Recommendations for radiosurgery and stereotactic ablative radiotherapy terminology to guide clinical and research practices for the medical oncologist, radiation oncologist, and surgeon

Excerpt

Stereotactic radiosurgery (SRS), stereotactic ablative radiotherapy (SABR), and stereotactic body radiation therapy (SBRT) are tools used independently or in conjunction with systemic therapies and have transformed oncologic practice. With the emergence of these therapeutic modalities, and in part due to a lack of established guidelines differentiating these treatments, the term “radiosurgery” is frequently erroneously ascribed to procedures marketed to the medical community and patients as having ablative radiobiologic effects. This may not always be the case and depends on dose, fractionation, and tumor type. At times, such marketing appears arbitrary and unscientific. To the dismay of the radiation oncology community, utilization of stereotactic targeting has been frequently misconstrued as delivery of ablative dosing. Prior attempts have been made to focus nomenclature, notably such as those of Loo and colleagues who argued that the term SABR more precisely describes the treatment modality than SBRT [1]. Since that time and with continued advances in technology, further terminology ambiguities have arisen including (hypo)fractionated stereotactic radiosurgery, multi-session radiosurgery, and (hypo)fractionated stereotactic radiotherapy, all of which are frequently used interchangeably with SABR and SBRT. The ramifications of inconsistencies in nomenclature are vast and have implications to standard clinical practice, interpretation of previously reported outcomes comparing radiosurgery to competing modalities, and for those of future trial design. In addition, billing and compensation for these procedures are altered by the application of these nomenclatures, and it is unknown whether compensation and/or marketing drives the use of the term radiosurgery when treatment is non-ablative. For example, fractionated radiosurgery according to US insurance companies is typically reimbursed only as radiosurgery if the number of fractions is no greater than 5; by contrast, some countries in Europe have a fraction limitation of 8, and regimens of 8 fractions may be equivalently ablative. …