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Lung SBRT guideline 2017.pdf
Current Oncology (2017)
  • Conrad B. Falkson
  • E Vella
  • Edward Yu
  • M El-Mallah
  • R Mackenzie
  • P Ellis
  • Y Ung
Objectives For this guideline, we investigated the effectiveness of radiotherapy with curative intent in medically
inoperable patients with early-stage non-small-cell lung cancer (nsclc).
Methods The guideline was developed by Cancer Care Ontario’s Program in Evidence-Based Care and by the
Lung Cancer Disease Site Group through a systematic review of mainly retrospective studies, expert consensus, and
formal internal and external reviews.
■■ Stereotactic body radiation therapy (sbrt) with curative intent is an option that should be considered for patients
with early-stage, node-negative, medically inoperable nsclc.
Qualifying Statements
■■ Because of the high dose per fraction, the planning process and treatment delivery for sbrt require the
use of advanced technology to maintain an appropriate level of safety. Consistent patient positioning and
4-dimensional analysis of tumour and critical structure motion during simulation and treatment delivery
are essential.
■■ Preliminary results for proton-beam therapy have been promising, but the technique requires further
clinical study.
■■ Recommended fractionation schemes for sbrt should result in a biologically effective dose of 100 or greater by
the linear quadric model, choosing an α/β value of 10 [bed10(LQ) ≥ 100].
Qualifying Statements
■■ Because of the increased risk of treatment-related adverse events associated with centrally located tumours,
consideration of tumour size and proximity to critical central structures is required when determining the
dose and fractionation.
■■ Examples of dose–fractionation schemes used in the included studies have been provided.
■■ Based on the current evidence and the opinion of the authors, radiation doses at bed10(LQ) greater than 146
might significantly increase toxicity and should be avoided.
■■ Determination of the radiation bed by the linear quadratic model has limitations for the extreme hypofractionated
schemes used in sbrt.

  • Key Words Early-stage disease,
  • inoperable tumours,
  • non-small-cell lung cancer,
  • stereotactic body radiation therapy,
  • stereotactic ablative radiation therapy,
  • clinical practice guidelines
Publication Date
Winter February, 2017
Publisher Statement
open access
Citation Information
Conrad B. Falkson, E Vella, Edward Yu, M El-Mallah, et al.. "Lung SBRT guideline 2017.pdf" Current Oncology Vol. 24 Iss. 1 (2017) p. e44 - e49
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