[Stereotactic body radiotherapy. How to better protect normal tissues?]

Area of Science:

• Radiation Oncology
• Medical Physics

Background:

• Stereotactic body radiotherapy (SBRT) use has surged, presenting challenges in normal tissue preservation due to high fraction doses.
• High sensitivity of normal tissues to escalated doses necessitates robust strategies for organ at risk protection.

Purpose of the Study:

• To outline methods for optimizing normal tissue protection in stereotactic body radiotherapy.
• To discuss the role of guidelines, imaging, and advanced techniques in minimizing SBRT-related toxicity.

Main Methods:

• Review of SBRT implementation guidelines, emphasizing rigorous adherence.
• Discussion of dose fractionation, heterogeneity, and ballistics for normal tissue sparing.
• Exploration of advanced techniques including non-coplanarity, target tracking, automatic planning, and adaptive SBRT with MRI guidance.

Main Results:

• Rigorous implementation of SBRT according to guidelines is crucial for normal tissue protection.
• Advanced techniques such as non-coplanar beams, motion management, and automatic planning offer dosimetric improvements.
• Adaptive SBRT, particularly with MRI-guidance, shows promise for further reducing toxicity risks.

Conclusions:

• Optimal normal tissue protection in SBRT hinges on strict adherence to guidelines and careful technique selection.
• Emerging technologies like MRI-guided adaptive SBRT represent a significant advancement in minimizing treatment-related toxicity.