Abstract
Recently there has been significant research comparing the effectiveness of stereotactic body radiation therapy (SBRT) to alternative treatment modalities. Comparative effectiveness studies within SBRT come from a variety of different data sources including prospective and retrospective series, large database analyses, and cost-effectiveness studies. Studies have largely centered on evaluating stereotactic treatment to the brain, prostate, lung, and liver. As the use of SBRT increases, and as long-term follow-up of patients after SBRT treatment grows, there will continue to be advances in this emerging area of research.
Access provided by Autonomous University of Puebla. Download chapter PDF
Similar content being viewed by others
Introduction
As the use of stereotactic body radiation therapy (SBRT) across multiple disease sites increases over time, there has been a growing area of research comparing the effectiveness of SBRT to alternative treatment modalities. Comparative effectiveness studies within SBRT come from a variety of different data sources including prospective and retrospective series, large database analyses, and cost-effectiveness studies. In this chapter, we will discuss comparative effectiveness studies within SBRT. We will limit our discussion to comparative effectiveness studies evaluating stereotactic treatment to the brain, prostate, lung, and liver. For each disease site, we will include a brief overview of prospective and retrospective series, followed by a discussion of comparative effectiveness studies using large databases, and finally cost-effectiveness studies. Summaries of the selected studies for each disease site are located in the tables throughout the chapter as references.
Brain
Prospective and Retrospective Series
Several prospective clinical trials have been conducted to compare treatment strategies for brain metastases [1, 2]. Initially, whole brain radiotherapy and radiosurgery were combined in several trails. In a phase III trial by Muacevic and colleagues, patients with a solitary brain metastasis were randomized to surgery followed by whole brain radiotherapy or Gamma Knife radiosurgery alone. Local recurrence was similar between both groups, but distant recurrence was experienced more often in the radiosurgery group. This difference was lost after adjusting for the effects of salvage radiosurgery [3]. RTOG 9508 randomized patients to whole brain radiation therapy (WBRT) versus WBRT plus a stereotactic radiosurgery (SRS) boost. On univariate analysis, there was improved median survival in the WBRT + SRS group compared to the WBRT-alone group (MS 6.5 vs. 4.9 months). Multivariate analysis showed improved survival in patients with RPA class I or favorable histology [4]. Gantery and colleagues randomized a total of 60 patients with 1–3 brain metastases to SRS and WBRT, SRS alone, or WBRT alone. Local control was improved in the group who received combined therapy compared to SRS alone or WBRT alone (median local control of 10 vs. 5 vs. 5 months, respectively) [5].
Given the increased cognitive side effects of whole brain radiotherapy, comparative trials were also conducted to eliminate WBRT from treatment of metastatic brain disease. In EORTC 22952–26,001, patients with 1–3 brain metastases who underwent surgery or SRS were randomized to WBRT or observation. The 2-year relapse rate at initial sites and new sites was decreased in the WBRT group compared to the observation group, but overall survival (OS) was similar in both groups (10.9 vs. 10.7 months) [6]. A later publication revealed that health-related quality of life scores were higher in the observation group, including cognitive function at 8 weeks and 12 months [7]. JROSG 99–1 randomized 132 patients with 1–4 brain metastases to SRS and WBRT or SRS alone. Overall survival was similar in both groups, but 12-month brain tumor recurrence was improved in the patients who received WBRT in addition to SRS (46.8% vs. 76.4%). Local tumor control at 12 months was also improved in the patients who received combined therapy (88.7% vs. 72.5%) [8]. Chang and colleagues conducted a trial with similar randomization, but the main outcome was neurocognitive effects. In this study, 58 patients with 1–3 brain metastases were randomized to SRS and WBRT versus SRS alone. However, the trial was stopped early by the data monitoring committee because there was a high probability that patients receiving combined therapy were more likely to show a decline in learning and memory function at 4 months compared to patients who received SRS alone [9].
Sahgal and colleagues conducted an individual patient meta-analysis of phase III trials that evaluated patients with 1–4 brain metastases who were randomized to SRS alone or SRS plus WBRT. A total of 364 patients were included in the analysis from three randomized trials. SRS alone was found to improve survival in patients ≤50 years of age, but local control was improved with the addition of WBRT in all age groups [10].
Surgery and radiosurgery alone have never been directly compared in a randomized trial, as surgery is rarely used alone in the treatment of brain metastases in the modern era. Patchell and colleagues randomized patients with a single brain metastasis who underwent complete surgical resection to whole brain radiation therapy or observation. Local recurrence at the site of metastasis was 46% in the patients who received surgery alone [11]. This does not compare favorably to historical data of SRS alone (12-month local tumor recurrence rate of 27.5% in JROSG 99-1) [8].
A retrospective series by O’Neill and colleagues directly compared surgery and radiosurgery alone. In this study, 74 patients underwent surgical resection, and 23 patients underwent radiosurgery. After a median follow-up of 20 months for living patients, no SRS patients had local recurrence compared to 58% of patients in the surgical group [12].
Given the poor local control of surgery alone, surgery followed by postoperative radiosurgery has been evaluated in prospective single-arm series as well as retrospective studies. Brennan and coworkers conducted a prospective phase II trial that included 39 patients with 40 lesions who received adjuvant SRS to the surgical bed with a median dose of 1800 cGy. At 12 months, local failure was 22% and regional failure outside the treated metastasis was 44% [13]. A retrospective series by Soltys and coworkers examined 72 patients with 76 cavities who received postoperative SRS. Local control was 88% and 70% at 6 and 12 months, respectively [12, 14].
The question of radiosurgery alone versus surgery combined with radiosurgery was addressed in a retrospective series by Prabhu and coworkers that examined patients with large brain metastases ≥4 cm3 (2 cm diameter). In this study, 213 patients with 223 brain metastases were included, and 30% were treated with SRS alone, while the remaining 70% received surgery and SRS, which was either preoperative or postoperative. The 1-year local recurrence rate was higher in the patients who received surgery alone compared to those who received surgery and SRS (36.7% vs. 20.5%) [15]. A summary of select SRS series is found in Table 1.
Large Database Studies
There are limited comparative effectiveness data from large national databases, but this may change in the near future. In 2014, the American Association of Neurological Surgeons (AANS) and the American Society for Radiation Oncology (ASTRO) launched a national registry for SRS treatments [16]. Regarding other national database publications, Kann and coworkers conducted a National Cancer Database (NCDB) study that examined patients with metastatic NSCLC, breast cancer, colorectal cancer, and melanoma who received radiation therapy to the brain. A total of 75,953 patients were included in the study, and of these, 16.1% received SRS and the remaining 83.9% received non-SRS. The proportion of patients receiving SRS compared to non-SRS increased over time from 2004 to 2014 (9.8% to 25.6%). 1-year survival was higher in the patients who received SRS compared to those who received non-SRS (40.9% vs. 24.1%) [17].
Cost-Effectiveness Studies
Several studies have examined the cost-effectiveness of local therapies for brain metastases [18]. Lal and coworkers conducted a cost-effectiveness study using data from patients with brain metastases in a randomized trial, in which patients received either SRS and observation or SRS and WBRT. Despite SRS with salvage therapy having a higher cost compared to SRS and following WBRT, it was found to be more cost-effective [19]. Kimmel and coworkers conducted a cost-effectiveness analysis for various combinations of treatments for brain metastases. SRS and WBRT combination was cost-effective compared to WBRT alone, and SRS alone was more cost-effective than WBRT [20]. In the setting of multiple brain metastases, Lester-Coll and coworkers found SRS to be more cost-effective than SRS + WBRT in patients with up to 10 brain metastases [21]. A summary of selected large database and cost-effectiveness studies of SRS is found in Table 2.
Prostate Cancer
Prospective and Retrospective Series
Prostate cancer is one of the most commonly treated primary tumors with stereotactic body radiation therapy (SBRT) increasing in utilization across the country [22]. Although conventionally fractionated radiation therapy has shown to be quite effective in the treatment of prostate cancer, it is associated with as many as 45 treatment sessions over the course of 9 weeks. With increasing research studying the effectiveness of shortened hypofractionated dose regiments, SBRT was a natural progression in advances in treatment. Moreover, many argue that given the low alpha-beta ratio of prostate cancer, SBRT would have a radiobiological advantage to doses delivered at a larger fraction size [23].
The major limitation comparing SBRT to conventionally fractionated radiation therapy for prostate cancer is the lack of long-term SBRT follow-up and randomized data. Much of the growing evidence supporting SBRT for prostate cancer is founded upon comparisons to historical outcomes of dose-escalated conventionally fractionated radiation therapy using 3D/IMRT techniques. Among the first studies to look at prostate SBRT was from Madsen and associates in 2007 [24]. This phase I/II clinical trial evaluated the effectiveness of 33.5 Gy in 5 fractions to 40 patients with low-risk prostate cancer. With a median follow-up of 3.4 years, authors reported biochemical control of 90% by Phoenix criteria and 70% by ASTRO definition. The toxicity was acceptable with only 1 acute Grade 3 GU toxicity and no late Grade 3 or higher toxicity. In 2011, King and associates from Stanford published a prospective phase II trial of 67 patients with low to intermediate risk prostate cancer treated to a higher dose of 36.25 Gy in 5 fractions using Cyberknife SBRT [25]. With a median follow-up of 2.7 years, the authors reported a 4-year biochemical relapse-free survival was 94%. The toxicity profile remained relatively favorable with only 3.5% late grade 3 GU toxicity. More importantly, the authors found every other day treatment to be associated with a more favorable toxicity profile than daily treatment. The criticism of the initial prostate SBRT experiences was a lack of long-term follow-up data. The longest follow-up experience published to date is a retrospective series published by Katz and associates in 2016 [26]. Among 515 patients treated with organ defined low-, intermediate-, and high-risk prostate cancer treated with 35–36.25 Gy in 5 fractions, the authors found an 8-year biochemical disease-free survival of 93.6% (low risk), 84.3% (intermediate risk), and 65.0% (high risk). The authors similarly noted a late grade GU toxicity of 2% at 7 years.
Unfortunately, there is a paucity of published randomized controlled trials for which SBRT is compared to conventional radiation therapy or surgery. RTOG 0938 compared the effectiveness of 36.25 Gy in 5 fractions versus 51.6 Gy in 12 fractions for patients with favorable risk prostate cancer [27, 28] and reported initial quality of life analysis in 2016. Both fractionation schema were well tolerated [29]. The HYPO-RT-PC study compared 6.1 Gy × 7 fractions to 2 Gy × 39 fractions, enrolling 1200 patients. The study, also reported at ASTRO in 2016, reported increased urinary side effects for the more extreme fractionation arm at 1 year, but no differences at 2 years. Bowel symptoms were also greater after radiation treatment, but no differences were seen at later endpoints [30].
Ongoing trials include the UK-based phase 3 PACE trial in which low- and favorable intermediate-risk prostate cancer patients who are surgical candidates are randomized to SBRT versus surgery and those who are not surgical candidates are randomized to SBRT versus conventional radiotherapy. The NRG Oncology GU-005 study is comparing 5 fractions of 7.25 Gy to 28 fractions of 2.5 Gy and has both biochemical and quality of life endpoints.
A summary of select prostate SBRT series is found in Table 3.
Large Database Studies
Some of the most significant work comparing SBRT to alternative treatment modalities has been using large national databases. In 2014, Yu and associates published an analysis of patients from the CMS Chronic Conditions Data Warehouse who received SBRT or IMRT as a primary treatment for prostate cancer [28]. Using Medicare claims to assess for GI and GU toxicity, the authors found SBRT to be associated with worse GU toxicity at 6 months (15.6% vs. 12.6%) and 24 months (43% vs. 36%). The differences were largely driven by claims indicative of urethritis, urinary incontinence, and obstruction. Similarly, there was worse GI toxicity associated with SBRT at 6 months (5.8% vs. 4.1%). There is no large national database analysis of biochemical control for prostate SBRT versus conventionally fractionated radiation therapy; however, a recent analysis of the National Cancer Database from Ricco and associates published in 2017 found no difference in 8-year overall survival when comparing prostate cancer patients treated with SBRT versus IMRT [31].
Cost-Effectiveness Studies
There has been substantial work studying cost-effectiveness of prostate SBRT. In the previously described study by Yu and associates, the authors also examined the costs of prostate SBRT versus IMRT among Medicare beneficiaries [28]. The authors found SBRT was cheaper than IMRT ($13,645 vs. $21,023) but most expensive with respect to non-radiation-related cancer care ($2963 vs. $1978). Halpern and associates published a cost analysis in 2016 of prostate cancer patients treated with SBRT, IMRT, proton beam therapy, or brachytherapy. Brachytherapy ($17,183) was found to be the least expensive treatment modality followed by SBRT ($27,145), IMRT ($37,090), and proton therapy ($54,706) [22]. Cost-effectiveness studies by Parthan and associates which analyzed costs and toxicity using Markov modeling found prostate SBRT to be more cost-effective than proton therapy and IMRT [32]. One criticism of this study is that authors used a singular institutional source to estimate estimated rates of toxicity [18]. Sher and associates published a similar updated Markov analysis in 2014 assuming worse toxicity for SBRT and with a larger variety of sources to estimate rates of toxicity. The authors found SBRT to most likely to be cost-effective compared to IMRT [33]. A summary of select large database analysis and cost-effectiveness studies of prostate SBRT can be found in Table 4.
Lung
Prospective and Retrospective Series
Relative to other disease sites, lung SBRT has been an area of significant comparative effectiveness research. Similar to prostate SBRT, initial trials studying the effectiveness of lung SBRT were single-arm studies compared to historical controls. Uematsu and associates published one of the first experiences of SBRT in inoperable lung cancer in 1998. With a median follow-up of 36 months, the authors found SBRT to be associated with a 2-year local control of 94% [34]. The landmark study which solidified SBRT for inoperable NSCLC was published in 2010 by Timmerman and associates. RTOG 0236 was a prospective multicenter single-arm study of 55 patients with inoperable early-stage NSCLC treated to 60 Gy in 3 fractions [35]. The authors found a promising 3-year tumor control rate of 97% with a favorable toxicity profile.
Studies comparing surgery to SBRT for lung cancer have been difficult given SBRT has often been reserved for patients who are not candidates for surgical resection. Crabtree and associates published one of the largest single institutional series of matched patients comparing surgery and SBRT [36]. The authors found no differences in 4-year local, regional, or cancer-specific survival when comparing SBRT to surgical resection. Mokhles and associates have published the comparative series with the longest follow-up [37]. With a median follow-up of 49 months, the authors studied 146 patients treated with SBRT or surgery. After propensity score matching, there was no difference in 1-year or 5-year overall survival between surgery and SBRT.
Patient accrual has halted many efforts at randomized clinical trials comparing SBRT to surgery. Both the STARS and ROSEL clinical trials which randomized SBRT to surgery for early-stage NSCLC failed to meet accrual goals. A pooled analysis of both studies was published by Chang and associates in 2016 and found SBRT to be associated with a 3-year overall survival benefit [38]. Thus, there is mounting evidence to suggesting equipoise between both surgery and SBRT for early-stage NSCLC. A summary of select lung SBRT series is found in Table 5.
Large Database Studies
Given the paucity of randomized clinical trials studying the efficacy of SBRT versus surgery for early-stage lung cancer, much of the comparative effectiveness research has risen from large database studies. Yu and colleagues, Shirvani and colleagues, and Ezer and colleagues have all conducted analysis of the SEER-Medicare database comparing surgery to SBRT for early-stage NSCLC [39,40,41]. Both studies from Yu and Shirvani found SBRT to be an effective treatment option compared to surgery for patients with short life expectancy and/or multiple comorbidities. Ezer and colleagues found no differences in overall survival when comparing SBRT to wedge resection, but did find segmentectomy to be associated with improved overall survival compared to SBRT. When comparing radiofrequency ablation (RFA) to SBRT for lung cancer, a meta-analysis from Bi and colleagues found SBRT to be associated with improved local control at both 1 and 5 years [42].
Cost-Effectiveness Studies
There have been a number of cost-effectiveness studies evaluating the utility of SBRT for lung cancer. Sher and colleagues published one of the first Markov analysis comparing SBRT, 3DCRT, and RFA for inoperable early-stage lung cancer [43]. SBRT was the most cost-effective under a variety of different clinical scenarios. When studying operable early-stage lung cancer, Shah and colleagues found SBRT to be more cost-effective than surgery unless the patient was “clearly operable” and willing to undergo lobectomy [44]. The cost-effectiveness of lung SBRT is affected somewhat by the health system in which one practices. Lanni and colleagues found SBRT to be more cost-effective than 3DCRT in a US-based healthcare system in which reimbursements are based on the number of fractions [45]. However, from the Canadian payer perspective, SBRT was less cost-effective than 3DCRT because in Canada activity-related reimbursements based on the total course of treatment are used to calculate costs rather than the number of fractions received. A summary of select large database analysis and cost-effectiveness studies of lung SBRT can be found in Table 6.
Liver
Prospective and Retrospective Series
In patients with hepatic metastatic disease, options for local therapy include surgery, SBRT, Y-90 microspheres, chemoembolization, and radiofrequency ablation . To our knowledge, there are no randomized trials directly comparing these modalities with SBRT. Table 1 displays the results of liver SBRT outcomes in the setting of hepatic metastases from various prospective Phase I/II trials. Actuarial local control ranges from 67% to 92% at 2 years. In terms of microsphere treatment, SIRFLOX was a phase III trial in which patients with metastatic colorectal cancer with hepatic metastases were randomized to modified FOLFOX plus or minus Y-90 microspheres. Median PFS in the liver was better in the Y-90 group (20.5 months vs. 12.6 months, P = 0.002) [46]. For SBRT, the median progression-free survival in the phase II trial of SBRT by Rusthoven and colleagues was 6.1 months [47].
There are also limited data regarding comparison of treatment options for hepatocellular carcinoma. RTOG 1112 is currently accruing, and it randomizes patients with unresectable HCC to sorafenib or SBRT followed by sorafenib. Su and colleagues conducted a retrospective analysis of 117 patients with hepatocellular carcinoma, 82 of which received SBRT. The remaining 35 patients underwent liver resection . After propensity score matching, overall survival and progression-free survival were similar between both groups. The 3-year OS was 91.8% in the SBRT group and 89.3% in the resection group, and the 3-year PFS was 59.2% and 62.4%, respectively [48].
Wahl and colleagues conducted a retrospective study that compared radiofrequency ablation (RFA) to SBRT of the liver for patients with hepatocellular carcinoma. A total of 224 patients with inoperable hepatocellular carcinoma were included in the study, with 161 patients undergoing RFA and 63 patients receiving SBRT. 2-year freedom from local progression was 80.2% in patients who received RFA and 83.8% in patients who received SBRT (P = 0.016). Overall survival at 2 years was not statistically different between groups [49]. A summary of select liver SBRT series is found in Table 7.
Large Database Studies
Given the use of SBRT to treat liver disease has only recently become more popularized, there are limited large database studies studying liver SBRT. Berber and colleagues conducted a study of 153 patients from a combined multicenter database who received SBRT for metastatic disease to the liver. A total of 363 metastatic liver lesions were included, and mean dose was 37.5 Gy. After a mean follow-up of 25 months, local control was 62% with a 1-year OS of 51% [50]. Oladeru and colleagues conducted a SEER analysis of 189 patients with unresectable HCC treated with either SBRT to selective internal radiation therapy [51]. With a median survival of 14 months, the authors found no differences in statistical significance in overall survival or disease-specific survival.
Cost-Effectiveness Studies
Compared to SRS and SBRT of other body sites, relatively few cost-effectiveness studies have been conducted for SBRT of the liver. Leung and colleagues conducted a cost-effectiveness analysis of Sorafenib compared to SBRT for unresectable hepatocellular carcinoma and found SBRT to be more cost-effective in all clinical scenarios. In a study by Kim and colleagues, cost-effectiveness of SBRT was compared to radiofrequency ablation (RFA) in patients with unresectable liver metastases. The authors found that SBRT was less cost-effective than RFA for inoperable liver metastasis [52]. A summary of select large database analysis and cost-effectiveness studies of liver SBRT can be found in Table 8.
Conclusion
In this chapter, we have briefly introduced the growing comparative effectiveness research surrounding stereotactic body radiation therapy. As the use of SBRT increases, there will continue to be advances in this emerging area of research. Moreover, as we begin to generate long-term follow-up on patients who have undergone SBRT, the utility of comparative effectiveness studies will become more important.
References
Badiyan SN, Regine WF, Mehta M. Stereotactic radiosurgery for treatment of brain metastases. J Oncol Pract. 2016;12(8):703–12.
Sheehan JP, Yen CP, Lee CC, Loeffler JS. Cranial stereotactic radiosurgery: current status of the initial paradigm shifter. J Clin Oncol. 2014;32(26):2836–46.
Muacevic A, Wowra B, Siefert A, Tonn JC, Steiger HJ, Kreth FW. Microsurgery plus whole brain irradiation versus Gamma Knife surgery alone for treatment of single metastases to the brain: a randomized controlled multicentre phase III trial. J Neuro-Oncol. 2008;87(3):299–307.
Andrews DW, Scott CB, Sperduto PW, Flanders AE, Gaspar LE, Schell MC, et al. Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial. Lancet. 2004;363(9422):1665–72.
El Gantery MM, Abd El Baky HM, El Hossieny HA, Mahmoud M, Youssef O. Management of brain metastases with stereotactic radiosurgery alone versus whole brain irradiation alone versus both. Radiat Oncol. 2014;9:116.
Kocher M, Soffietti R, Abacioglu U, Villa S, Fauchon F, Baumert BG, et al. Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study. J Clin Oncol. 2011;29(2):134–41.
Soffietti R, Kocher M, Abacioglu UM, Villa S, Fauchon F, Baumert BG, et al. A European Organisation for Research and Treatment of Cancer phase III trial of adjuvant whole-brain radiotherapy versus observation in patients with one to three brain metastases from solid tumors after surgical resection or radiosurgery: quality-of-life results. J Clin Oncol. 2013;31(1):65–72.
Aoyama H, Shirato H, Tago M, Nakagawa K, Toyoda T, Hatano K, et al. Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. JAMA. 2006;295(21):2483–91.
Chang EL, Wefel JS, Hess KR, Allen PK, Lang FF, Kornguth DG, et al. Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol. 2009;10(11):1037–44.
Sahgal A, Aoyama H, Kocher M, Neupane B, Collette S, Tago M, et al. Phase 3 trials of stereotactic radiosurgery with or without whole-brain radiation therapy for 1 to 4 brain metastases: individual patient data meta-analysis. Int J Radiat Oncol Biol Phys. 2015;91(4):710–7.
Patchell RA, Tibbs PA, Regine WF, Dempsey RJ, Mohiuddin M, Kryscio RJ, et al. Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. JAMA. 1998;280(17):1485–9.
O’Neill BP, Iturria NJ, Link MJ, Pollock BE, Ballman KV, O’Fallon JR. A comparison of surgical resection and stereotactic radiosurgery in the treatment of solitary brain metastases. Int J Radiat Oncol Biol Phys. 2003;55(5):1169–76.
Brennan C, Yang TJ, Hilden P, Zhang Z, Chan K, Yamada Y, et al. A phase 2 trial of stereotactic radiosurgery boost after surgical resection for brain metastases. Int J Radiat Oncol Biol Phys. 2014;88(1):130–6.
Soltys SG, Adler JR, Lipani JD, Jackson PS, Choi CY, Puataweepong P, et al. Stereotactic radiosurgery of the postoperative resection cavity for brain metastases. Int J Radiat Oncol Biol Phys. 2008;70(1):187–93.
Prabhu RS, Press RH, Patel KR, Boselli DM, Symanowski JT, Lankford SP, et al. Single-fraction stereotactic radiosurgery (SRS) alone versus surgical resection and SRS for large brain metastases: a multi-institutional analysis. Int J Radiat Oncol Biol Phys. 2017;99(2):459–67.
Sheehan JP, Kavanagh BD, Asher A, Harbaugh RE. Inception of a national multidisciplinary registry for stereotactic radiosurgery. J Neurosurg. 2016;124(1):155–62.
Kann BH, Park HS, Johnson SB, Chiang VL, Yu JB. Radiosurgery for brain metastases: changing practice patterns and disparities in the United States. J Natl Compr Cancer Netw. 2017;15(12):1494–502.
Lester-Coll NH, Sher DJ. Cost-effectiveness of stereotactic radiosurgery and stereotactic body radiation therapy: a critical review. Curr Oncol Rep. 2017;19(6):41.
Lal LS, Byfield SD, Chang EL, Franzini L, Miller LA, Arbuckle R, et al. Cost-effectiveness analysis of a randomized study comparing radiosurgery with radiosurgery and whole brain radiation therapy in patients with 1 to 3 brain metastases. Am J Clin Oncol. 2012;35(1):45–50.
Kimmell KT, LaSota E, Weil RJ, Marko NF. Comparative effectiveness analysis of treatment options for single brain metastasis. World Neurosurg. 2015;84(5):1316–32.
Lester-Coll NH, Dosoretz AP, Magnuson WJ, Laurans MS, Chiang VL, Yu JB. Cost-effectiveness of stereotactic radiosurgery versus whole-brain radiation therapy for up to 10 brain metastases. J Neurosurg. 2016;125(Suppl 1):18–25.
Halpern JA, Sedrakyan A, Hsu WC, Mao J, Daskivich TJ, Nguyen PL, et al. Use, complications, and costs of stereotactic body radiotherapy for localized prostate cancer. Cancer. 2016;122(16):2496–504.
Fowler J, Chappell R, Ritter M. Is alpha/beta for prostate tumors really low? Int J Radiat Oncol Biol Phys. 2001;50(4):1021–31.
Madsen BL, Hsi RA, Pham HT, Fowler JF, Esagui L, Corman J. Stereotactic hypofractionated accurate radiotherapy of the prostate (SHARP), 33.5 Gy in five fractions for localized disease: first clinical trial results. Int J Radiat Oncol Biol Phys. 2007;67(4):1099–105.
King CR, Brooks JD, Gill H, Presti JC Jr. Long-term outcomes from a prospective trial of stereotactic body radiotherapy for low-risk prostate cancer. Int J Radiat Oncol Biol Phys. 2012;82(2):877–82.
Katz A, Formenti SC, Kang J. Predicting biochemical disease-free survival after prostate stereotactic body radiotherapy: risk-stratification and patterns of failure. Front Oncol. 2016;6:168.
Zaorsky NG, Studenski MT, Dicker AP, Gomella L, Den RB. Stereotactic body radiation therapy for prostate cancer: is the technology ready to be the standard of care? Cancer Treat Rev. 2013;39(3):212–8.
Yu JB, Cramer LD, Herrin J, Soulos PR, Potosky AL, Gross CP. Stereotactic body radiation therapy versus intensity-modulated radiation therapy for prostate cancer: comparison of toxicity. J Clin Oncol. 2014;32(12):1195–201.
Lukka H, Stephanie P, Bruner D, Bahary JP, Lawton CAF, Efstathiou JA, et al. Patient-reported outcomes in NRG oncology/RTOG 0938, a randomized phase 2 study evaluating 2 Ultrahypofractionated Regimens (UHRs) for prostate cancer. Int J Radiat Oncol Biol Phys. 2016;94(1):2.
Widmark A, Gunnlaugsson A, Beckman L, Thellenberg-Karlsson C, Hoyer M, Lagerlund M, et al. Extreme hypofractionation versus conventionally fractionated radiotherapy for intermediate risk prostate cancer: early toxicity results from the Scandinavian Randomized Phase III Trial “HYPO-RT-PC”. Int J Radiat Oncol Biol Phys. 2016;96(5):938–9.
Ricco A, Hanlon A, Lanciano R. Propensity score matched comparison of intensity modulated radiation therapy vs stereotactic body radiation therapy for localized prostate cancer: a survival analysis from the National Cancer Database. Front Oncol. 2017;7:185.
Parthan A, Pruttivarasin N, Davies D, Taylor DC, Pawar V, Bijlani A, et al. Comparative cost-effectiveness of stereotactic body radiation therapy versus intensity-modulated and proton radiation therapy for localized prostate cancer. Front Oncol. 2012;2:81.
Sher DJ, Parikh RB, Mays-Jackson S, Punglia RS. Cost-effectiveness analysis of SBRT versus IMRT for low-risk prostate cancer. Am J Clin Oncol. 2014;37(3):215–21.
Uematsu M, Shioda A, Tahara K, Fukui T, Yamamoto F, Tsumatori G, et al. Focal, high dose, and fractionated modified stereotactic radiation therapy for lung carcinoma patients: a preliminary experience. Cancer. 1998;82(6):1062–70.
Timmerman R, Paulus R, Galvin J, Michalski J, Straube W, Bradley J, et al. Stereotactic body radiation therapy for inoperable early stage lung cancer. JAMA. 2010;303(11):1070–6.
Crabtree TD, Denlinger CE, Meyers BF, El Naqa I, Zoole J, Krupnick AS, et al. Stereotactic body radiation therapy versus surgical resection for stage I non-small cell lung cancer. J Thorac Cardiovasc Surg. 2010;140(2):377–86.
Mokhles S, Nuyttens JJ, Maat AP, Birim O, Aerts JG, Bogers AJ, et al. Survival and treatment of non-small cell lung cancer stage I-II treated surgically or with stereotactic body radiotherapy: patient and tumor-specific factors affect the prognosis. Ann Surg Oncol. 2015;22(1):316–23.
Chang JY, Senan S, Paul MA, Mehran RJ, Louie AV, Balter P, et al. Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell lung cancer: a pooled analysis of two randomised trials. Lancet Oncol. 2015;16(6):630–7.
Yu JB, Soulos PR, Cramer LD, Decker RH, Kim AW, Gross CP. Comparative effectiveness of surgery and radiosurgery for stage I non-small cell lung cancer. Cancer. 2015;121(14):2341–9.
Shirvani SM, Jiang J, Chang JY, Welsh J, Likhacheva A, Buchholz TA, et al. Lobectomy, sublobar resection, and stereotactic ablative radiotherapy for early-stage non-small cell lung cancers in the elderly. JAMA Surg. 2014;149(12):1244–53.
Ezer N, Veluswamy RR, Mhango G, Rosenzweig KE, Powell CA, Wisnivesky JP. Outcomes after stereotactic body radiotherapy versus limited resection in older patients with early-stage lung cancer. J Thorac Oncol. 2015;10(8):1201–6.
Bi N, Shedden K, Zheng X, Kong FS. Comparison of the effectiveness of radiofrequency ablation with stereotactic body radiation therapy in inoperable stage I non-small cell lung cancer: a systemic review and pooled analysis. Int J Radiat Oncol Biol Phys. 2016;95(5):1378–90.
Sher DJ, Wee JO, Punglia RS. Cost-effectiveness analysis of stereotactic body radiotherapy and radiofrequency ablation for medically inoperable, early-stage non-small cell lung cancer. Int J Radiat Oncol Biol Phys. 2011;81(5):e767–74.
Shah A, Hahn SM, Stetson RL, Friedberg JS, Pechet TT, Sher DJ. Cost-effectiveness of stereotactic body radiation therapy versus surgical resection for stage I non-small cell lung cancer. Cancer. 2013;119(17):3123–32.
Lanni TB Jr, Grills IS, Kestin LL, Robertson JM. Stereotactic radiotherapy reduces treatment cost while improving overall survival and local control over standard fractionated radiation therapy for medically inoperable non-small-cell lung cancer. Am J Clin Oncol. 2011;34(5):494–8.
van Hazel GA, Heinemann V, Sharma NK, Findlay MP, Ricke J, Peeters M, et al. SIRFLOX: randomized phase III trial comparing first-line mFOLFOX6 (plus or minus bevacizumab) versus mFOLFOX6 (plus or minus bevacizumab) plus selective internal radiation therapy in patients with metastatic colorectal cancer. J Clin Oncol. 2016;34(15):1723–31.
Rusthoven KE, Kavanagh BD, Cardenes H, Stieber VW, Burri SH, Feigenberg SJ, et al. Multi-institutional phase I/II trial of stereotactic body radiation therapy for liver metastases. J Clin Oncol. 2009;27(10):1572–8.
Su TS, Liang P, Liang J, Lu HZ, Jiang HY, Cheng T, et al. Long-term survival analysis of stereotactic ablative radiotherapy versus liver resection for small hepatocellular carcinoma. Int J Radiat Oncol Biol Phys. 2017;98(3):639–46.
Wahl DR, Stenmark MH, Tao Y, Pollom EL, Caoili EM, Lawrence TS, et al. Outcomes after stereotactic body radiotherapy or radiofrequency ablation for hepatocellular carcinoma. J Clin Oncol. 2016;34(5):452–9.
Berber B, Ibarra R, Snyder L, Yao M, Fabien J, Milano MT, et al. Multicentre results of stereotactic body radiotherapy for secondary liver tumours. HPB (Oxford). 2013;15(11):851–7.
Oladeru OT, Miccio JA, Yang J, Xue Y, Ryu S, Stessin AM. Conformal external beam radiation or selective internal radiation therapy-a comparison of treatment outcomes for hepatocellular carcinoma. J Gastrointest Oncol. 2016;7(3):433–40.
Kim H, Gill B, Beriwal S, Huq MS, Roberts MS, Smith KJ. Cost-effectiveness analysis of stereotactic body radiation therapy compared with radiofrequency ablation for inoperable colorectal liver metastases. Int J Radiat Oncol Biol Phys. 2016;95(4):1175–83.
Hall MD, McGee JL, McGee MC, Hall KA, Neils DM, Klopfenstein JD, et al. Cost-effectiveness of stereotactic radiosurgery with and without whole-brain radiotherapy for the treatment of newly diagnosed brain metastases. J Neurosurg. 2014;121 Suppl:84–90.
Savitz ST, Chen RC, Sher DJ. Cost-effectiveness analysis of neurocognitive-sparing treatments for brain metastases. Cancer. 2015;121(23):4231–9.
Wernicke AG, Yondorf MZ, Parashar B, Nori D, Clifford Chao KS, Boockvar JA, et al. The cost-effectiveness of surgical resection and cesium-131 intraoperative brachytherapy versus surgical resection and stereotactic radiosurgery in the treatment of metastatic brain tumors. J Neuro-Oncol. 2016;127(1):145–53.
Freeman DE, King CR. Stereotactic body radiotherapy for low-risk prostate cancer: five-year outcomes. Radiat Oncol. 2011;6:3.
Meier R, Beckman A, Henning G, Mohideen N, Woodhouse SA, Cotrutz C, et al. Five-year outcomes from a multicenter trial of stereotactic body radiation therapy for low- and intermediate-risk prostate cancer. Int J Radiat Oncol Biol Phys. 2016;96(2):S33–S4.
Hodges JC, Lotan Y, Boike TP, Benton R, Barrier A, Timmerman RD. Cost-effectiveness analysis of stereotactic body radiation therapy versus intensity-modulated radiation therapy: an emerging initial radiation treatment option for organ-confined prostate cancer. J Oncol Pract. 2012;8(3 Suppl):e31s–7s.
Onishi H, Araki T, Shirato H, Nagata Y, Hiraoka M, Gomi K, et al. Stereotactic hypofractionated high-dose irradiation for stage I nonsmall cell lung carcinoma: clinical outcomes in 245 subjects in a Japanese multiinstitutional study. Cancer. 2004;101(7):1623–31.
Grills IS, Mangona VS, Welsh R, Chmielewski G, McInerney E, Martin S, et al. Outcomes after stereotactic lung radiotherapy or wedge resection for stage I non-small-cell lung cancer. J Clin Oncol. 2010;28(6):928–35.
Onishi H, Shirato H, Nagata Y, Hiraoka M, Fujino M, Gomi K, et al. Stereotactic body radiotherapy (SBRT) for operable stage I non-small-cell lung cancer: can SBRT be comparable to surgery? Int J Radiat Oncol Biol Phys. 2011;81(5):1352–8.
Timmerman RD, Hu C, Michalski J, Straube W, Galvin J, Johnstone D, et al. Long-term results of RTOG 0236: a phase II trial of stereotactic body radiation therapy (SBRT) in the treatment of patients with medically inoperable stage I non-small cell lung cancer. Int J Radiat Oncol Biol Phys. 2014;90(1):S30.
Nanda RH, Liu Y, Gillespie TW, Mikell JL, Ramalingam SS, Fernandez FG, et al. Stereotactic body radiation therapy versus no treatment for early stage non-small cell lung cancer in medically inoperable elderly patients: a National Cancer Data Base analysis. Cancer. 2015;121(23):4222–30.
Smith BD, Jiang J, Chang JY, Welsh J, Likhacheva A, Buchholz TA, et al. Cost-effectiveness of stereotactic radiation, sublobar resection, and lobectomy for early non-small cell lung cancers in older adults. J Geriatr Oncol. 2015;6(4):324–31.
Louie AV, Rodrigues G, Hannouf M, Zaric GS, Palma DA, Cao JQ, et al. Stereotactic body radiotherapy versus surgery for medically operable Stage I non-small-cell lung cancer: a Markov model-based decision analysis. Int J Radiat Oncol Biol Phys. 2011;81(4):964–73.
Milano MT, Katz AW, Muhs AG, Philip A, Buchholz DJ, Schell MC, et al. A prospective pilot study of curative-intent stereotactic body radiation therapy in patients with 5 or fewer oligometastatic lesions. Cancer. 2008;112(3):650–8.
Hoyer M, Roed H, Traberg Hansen A, Ohlhuis L, Petersen J, Nellemann H, et al. Phase II study on stereotactic body radiotherapy of colorectal metastases. Acta Oncol. 2006;45(7):823–30.
Mendez Romero A, Wunderink W, Hussain SM, De Pooter JA, Heijmen BJ, Nowak PC, et al. Stereotactic body radiation therapy for primary and metastatic liver tumors: a single institution phase i-ii study. Acta Oncol. 2006;45(7):831–7.
Leung HW, Liu CF, Chan AL. Cost-effectiveness of sorafenib versus SBRT for unresectable advanced hepatocellular carcinoma. Radiat Oncol. 2016;11:69.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Aneja, S., Kumar, R.J., Yu, J.B. (2019). Comparative Effectiveness of SBRT. In: Trifiletti, D., Chao, S., Sahgal, A., Sheehan, J. (eds) Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy. Springer, Cham. https://doi.org/10.1007/978-3-030-16924-4_34
Download citation
DOI: https://doi.org/10.1007/978-3-030-16924-4_34
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-16923-7
Online ISBN: 978-3-030-16924-4
eBook Packages: MedicineMedicine (R0)