Updated ASTRO SBRT model policy

The CyberKnife Coalition (CKC) is pleased to make you aware of a significant policy development supporting SBRT for the treatment of prostate and metastatic bone cancer. The American Society for Radiation Oncology (ASTRO) has just updated its model Stereotactic Body Radiation Therapy (SBRT) policy. This updated policy can be found on ASTRO’s website at:

https://www.astro.org/uploadedFiles/Main_Site/Practice_Management/Reimbursement/2013HPcoding%20guidelines_SBRT_Final.pdf

ASTRO’s new position on prostate cancer and bone metastases is as follows:

Prostate Cancer:

Many clinical studies supporting the efficacy and safety of SBRT in the treatment of prostate cancer have been published. At least one study has shown excellent five year biochemical control rates with very low rates of serious toxicity. Additionally, numerous studies have demonstrated the safety of SBRT for prostate cancer after a follow-up interval long enough (two to three years) to provide an opportunity to observe the incidence of late GU or GI toxicity. While it is necessary to observe patients treated for prostate cancer for extended intervals to gauge the rate of long term (beyond 10 years) biochemical control and overall survival, the interim results reported appear at least as good as other forms of radiotherapy administered to patients with equivalent risk levels followed for the same duration post-treatment.

It is ASTRO’s opinion that data supporting the use of SBRT for prostate cancer have matured to a point where SBRT could be considered an appropriate alternative for select patients with low to intermediate risk disease.

Bone Metastases:

SBRT has been demonstrated to achieve durable tumor control when treating lesions in vertebral bodies or the paraspinous region, where extra care must be taken to avoid excess irradiation of the spinal cord when tumor-ablative doses are administered. There is an important clinical distinction between the status of patients described above and patient with widely metastatic disease for whom palliation is the major objective. In one setting, a patient with limited metastatic disease and good performance status is treated with the intention of eradicating all known active disease or greatly reducing the total disease burden in a manner that can extend progression-free survival. For such a patient SBRT can be a reasonable therapeutic intervention. However, for uncomplicated, previously untreated bone metastases in a patient with widespread progressive disease in the spine or elsewhere, where the prognosis is unfavorable, it is generally appropriate to use a less technically complex form of palliative radiotherapy rather than SBRT.

We wish to thank ASTRO for making these important changes to its model policy and for endorsing SBRT as an effective and safe treatment for prostate cancer and bone metastases. We look forward to working collaboratively with our member facilities and payers to ensure that appropriate patients have access to this important and technologically advancement treatment option.