Biological Principles of Stereotactic Body Radiation Therapy (SBRT) and Stereotactic Radiation Surgery (SRS): Indirect Cell Death

Chang W. Song, Eli Glatstein, Lawrence B. Marks, Bahman Emami, Jimm Grimm, Paul W. Sperduto, Mi Sook Kim, Susanta Hui, Kathryn E Dusenbery, L. Chinsoo Cho

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Purpose: To review the radiobiological mechanisms of stereotactic body radiation therapy stereotactic body radiation therapy (SBRT) and stereotactic radiation surgery (SRS). Methods and Materials: We reviewed previous reports and recent observations on the effects of high-dose irradiation on tumor cell survival, tumor vasculature, and antitumor immunity. We then assessed the potential implications of these biological changes associated with SBRT and SRS. Results: Irradiation with doses higher than approximately 10 Gy/fraction causes significant vascular injury in tumors, leading to secondary tumor cell death. Irradiation of tumors with high doses has also been reported to increase the antitumor immunity, and various approaches are being investigated to further elevate antitumor immunity. The mechanism of normal tissue damage by high-dose irradiation needs to be further investigated. Conclusions: In addition to directly killing tumor cells, high-dose irradiation used in SBRT and SRS induces indirect tumor cell death via vascular damage and antitumor immunity. Further studies are warranted to better understand the biological mechanisms underlying the high efficacy of clinical SBRT and SRS and to further improve the efficacy of SBRT and SRS.

Bibliographical note

Funding Information:
This work was supported by grants from The Karen Wyckoff Rein in Sarcoma Foundation, University of Minnesota Foundation, and Elekta (Sweden). This work was supported by grants from The Karen Wyckoff Rein in Sarcoma Foundation, University of Minnesota Foundation, and Elekta (Sweden). We thank Inhwan Park and Haeun Cho for their dedicated and skillful assistance. We would like to dedicate this article to the late Dr Seymour H. Levitt, who helped us draft this article. This work was supported by grants from The Karen Wyckoff Rein in Sarcoma Foundation, University of Minnesota Foundation, and Elekta (Sweden).

Funding Information:
This work was supported by grants from The Karen Wyckoff Rein in Sarcoma Foundation, University of Minnesota Foundation, and Elekta (Sweden).

Publisher Copyright:
© 2019 Elsevier Inc.

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