Copyright ©The Author(s) 2022.
World J Clin Oncol. Feb 24, 2022; 13(2): 101-115
Published online Feb 24, 2022. doi: 10.5306/wjco.v13.i2.101
Table 1 Prospective data, single fraction stereotactic ablative body radiotherapy early-stage peripheral non-small cell lung cancer
Toxicity rates > GIII
SABR technique/prescription
Le et al[29], 2006Phase I, n = 3215 Gy (1fr)9054NSCLC1: 67%NSCLC1: 85%18Cyberknife
Gold fiducials
Breathold or Synchrony (Accuray) respiratory tracking system/Isodose coverage: 95% of PTV
20 Gy (1fr)10
25 Gy (1fr)201p (GIII)3p (GV)91
Metastatic1: 25%Metastatic1: 56%
30 Gy (1fr)20
Videtic et al[30], 2015Phase II, n = 8448 Gy (4fr)456 (13.3%)92.7%171.1%277.7%230.2Abdominal compression, gating with the respiratory cycle, tumor tracking, and active breath-holding techniques were allowed. Image guidance was required/prescription isodose surface ≥ 60% and < 90% of the maximun dose.
RTOG 0915
34 Gy (1fr)394 (10.3%)97%156.4%262.3%2
Singh et al[31], 2019Phase II, n = 9860 Gy (3fr)496 (15%)97.1%150%262%253.8Body Fix (Elekta) immobilizer. Real-Time Position Management by Varían Medical System or abdominal compression. 3D-CRT was preferred. Image guidance was required/tumor coverage and normal tissue dose constraints followed RTOG 0915
30 Gy (1fr)498 (17%)94.9%265%273%2
Table 2 Single fraction stereotactic ablative body radiotherapy for pulmonary metastases
Study design
Total lesions (n)/LM (n)
Mean, Dose Gy (range)/Location
SABR technique/prescription
Mean GTV (cc) (range) failing this, cm
FU (mo), median
Toxicity ≥ GIII
Nakagawa et al[11]P22/1222.8 (18-25)1/NRRotational or StaticTherapy 3D-CRT. Abdominal compression/PTV enclosing isodose.4.8 (0.8-13)10100%10Non actuarial LC
Hara et al[26]P59/4830(20-34)/PeriphStatic 3D-CRT. Gating/Minimal dose to GTV5 (1-19)12(mean)1-yr 93%1 GIIILC 52% < 30 Gy
LC 83% ≥ 30 Gy
P = 0.068
2-yr 78%
Wulf et al[54]R92/3126/CentralStatic 3D-CRT. Abdominal compression/65-80%-isodose enclosing PTVNR14100%NRSF data are shown
Fritz et al[53]P64/3130/PeriphStatic 3D-CRT. Abdominal compression/Isocenter, 90% isodose enclosing GTV, 80% isodose enclosing PTVMedian: 6 (2.8-55.8)12215-yr 80%10No difference LC and OS LM vs primary lung cancer
Le et al [29]Phase I32/1122.34 (15-30)/PeriphCyberknife. Gold fiducials.Breathold or Synchrony (Accuray) respiratory tracking system / Isodose coverage: 95% of PTVMedian: 17.1 (2-103)181-yr 91% (≥ 20 Gy)1 GIII (pn)LC primary vs LM: 78% vs 58%
And OS (85% vs 56%)
1-yr 54% (< 20 Gy)3 GV (central)
Higher toxicity in central tumors
Hof et al [63]P0/7124.35 (12-30)/NRStatic 3D-CRT. Abdominal compression/Isocenter: 80% isodose enclosing PTV10 (1-53)141-yr 88.6%3 GIII (pn)LC 3 yr 78% 26-30 Gy
2-yr 73.7%
3-yr 63.1%
Gandhidasan et al [56]R186/9518/Central26 or 28/PeriphStatic 3D-CRT or IMRT/80% isodose enclosing PTVNR222yr 84%0
Osti et al [57]P0/10323Gy/Central30 Gy/PeriphStatic 3D-CRT. 4DCT. 80% isodose enclosing PTVNR15Central vs peripheral:1-yr 79.4% vs 94.7%2 GIII (pn)Prognostic factors for LC: sex and histology
Global: 1-yr 89.1%, 2-yr 82.1%
Filippi et al[58]R0/9026Gy/PeriphStatic 3D-CRT or IMRT or VMAT. Abdominal compression/80% isodose enclosing PTV< 5 cm241-yr 93.4%8 GII-IIIlate radiological toxicityThey suggest not to use a SF in lesions close to the chest wall
2-yr 88.1%
6 GII-IIIchest wall toxicity
Siva et al [44]R0/4118/Central26/PeriphStatic 3D-CRT or IMRT or VMAT. /70-80% isodose enclosing PTV< 5 cm252-yr 93%0LC, OS and toxicity rates between SF and multi-fraction SABR
Osti et al [59]R0/16630/PeriphStatic 3D-CRT. 4DCT/95% isodose enclosing PTV3.46 (0.03-47.48)383-yr 80.1%6 GIII (pn)Lesions ≤ 15 mm from mediastinum were not included in the study
11 GIIIlung fibrosis
5-yr 79.2%
1 GV at 15 mm PBT
Sharma et al [61]R3230/PeriphCyberknife. Radiopaque markers Tumor traking.70-90% isodose enclosing PTV< 3 cm222-yr 68%No details for SFBED10 < 100, delivery of pre-SBRT chemo. and synchronous metastasis: independently < LC
3-yr 63%
4-yr 59%
Sogono et al [60]R167 (95% peripher)16-18/Central26-28/PeriphStatic 3D-CRT or IMRT or VMAT. 4DCT/99% isodose enclosing PTVNR371-yr 96%NRSeveral locations
2-yr 92%
5-yr 92%
Siva et al[55]Phase II13328/NRStatic 3D-CRT or IMRT or VMAT. Abdominalo compression/70-80% isodose enclosing PTV2.2 cm (mean)121-yr 93%2 GIIIPreliminary results (TROG 13.01 SAFRON II)
1-3 metastases non-central targets < 5 cm
Table 3 Benefits and constraints to using single fraction stereotactic ablative body radiotherapy schemes
Low medium-long term toxicityFear of severe toxicity in initial studies
Prospective efficacy and toxicity dataInsufficient long-term data
Convenience for patient, fewer hospital visits (indirect costs), shorter treatment times
Less occupation of accelerators
Reduced positioning errors between fractionsGreater risk of positioning errors
Peripheral tumorsCentral tumors
Reduction in direct costs
Less interference with systemic therapiesCases of Neumonitis recall with some systemic therapies
Convenience for COVID-19 pandemic
Table 4 Biologically effective dose

Early tumor effects α/β = 10
Late tumor effects α/β = 3
28 Gy in 1 fraction106 Gy289 Gy
48 Gy in 4 fractions105 Gy240 Gy
Table 5 Summary of indications for stereotactic ablative body radiotherapy in pandemic COVID-19 in patients with early stage non-small cell lung cancer
45-54 Gy in 3 fx, 48 Gy in 4 fx; Maximum hypofractionation supported, 30-34 Gy in 1 fx (90% support if choosing hypofractionation)Safe zone: 34 Gy in 1 fxSafe zone: 30-34 Gy, 1 fx (first option); 54 Gy in 3 fx
Tumours within 2.5 cm of the Chest Wall: 48-54 Gy in 3 fx
Peripheral lesions: 48 Gy in 4 fx (first option)
Moderately central: 50 Gy in 5 fx
Central tumour: 50-60 Gy in 5 fx, 60 Gy in 8 fx
Ultra-central: 45-50 Gy in 4-5 fx, 60 Gy in 8 fx
Central/ultra-central early stage tumours not suitable for stereotactic ablative radiotherapy: 50-60 Gy in 15 fx