Current conventional or standard EBRT uses three-dimensional (3D) imaging technology from computed tomography (CT), positron-emission tomography (PET), and/or magnetic resonance imaging (MRI) for planning purposes and delivers photon beams of uniform intensity to the target tumor using a medical linear accelerator (linac). Conformal refers to the ability to precisely conform the delivery of the EBRT to the shape and size of the tumor, so current conventional EBRT is often referred to as 3D conformal radiation therapy (3DCRT).
Over the past ten years, significant advances have been made in the techniques available to deliver EBRT including stereotactic radiation surgery (SRS) limited to the central nervous system and a single dose, stereotactic body radiation therapy (SBRT), intensity modulated radiation therapy (IMRT), and proton or particle beam radiation therapy. For SRS and SBRT, the technical goals are to 1) improve the targeting of the radiation to the tumor to minimize damage of normal tissue and 2) increase the dose of radiation (fraction) delivered to improve outcomes and decrease the number of fractions (doses) and length of treatment. The patient-important outcomes of SRS and SBRT include: 1) improved survival in patients with inoperable cancer due to the location of the tumor or patient condition, 2) reduced acute and chronic radiation side-effects, and 3) improved convenience for patients since the course of treatment may be substantially shorter.
The focus of this report will be on SRS and SBRT. However, it should be noted that SBRT and IMRT are not mutually exclusive.
Updated Key Questions Published: June 18, 2012
Updated Public Comment Period: June 18 - July 2, 2012
Draft Report Published: August 31, 2012
Public Comment Period: August 31 - October 1, 2012
Final Report Published: October 15, 2012
HTCC Public Meeting: November 16, 2012
There is increasing use of IMRT for a variety of cancers. The impact of this technology on patient-important outcomes compared to current conventional (coronal or standard) EBRT is unclear.
Primary Criteria Ranking
Safety = Medium
Efficacy = High
Cost = High
Final Findings and Decision (416.9 KB)
Final Evidence Report (3.4 MB)
Appendix B: Excluded References (1.6 MB)
Appendix E: Summary of Findings Table by Malignancy (750.5 KB)
Appendix J: Peer Review Comments and Disposition (712.9 KB)
Appendix K: Public Comments and Disposition - Key Questions (5.2 MB)
Appendix L: Public Comments and Disposition - Draft Report (4.8 MB)
Final Key Questions - Version 2 (107.7 KB)
Final Key Questions - Public Comments (7 MB)