Establishing a National SABR Service: A Model for Safe and Effective Clinical Implementation

Following the successful completion of a registry-based evaluation study of patients with extracranial oligometastatic disease or hepatocellular carcinoma treated with stereotactic ablative body radiotherapy (SABR), National Health Service (NHS) England and NHS Improvement funded an implementation and expansion programme in 2020 to increase SABR provision to 51 radiotherapy centres. This report details the integration of structured mentoring and radiotherapy quality assurance (RT QA) as core components for a safe and effective national SABR implementation programme.

Six members of the UK SABR Consortium developed a framework for effective mentoring that experienced SABR centres could follow to mentor those with limited or no experience. In parallel, the National Radiotherapy Trials Quality Assurance Group delivered an accreditation programme for completion by those centres comprising a facility questionnaire, contouring and planning benchmarks, end-to-end dosimetry audit and individual case review.

Sixteen experienced centres mentored thirty-three new SABR sites, covering a range of techniques and equipment. A large multidisciplinary team of 25 individuals, consisting of clinical oncologists, medical physicists and therapeutic radiographers developed and delivered the RT QA programme. As of April 2025, all centres are accredited for lung, bone and nodes; the programme for the remaining anatomical sites is ongoing. Nearly 24,000 patients have been treated since the NHSE 2020 programme commenced.

This is the first nationally funded programme demonstrating how structured mentorship and RT QA have been beneficial in the safe, effective and timely implementation of SABR services in England. The programme, developed through a multi-professional inter-group collaboration of SABR experts, ensured that radiotherapy centres were trained and supported to deliver consistent, high-quality SABR.