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Introduction: Where We Are, Where We Have Been, and Where We Are Going
February 1, 2021 from 11:15am EST to 12:45pm EST
Medical Physics Perspective
SABR/SBRT has been dominating our horizons since making the leap from cranial applications in the 1990’s. It is an exciting, albeit risky venture - balancing potential for a meaningful impact in radiotherapy with the risk of doing significant harm if not done correctly. For a medical physicist, it is a dream come true as there are many complex problems that need solving; exquisite equipment performance, inventive immobilization systems, impressive image registrations, devilish dose calculations, maddening moving targets, beautiful beam arrangements, and intense image guidance. The balance between achieving a sufficient BED to the target while respecting still-evolving normal tissue tolerances makes for a challenging treatment scenario. With clinical trial data coming in fast to support SABR in both primary cancer (i.e. NSCLC, HCC, prostate) and metastatic (i.e. oligometastatic) settings, centres are in a stronger position to advocate for operational support from their hospital administrations and health ministries as the up-front human & equipment investment is considerable. The recent COVID pandemic has forced many centres to look closely at the evidence for hypofractionation and this may facilitate the push that is needed to make the leap towards more SABR-like dose fractionations.