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20 2011


IMAGING & ONCOLOGY


This ability to accurately track tumours during respiratory motion solves one of the main challenges of utilising SBRT for lung and abdominal tumours.


New equipment currently being developed provides real time imaging, together with increased flexibility for beam arrangement. This is called the Vero system, which has a gimbals-based mechanism designed to anticipate tumour mobility during treatment.


There is an obvious need for specialisation of staff due to the complex nature of the technique. Each department should establish a stereotactic team, dedicated to stereotactic treatments and associated issues. This would include clinicians, physicists and radiographers and may be appropriate for both extra-cranial and cranial sterotactic treatments. There may also be a requirement for a SRT dedicated linac in each department. This is already happening in the UK with Cyberknife equipment at a number of centres.


A current informal referral system enables patients to have SBRT treatment if thought to be beneficial (even if not offered in their local centre). This might usefully be developed into a centralised national referral system to SBRT centres across the UK, considering the specialisation in different anatomical sites of each hospital.


CONCLUSION Teamwork, national integration and collaboration are fundamental for the implementation of the complex, continuously evolving technique of SBRT.


The provision of SBRT must be a patient focused service with a clear vision to offer all patients the most appropriate treatment for them. This should be equitable across the UK.


SBRT for small NSCLC (non-small cell lung cancer) tumours is increasing local control rate and significantly improving the patient’s quality of life. It seems likely that similar advantages are possible for other tumour sites and therefore we expect a growth in hypofractionated techniques in the UK.


Arguably, if the UK radiotherapy workforce is to be able to meet this challenge, two areas require urgent development: Firstly, additional funding must be provided to support implementation of new technologies, both in terms of quality assurance and data collection. Secondly, specialised teams must be established with the creation of consultant radiographer roles specifically in this area.


Angela Baker is the lead research and SBRT radiographer. Lynda Appleton is a research nurse. Dr Alison Scott is the lead stereotactic physicist. Dr Pooja Jain is a consultant oncologist with special interest in technical radiotherapy for lung cancer. All practice at the Clatterbridge Centre for Oncology. CCO was one of the first UK centres to implement SBRT in lung patients and was a founding member of the UK SBRT consortium.


Acknowledgements We would like to thank the UK SBRT consortium members for their input to this article.


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