A survey of the practice of stereotactic body radiotherapy for hepatocellular and pancreatic malignancies in India.

Abstract

Background\nStereotactic body radiotherapy (SBRT) is increasingly being performed for hepatocellular cancer and liver metastases. The purpose of this study was to review the practice of SBRT for hepatocellular, pancreatic cancer and liver metastases in India.\n\n\nMethods\nA survey comprising of 25 questions was designed and served to radiation oncology professionals at two major conferences. The survey consisted of 25 multiple choice questions on SBRT infrastructure and caseload, simulation methods and immobilizations, organ motion control methods, simulation and delivery, indications of liver and pancreatic SBRT and prescribed dose. The responses were analyzed using descriptive statistics.\n\n\nResults\nFrom January to June 2017, about 200 professionals were approached and 71 professionals responded with a response rate of 35.5%. The duration of the SBRT practice among respondents was less than 3 years in 53% with 32% having formal training in SBRT. The most common sites for the use of SBRT were lung and brain followed by liver and spine. Liver SBRT was practiced by 29 (59.2%) for hepatic oligometastases, hepatocellular carcinoma (HCC), and cholangiocarcinoma. The most common fractionation used was 50-60 Gy/6 fractions and 45 Gy/3 fractions. Pancreatic SBRT was practiced by 37%, mostly for medically inoperable or locally advanced pancreatic cancer. SBRT was not practiced by 22 (31%) of the respondents, and the main reasons were lack of infrastructure and structured training.\n\n\nConclusion\nThe SBRT for liver has increased with a usage rate of over 50% amongst respondents. Pancreatic SBRT use is infrequent and limited to inoperable or advanced cases. Lack of infrastructure and training are the main challenges in the routine adaptation of SBRT.