SBRT Radiation Therapy - Stereotactic Body Radiation Therapy

Three sessions controlled 97.6 percent of early lung tumors at three years. SBRT compresses a course of radiotherapy into one to five visits.

The lung result comes from a North American trial in JAMA, in patients too unwell for surgery whose tumors, with older radiotherapy, were controlled in only three or four cases out of ten. Randomized trials have since tested the same approach in the prostate, in the spine and in cancers that have spread to a few sites. Each of those trials also recorded harm. This page reports both. Send us your pathology, your scans and your treatment history, and a radiation oncologist will tell you whether your tumor is one that SBRT suits.

What makes SBRT different from ordinary radiotherapy?

Conventional radiotherapy works by repetition. A dose of about 2 gray is given every weekday for weeks, healthy tissue repairs itself overnight a little better than tumor does, and the difference adds up. SBRT abandons that logic. A single session delivers 7 to 20 gray, enough to destroy whatever receives it (doctors call such a dose ablative), and the protection of healthy tissue comes entirely from geometry. Dose must be confined to the tumor with a margin of a few millimeters and must fall away steeply outside it. A conventional course forgives a few millimeters of error on a given day, because 30 other days average it out. Five sessions do not.

Four technical conditions follow from that, and a unit offering SBRT should be able to describe how it meets each.

1. Rigid, reproducible positioning. A vacuum cushion molded to the body, or a mask for targets near the neck.
2. Control of breathing motion. Lung, liver, pancreas and kidney tumors move by a centimeter or more with each breath. A four-dimensional planning CT records the motion, and treatment is either timed to one phase of breathing, given during a breath-hold, or planned to cover the measured path.
3. Imaging before every session. A cone-beam CT on the treatment machine is matched to the plan and the couch corrected before the beam is switched on. For the prostate, some units implant tiny gold markers beforehand so that the gland itself can be seen.
4. Physics checks on every plan. The plan is delivered to a measuring device and verified before the patient is treated.

What do the trials show?

SBRT has earned its place in early lung cancer, in low and intermediate-risk prostate cancer and in painful spinal deposits. For limited metastatic disease the evidence is promising and still of phase 2 quality.

How is treatment planned for someone traveling to Istanbul?

For a patient from abroad the calendar counts for a great deal, since the whole of an SBRT treatment, from the first consultation to the last session, fits into a stay during which a conventional course of radiotherapy would barely have started.

Days to allow

Planning takes longer than treating. Allow for both.

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SBRT sets no waiting period before flying. You can leave the day after the last session, and you are not radioactive at any point.

• For the remote review, send the pathology report and any molecular results.
• PET-CT, CT and MRI reports with the images, taken within the past six to eight weeks.
• Lung function tests for a lung tumor, PSA history and prostate MRI for the prostate, liver blood tests for the liver.
• A summary of every earlier treatment, above all any radiotherapy, with its doses.
• Your medication list, a note of any pacemaker, and how far you can walk without stopping.

Afterward

1. The same evening. Tiredness, sometimes mild nausea after abdominal treatment. After spinal SBRT, a flare of pain for a day or two that steroids prevent or settle.
2. The first month. Tiredness lifts. After prostate SBRT, urinary frequency and urgency peak in the second week and ease over a month or two.
3. Three months. The first scan, done at home. After lung SBRT the treated area scars, and the scar can look alarming on CT to a radiologist who does not know SBRT was given. Send the treatment summary with every scan request.
4. Six months and beyond. Scans at intervals set by your own oncologist, who should also watch for the late effects that, where they occur, appear in this period.

What are the risks, and does the machine matter?

Side effects of SBRT depend on what lies next to the tumor. During treatment there is little to notice. What counts arrives weeks or months later, in the organ that sat closest to the high dose, and the rows below give the pattern for each of the common sites along with the patients in whom the risk runs higher than average.

What decides the cost?

Hospitals quote SBRT per treated site, and the session count changes the figure less than patients expect, because most of the work lies in planning. Lesions multiply it. Each additional one needs its own contours, plan and checks, and motion management adds a four-dimensional scan and longer sessions. PET-CT or MRI repeated for planning, gold markers and their placement under ultrasound, and a rectal spacer for prostate patients are separate items where they are used, and any drug treatment given alongside belongs to medical oncology and is quoted by that department. Hotel costs come to a fraction of what a conventional course demands, and for many families that saving, three weeks of accommodation in place of eight or nine, decides the matter. Your own history moves the quote too. Earlier radiotherapy nearby, a pacemaker, poor lung function or liver disease all add assessments before anyone will sign off a plan.

Packages published in Turkey for stereotactic treatment cover three to five sessions with consultation, planning images, the sessions themselves, a follow-up consultation and transfers, and they describe a stay of eight to ten days in the country. Treat that stay as a minimum. Compare quotes on the number of lesions covered, whether imaging before every session is included, and whether the treatment summary with organ doses is issued in English.

Your own figure follows the free review of your file.

What about language, companions and follow-up at home?

One coordinator from the international patients team is assigned from your first message and stays on your case. The team works in English, Arabic, French, Russian, Serbian, Romanian and Spanish and arranges interpreting in other languages on request, and an interpreter attends the consultation and consent. An invitation letter naming the hospital and the treating doctor is sent about ten days before travel, and the international patients office arranges the airport transfer, the hotel for you and a companion, and the rides to each session. SBRT needs no admission. Should you be admitted for any other reason, the room has a companion bed. Halal, vegetarian and diabetic meals are available. A prayer room is on site. A request for a female doctor is passed to the department and met wherever the rota allows. Surgery, chemotherapy and radiotherapy share one site, so a change of plan at the tumor board does not mean a change of hospital.

Back home, the coordinator stays reachable on the same WhatsApp number. Send your scans there for the treating oncologist to see.

See a doctor locally the same day for coughing up blood, new breathlessness or fever after lung treatment, for inability to pass urine after prostate treatment, for new leg weakness or loss of bladder control after spinal treatment, and for black stools or vomiting blood after abdominal treatment.

SBRT FAQ