Stereotactic Body Radiation Therapy: Is It Ready For Primetime? Joseph Herman MD, MSc Department of Radiation Oncology

Treatment Planning Liver Planning Target Volume Target Volumes

Target Volumes Gross Tumor Volume Planning Target Volume

Pre-radiation 6 months post-radiation Radiographic Response

Survival as a Function of Dose Dawson et. al., J Clin. Onc . 18:2210, 2000 ; Ben-Josef et al 2006 Time (years)

IMRT Plan to Deliver High Dose to Potential Resection Margin Vineberg and Ten Haken, 2004

Image Alignment: AP Radiographs Reference Image Treatment Image Hepatic microcoil

Body Frame

Breath Hold at Normal Exhale Pressure Volume Flow Valve closed, Breath held Valve open

Synchrony ™ camera Treatment couch Linear accelerator Manipulator Image detectors X-ray sources Targeting System Robotic Delivery System Cyberknife

SRS Axial View GTV 60% 50% Koong et al. Stanford; IJROBP 2004

SRS Coronal View GTV 60% 50% Koong et al. Stanford; IJROBP 2004

Small Animal Irradiation