# SBRT / SABR (stereotactic radiotherapy)

Source: https://onco.cc/technologies/sbrt/  
OnCo record `sbrt` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Stereotactic body radiotherapy converges multiple beams with sub-millimetre accuracy to deliver tumour-destroying doses in one to five outpatient sessions, doing the job of surgery for inoperable early lung cancer and for metastases in liver, spine and brain. Tumour size and location limit its use, and late toxicity is a concern near the central airways.

## Summary

Stereotactic body radiotherapy delivers ablative doses in 1-5 sessions by converging multiple non-coplanar beams with sub-millimetre accuracy, producing steep dose gradients that spare surrounding tissue. It is standard for inoperable early lung cancer, oligometastatic disease, liver, spine, and brain metastases (radiosurgery). SABR-COMET showed an overall survival benefit in oligometastatic disease, which underpins the idea of metastasis-directed therapy. Treatment is outpatient with minimal recovery, and SBRT pairs with immunotherapy in the hope of abscopal effects, though that benefit remains unproven in randomised trials. Limits are tumour size and location, with late toxicity a concern near central airways. The simple version is a few very high, very precise doses that can ablate a tumour much as surgery would.

## Fields

- Kind: Technology
- Status: standard-of-care
- Last checked: 2026-09-04
- Principle: Multiple non-coplanar beams converge with sub-millimetre accuracy; steep dose gradients.
- Strengths: Ablative doses with minimal recovery; Outpatient
- Limitations: Size and location limits; Late toxicity near central airways

## Notes

- Lung cancer: NICE NG122 (1.5.8) says that for people with stage 1 to 2a non-small-cell lung cancer who decline surgery or in whom any surgery is contraindicated, offer stereotactic ablative radiotherapy, and if that is contraindicated offer either conventional or hyperfractionated radiotherapy; (1.5.11) says to follow the SABR Consortium guidance on fractionation. NICE's rationale notes that it is non-invasive, usually delivered as outpatient treatment, and often preferred because it involves fewer hospital visits. Cancer Research UK says radiotherapy to the chest can inflame the lungs, causing a dry cough or shortness of breath soon after treatment (acute radiation pneumonitis), and that in a small number of people cough and breathlessness continue months or years later.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Stereotactic_radiosurgery
- Wikipedia: https://en.wikipedia.org/wiki/Stereotactic_radiosurgery
- NICE NG122: lung cancer, management: https://www.nice.org.uk/guidance/ng122/chapter/Management
- Cancer Research UK: coping with breathlessness when you have lung cancer: https://www.cancerresearchuk.org/about-cancer/lung-cancer/living-with/coping-with-breathlessness

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Metastatic Non-Small Cell Lung Cancer](https://onco.cc/trials/nct06523673/), [Stereotactic Body Radiotherapy Plus FAK and RAF/MEK Inhibition in Advanced Pancreatic Adenocarcinoma](https://onco.cc/trials/nct07126158/), [Stereotactic Brain-directed Radiation With or Without Aguix Gadolinium-Based Nanoparticles in Brain Metastases](https://onco.cc/trials/nct04899908/), [Stereotactic Radiation for Growing/Changing Brain Metastases With Same-Day Radiation Planning and Treatment With Margin Reduction](https://onco.cc/trials/nct07132190/), [STOMP](https://onco.cc/trials/stomp-oligorecurrence/), [Testing if High Dose Radiation Only to the Sites of Brain Cancer Compared to Whole Brain Radiation That Avoids the Hippocampus is Better at Preventing Loss of M](https://onco.cc/trials/nct04804644/), [Testing Longer Duration Radiation Therapy Versus the Usual Radiation Therapy in Patients With Cancer That Has Spread to the Brain](https://onco.cc/trials/nct06500455/), [Testing the Addition of High Dose, Targeted Radiation to the Usual Treatment for Locally-Advanced Inoperable Non-Small Cell Lung Cancer](https://onco.cc/trials/nct05624996/), [Testing the Addition of the Drug Atezolizumab to the Usual Radiation Treatment for Patients With Early Non-small Cell Lung Cancer](https://onco.cc/trials/nct04214262/), [Testing the Addition of Total Ablative Therapy to Usual Systemic Therapy Treatment for Limited Metastatic Colorectal Cancer, ERASur Trial](https://onco.cc/trials/nct05673148/), [Testing the Combination of Two Approved Chemotherapy Drugs and Radiation Prior to Surgery in Localized Pancreatic Cancer](https://onco.cc/trials/nct03492671/), [The Miami "EMPIRE" Trial - Eradication of Metastatic Pancreatic Cancer With Immuno-Radiation](https://onco.cc/trials/nct06843551/)
- people: [Albert C. Koong](https://onco.cc/people/albert-koong/), [Amar U. Kishan](https://onco.cc/people/amar-kishan/), [B. S. Ajaikumar](https://onco.cc/people/ajaikumar-b-s/), [David A. Palma](https://onco.cc/people/david-palma/), [Joe Y. Chang](https://onco.cc/people/joe-chang/), [Maximilian Diehn](https://onco.cc/people/maximilian-diehn/), [Nicholas van As](https://onco.cc/people/nicholas-van-as/), [Robert D. Timmerman](https://onco.cc/people/robert-timmerman/), [Shankar Siva](https://onco.cc/people/shankar-siva/), [Theodore S. Hong](https://onco.cc/people/theodore-hong/), [Theodore S. Lawrence](https://onco.cc/people/theodore-lawrence/)
- journals: [Cancer radiothérapie](https://onco.cc/journals/cancer-radiotherapie/), [Clinical oncology](https://onco.cc/journals/clinical-oncology-rcr/), [Practical radiation oncology](https://onco.cc/journals/practical-radiation-oncology/), [Radiation oncology](https://onco.cc/journals/radiation-oncology/), [Seminars in radiation oncology](https://onco.cc/journals/seminars-in-radiation-oncology/), [Strahlentherapie und Onkologie](https://onco.cc/journals/strahlentherapie-und-onkologie/)
- institutions: [Aarhus University Hospital](https://onco.cc/institutions/aarhus-university-hospital/), [American Society for Radiation Oncology](https://onco.cc/institutions/astro/), [Apollo Hospitals (Apollo Cancer Centres)](https://onco.cc/institutions/apollo-hospitals/), [Atrium Health Wake Forest Baptist Comprehensive Cancer Center](https://onco.cc/institutions/wake-forest-cancer/), [Centre Oscar Lambret](https://onco.cc/institutions/centre-oscar-lambret/), [Champalimaud Foundation, Champalimaud Clinical Centre](https://onco.cc/institutions/champalimaud/), [Comprehensive Cancer Center Freiburg (CCCF)](https://onco.cc/institutions/ccc-freiburg/), [European Society for Radiotherapy and Oncology](https://onco.cc/institutions/estro/), [Fundación Arturo López Pérez](https://onco.cc/institutions/falp-chile/), [Hacettepe University Cancer Institute](https://onco.cc/institutions/hacettepe-cancer-institute/), [Hadassah Medical Center](https://onco.cc/institutions/hadassah/), [Harold C. Simmons Comprehensive Cancer Center, UT Southwestern](https://onco.cc/institutions/utsw-simmons/), [HealthCare Global Enterprises](https://onco.cc/institutions/hcg/), [Hokkaido University Hospital](https://onco.cc/institutions/hokkaido-university-hospital/), [Hospital Universitari i Politècnic La Fe](https://onco.cc/institutions/la-fe-valencia/), [IRCCS Humanitas Research Hospital](https://onco.cc/institutions/humanitas/), [Koo Foundation Sun Yat-Sen Cancer Center](https://onco.cc/institutions/koo-foundation-sun-yat-sen-cancer-center/), [Rajiv Gandhi Cancer Institute and Research Centre](https://onco.cc/institutions/rgci/), [Shandong Cancer Hospital and Institute](https://onco.cc/institutions/shandong-cancer-hospital/), [Stanford Health Care / Stanford Cancer Institute](https://onco.cc/institutions/stanford/), [Sunnybrook Odette Cancer Centre](https://onco.cc/institutions/sunnybrook-odette/), [UMC Utrecht Cancer Center](https://onco.cc/institutions/umc-utrecht/), [University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center](https://onco.cc/institutions/maryland-greenebaum/), [Velindre Cancer Centre](https://onco.cc/institutions/velindre-cardiff/), [Verspeeten Family Cancer Centre, London Health Sciences Centre](https://onco.cc/institutions/lhsc-verspeeten/)
- pathways: [cGAS-STING innate sensing](https://onco.cc/pathways/cgas-sting/), [Cold tumours: immune deserts and exclusion](https://onco.cc/pathways/immune-desert-exclusion/), [Double-strand break repair: HR versus end joining](https://onco.cc/pathways/homologous-recombination-repair/), [Organ tropism: seed and soil](https://onco.cc/pathways/organ-tropism-seed-soil/), [The blood-brain barrier & brain metastasis](https://onco.cc/pathways/blood-brain-barrier-metastasis/), [The cancer-immunity cycle](https://onco.cc/pathways/cancer-immunity-cycle/), [The metastatic cascade](https://onco.cc/pathways/metastatic-cascade/)
- pairings: [Radiotherapy + immunotherapy](https://onco.cc/pairings/radiation-plus-io/)
- bottlenecks: [Metastasis is understood least and studied last](https://onco.cc/bottlenecks/b-metastasis-biology/), [Surgery and radiotherapy cure most, get least](https://onco.cc/bottlenecks/b-surgery-radiation-innovation/), [The brain: barrier and sanctuary](https://onco.cc/bottlenecks/b-brain-delivery/)
- roadmaps: [Paths to cures: interception, eradication, control](https://onco.cc/roadmaps/cure-paths/), [Radiotherapy roadmap: X-rays → shaped beams → fewer fractions, particles and FLASH](https://onco.cc/roadmaps/radiation-roadmap/)

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JSON: https://onco.cc/api/v1/entities/sbrt.json