Beasley Matthew, Brown Sean, McNair Helen, Faivre-Finn Corinne, Franks Kevin, Murray Louise, van Herk Marcel, Henry Ann
1 Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust , Leeds , England.
2 The Christie Hospital, The Christie Hospital NHS Foundation Trust , Manchester , England.
Br J Radiol. 2019 Jun;92(1098):20180988. doi: 10.1259/bjr.20180988. Epub 2019 Apr 24.
Stereotactic ablative radiotherapy (SABR) has become the standard of care for suitable patients with peripherally located early stage non-small cell lung cancer. Lung SABR requires strict image-guided radiotherapy (IGRT) protocols to ensure its safe delivery. The aim of this survey was to provide an assessment of current lung SABR practice in the UK.
An online semi-structured survey containing a maximum of 32 questions regarding lung SABR, focussing on treatment image verification processes was piloted, developed and disseminated to the radiotherapy managers of 62 National Health Service centres across the UK.
The survey had a 100% complete response from NHS centres. 36 centres (58%) currently deliver lung SABR, with half treating fewer than 50 patients per year. Six centres deliver SABR despite not being commissioned by the NHS to provide this service. There is wide variation in the use of IGRT. Eight different permutations of cone beam CT order within the workflow were reported. Almost half of lung centres (17/36, 47%) believe there is a need to update national image guidance associated with lung SABR, such as the use of 'day zero', mid treatment and post treatment cone beam CTs.
Our results demonstrate wide variation in IGRT for lung SABR. There is an opportunity to develop existing IGRT workflows and the optimal approach to image guidance. Further work is required to investigate lung SABR provision and potential barriers to its implementation.
This survey represents the most comprehensive and accurate assessment of lung SABR practice in the UK since the 2014 SABR consortium survey.
立体定向消融放疗（SABR）已成为适合的外周型早期非小细胞肺癌患者的标准治疗方法。肺部SABR需要严格的图像引导放疗（IGRT）方案以确保其安全实施。本调查的目的是对英国目前的肺部SABR实践进行评估。
开展了一项在线半结构化调查，该调查最多包含32个关于肺部SABR的问题，重点关注治疗图像验证过程。该调查经过试点、开发，并分发给了英国62家国民保健服务中心的放疗管理人员。
国民保健服务中心对该调查的回复率为100%。36个中心（58%）目前开展肺部SABR，其中一半每年治疗的患者少于50例。有6个中心在未获国民保健服务体系委托提供此项服务的情况下开展了SABR。IGRT的使用存在很大差异。报告了工作流程中锥形束CT顺序的8种不同排列方式。几乎一半的肺部中心（17/36，47%）认为有必要更新与肺部SABR相关的国家图像引导，例如使用“零日”、治疗中期和治疗后的锥形束CT。
我们的结果表明，肺部SABR的IGRT存在很大差异。有机会改进现有的IGRT工作流程以及图像引导的最佳方法。需要进一步开展工作来调查肺部SABR的提供情况及其实施的潜在障碍。
本次调查是自2014年SABR联盟调查以来对英国肺部SABR实践最全面、准确的评估。
