accurate delivery has been firmly established as a therapy for medically inoperable early-stage non-small-cell lung cancer. To date, the technique has demonstrated improvements in controlling metastasis and, in some cases, improved palliation compared with conventionally fractionated radiotherapy. Active areas of research in SBRT include patient selection for curative intent, optimization of SBRT planning techniques, dosing schema and integration of SBRT into systemic therapies. Given the improvements in cytotoxic and targeted therapies over the past decade, studies testing the careful integration of SBRT into standard systemic therapy regimens are needed. Further investigations are also needed to understand the basic biological mechanisms underlying SBRT because they are likely to be different to those mechanisms in conventional radiotherapy.

Key Points

  • Patients with advanced-stage cancer with limited metastases have been shown to benefit from metastasis-directed therapy, usually in the form of surgery

  • For patients with limited metastases that are not resectable or for patients who are not medically fit for surgery, alternative metastasis-directed therapies are needed because standard systemic therapies are rarely curative

  • Stereotactic body radiotherapy (SBRT), in which one or a few high radiation doses are delivered to a very tightly focused region encompassing a tumour, might offer such an alternative

  • SBRT can result in high rates of treated-metastasis control for patients with limited pulmonary, hepatic, adrenal, spinal and multiple-organ metastases

  • SBRT also results in favourable outcomes for patients with metastases from non-small-cell lung cancer, breast cancer, sarcoma, renal cell carcinoma and melanoma

  • Further research is needed to integrate SBRT into the standard treatment paradigms for patients with limited metastatic cancer

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Figure 1
Figure 2: Treatment plans for extracranial SRS/SBRT for spinal metastases.
Figure 3: Treatment plans for extracranial SRS/SBRT for an adrenal metastasis.
Figure 4: Treatment plans for extracranial SRS/SBRT for multiple pulmonary metastases.
Figure 5: Modern SBRT target localization via CT-image-based alignment of patients using stereotactic body frame.
Figure 6: SBRT for large volume metastases.

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Authors and Affiliations

  1. Department of Radiation Oncology, Box 3085, Duke Cancer Institute, Durham, 27710, NC, USA

    Joseph K. Salama, John P. Kirkpatrick & Fang-Fang Yin

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  1. Joseph K. Salama
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  2. John P. Kirkpatrick
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  3. Fang-Fang Yin
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All authors researched the data for the Review, contributed to the discussion of its content, wrote and edited the manuscript before submission.

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Correspondence to Fang-Fang Yin.

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Salama, J., Kirkpatrick, J. & Yin, FF. Stereotactic body radiotherapy treatment of extracranial metastases. Nat Rev Clin Oncol 9, 654–665 (2012). https://doi.org/10.1038/nrclinonc.2012.166

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