title: Practical considerations arising from the implementation of lung stereotactic body radiation therapy (SBRT) at a comprehensive cancer center.
abstract: BACKGROUND
  With the anticipation of improved outcomes, especially for patients with early-stage non-small cell lung cancer, stereotactic body radiation therapy (SBRT) has been rapidly introduced into the thoracic radiation oncology community. Although at first glance lung SBRT might seem methodologically similar to conventional radiotherapy, there are important differences in its execution that require particular consideration. The objective of this paper is to highlight these and other issues to contribute to the safe and effective diffusion of lung SBRT. We discuss practical challenges that have been encountered in the implementation of lung SBRT at a single, large institution and emphasize the importance of a systematic approach to the design of lung SBRT services.
  
  
  METHODS
  Specific technical and clinical components that were identified as being important during the development of lung SBRT at Princess Margaret Hospital are described. The clinical system that evolved from these is outlined.
  
  
  RESULTS
  Using this clinical framework the practical topics addressed include: patient assessment, simulation and treatment planning, tumor and organ at risk delineation, trial set up before treatment, on-line image-guidance, and patient follow-up.
  
  
  CONCLUSIONS
  The potential gain in therapeutic ratio that is theoretically possible with lung SBRT can only be realized if the tumor is adequately irradiated and normal tissue spared. A discussion of the component parts of lung SBRT is presented. It is a complex process and specific challenges need to be overcome to effect the satisfactory transition of lung SBRT into routine practice.
authors.affiliation: Radiation Medicine Program, Princess Margaret Hospital, University Health Network, Toronto, Canada.
authors.forename: Max
authors.initials: M
authors.lastname: Dahele
authors.forename: Shannon
authors.initials: S
authors.lastname: Pearson
authors.forename: Tom
authors.initials: T
authors.lastname: Purdie
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Bissonnette
authors.forename: Kevin
authors.initials: K
authors.lastname: Franks
authors.forename: Anthony
authors.initials: A
authors.lastname: Brade
authors.forename: John
authors.initials: J
authors.lastname: Cho
authors.forename: Alex
authors.initials: A
authors.lastname: Sun
authors.forename: Andrew
authors.initials: A
authors.lastname: Hope
authors.forename: Andrea
authors.initials: A
authors.lastname: Marshall
authors.forename: Jane
authors.initials: J
authors.lastname: Higgins
authors.forename: Andrea
authors.initials: A
authors.lastname: Bezjak
mesh_terms: D002173:Cancer Care Facilities; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D017408:Guidelines as Topic; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011785:Quality Assurance, Health Care; D016634:Radiosurgery