Optimizing immobilization, margins, and imaging for lung stereotactic body radiation therapy

Stereotactic body radiation therapy (SBRT) is defined by the delivery of high doses of radiation over 1–5 treatments to a tumor volume known in 3D coordinates using image-guided conformal treatment plans. This technique was initially adapted from cranial stereotactic radiosurgery (SRS) to the treatment of cT1-2N0 early stage non-small cell lung cancer (ES-NSCLC) in medically inoperable patients (1). The use of SBRT has rapidly gained acceptance in the treatment of medically inoperable patients due to excellent disease control rates (2). More recently, it has also been employed as an alternative to surgical resection in operable patients due to its relative clinical equipoise from randomized trial data (3). It has also been proven an excellently effective treatment for small lesions in patients with oligometastatic disease (4,5)