title: Emerging radiotherapy technology in a developing country: A single Brazilian institution assessment of stereotactic body radiotherapy application.
abstract: To provide a quantitative profile of the indications and use of stereotactic body radiotherapy (SBRT) in a developing country oncology-based institution. In addition, to describe the patients' and treatment characteristics, and to provide a temporal analysis.
  SBRT patients treated from 2007 to 2015 were retrospectively evaluated by two independently investigators. Data were stratified and compared in two periods: first experience (FE) (May 2007 to April 2011), and following experience (FollowE) (May 2011 to April 2015). The following parameters were compared between the groups: total number of treated patients and lesions, treatment site, additional image fusion used, formal protocol adoption, and SBRT planning technique.
  One hundred and seventy-six (176) patients with 191 lesions were treated: 34 (18%) lesions in the FE and 157 (82%) lesions in FollowE. The majority of lesions were metastases (60.3%), and lung (60.2%) was the most common treatment site, followed by spine (31%), and others (8.8%). An average of 1.4 (±0.6) additional imaging exams for delineation was performed. Conformal 3D radiotherapy planning technique was used in 64.4%, and intensity modulated radiotherapy (IMRT) or volumetric-modulated arc therapy (VMAT) in the remaining 35.6% (p=0.0001). Higher rates of curative treatments were observed in FE, as well as more lung lesions, patients ≥ 70 years, 3D conformal, number of additional images and ECOG 0, and all presented p<0.05. The global rate of protocol statement was 79%, lung treatment being the most stated.
  SBRT application is rapidly increasing in our setting. Treatment sites and planning techniques are becoming more diversified and complex.
authors.affiliation: Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, SP, Brazil.
authors.forename: Fabio Ynoe
authors.initials: FY
authors.lastname: Moraes
authors.affiliation: Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, SP, Brazil.
authors.forename: Lorine Arias
authors.initials: LA
authors.lastname: Bonifacio
authors.affiliation: Department of Radiation Oncology and Medical Physics, Hospital Sírio-Libanês, São Paulo, SP, Brazil.
authors.forename: Wellington Pimenta
authors.initials: WP
authors.lastname: Neves-Junior
authors.affiliation: Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, SP, Brazil.
authors.forename: Samir Abdallah
authors.initials: SA
authors.lastname: Hanna
authors.affiliation: Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, SP, Brazil.
authors.forename: Carlos Eduardo Cintra Vita
authors.initials: CE
authors.lastname: Abreu
authors.affiliation: Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, SP, Brazil.
authors.forename: Fernando Freire
authors.initials: FF
authors.lastname: Arruda
authors.affiliation: Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, SP, Brazil.
authors.forename: João Luis Fernandes
authors.initials: JL
authors.lastname: Silva
authors.affiliation: Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, SP, Brazil.|Department of Radiology and Oncology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.
authors.forename: Heloisa Andrade
authors.initials: HA
authors.lastname: Carvalho
mesh_terms: D000368:Aged; D001938:Brazil; D003906:Developing Countries; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000532:radiotherapy; D008175:Lung Neoplasms / Q000532:radiotherapy / Q000556:secondary; D008297:Male; D009362:Neoplasm Metastasis / Q000532:radiotherapy; D009369:Neoplasms / Q000532:radiotherapy*; D016634:Radiosurgery / Q000379:methods / Q000706:statistics & numerical data* / Q000639:trends; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000706:statistics & numerical data*; D020266:Radiotherapy, Conformal / Q000706:statistics & numerical data*; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000532:radiotherapy; D016019:Survival Analysis; D013997:Time Factors