At a glance
Stereotactic Body Radiotherapy (SBRT) is a non-surgical radiation treatment that delivers very high, precisely aimed doses of radiation directly to a tumor in a small number of sessions, usually between one and five.
Unlike conventional radiotherapy, which spreads lower doses over many weeks, SBRT uses advanced imaging and computer-guided targeting to concentrate the beam on the tumor from multiple angles. The overlapping beams meet at the tumor with great force while the surrounding healthy tissue receives only a fraction of that dose. This focused attack damages the DNA inside cancer cells so severely that they cannot repair themselves and eventually die.
Medical Condition
SBRT is used most often when a tumor is small, well-defined on imaging, and located in a part of the body where surgery carries high risk or the patient prefers to avoid an operation.
- Early-stage lung cancer, particularly in patients whose lungs or heart cannot tolerate surgery.
- Liver tumors, including primary liver cancer and metastases (cancer that has spread from another organ).
- Spine or vertebral metastases that are pressing on or very close to the spinal cord.
- Prostate cancer, as a primary treatment for localized disease.
- Kidney tumors in patients who are not suitable candidates for surgery.
- Adrenal gland tumors and other isolated metastases in the abdomen or pelvis.
- Pancreatic cancer, often combined with chemotherapy.
- Oligometastatic disease, meaning a small number of metastatic tumors (usually five or fewer) in patients who have responded well to systemic treatment.
SBRT is not suitable for every patient. Your oncologist will review your case carefully before recommending it.
- Tumors that are too large or have irregular, poorly defined edges on imaging.
- Cancer that has spread widely through the body, making localized treatment insufficient on its own.
- Tumors located directly adjacent to a structure that cannot tolerate high radiation, such as the bowel or the main airway in the lung.
- Patients who cannot remain completely still during treatment, such as those with severe breathing difficulties or uncontrolled movement disorders.
- Prior radiation to the same area that has already reached the tissue's safe limit.
Risks & Complications
SBRT is generally well tolerated, but like any radiation treatment it carries risks that depend heavily on which organ is being treated and how close the tumor sits to sensitive structures.
- Fatigue in the days or weeks after treatment, which is the most commonly reported side effect.
- Skin redness or irritation in the area where the beams enter the body.
- Radiation pneumonitis (inflammation of the lung tissue), when the lungs are treated, causing cough or shortness of breath that usually resolves with medication.
- Esophagitis (irritation of the food pipe) when tumors near the chest or spine are treated, leading to difficulty or pain when swallowing.
- Liver inflammation or a temporary drop in liver function when liver tumors are targeted.
- Bowel irritation, including diarrhea or pain, when tumors in the abdomen or pelvis are treated.
- Rib fracture (a crack in a rib bone) in a small number of patients treated for lung tumors, usually minor and self-healing.
- Nerve damage near the treated area, which may cause numbness, weakness, or pain.
- A rare but serious risk called radiation-induced myelopathy (damage to the spinal cord) when spine tumors are treated very close to the cord.
- Secondary cancer from radiation is theoretically possible decades later, though the benefit of treating an existing cancer far outweighs this remote risk.
Preparation & Procedure
Preparation for SBRT takes place over several visits before the first treatment session, and includes both planning steps carried out by the medical team and things the patient does at home.
At home, patients are usually asked to eat lightly and avoid heavy meals on the day of each session. Some centers ask patients to follow a specific bowel preparation, such as a low-fiber diet or enema, for tumors in the abdomen or pelvis. Patients taking blood thinners or anti-inflammatory medications will be advised by their doctor whether to pause those medications before treatment. Smoking can affect how well the lungs heal, so the care team will encourage stopping before treatment begins. Alcohol is best avoided in the days leading up to each session.
Several tests are typically completed before treatment planning begins.
- CT scan and, in many cases, MRI or PET-CT scan to map the tumor precisely.
- Blood tests to check liver function, kidney function, and blood cell counts.
- Pulmonary function tests (breathing tests) when the lungs will be treated.
- Biopsy results or prior pathology reports confirming the tumor type, if not already available.
- Cardiac evaluation for patients with a history of heart disease, since lying still during treatment may not be suitable for everyone.
The procedure itself follows a set sequence of steps, though the exact number of sessions and the duration of each session vary by center and by tumor location.
- Simulation session: the patient lies in the treatment position while a CT scan is taken. Tiny tattoo marks or surface marks are placed on the skin to ensure exact positioning at every session.
- Immobilization device fitting: a custom mold, vest, or frame is made to hold the patient still and in the same position each time.
- If a tumor in the lung or liver moves with breathing, the team may use a technique called respiratory gating or ask the patient to hold their breath at a set point during imaging and treatment.
- Treatment planning: radiation oncologists and medical physicists spend several days designing the exact beam angles and doses using computer software. The patient is not present for this step.
- Quality check: the plan is tested on a phantom (a body-like object) before it is used on a patient.
- Treatment delivery: the patient lies still on the treatment table in the same position as during simulation. The machine rotates around the body or moves in set arcs, delivering the planned dose. A single session typically lasts between 30 and 90 minutes, much of which is setup time.
- This is repeated for the planned number of sessions, usually spread over one to two weeks.
Aftercare
Most patients go home the same day as each treatment session, since SBRT is almost always delivered as an outpatient procedure. A brief observation period after the session is common, but overnight stays are rarely needed unless the patient has other medical conditions requiring monitoring.
- Fatigue is normal in the first few weeks after the final session. Rest when needed and gradually return to normal activity as energy allows.
- Driving is usually avoided on treatment days if the patient has received sedation or anxiety medication, though many patients drive themselves without issue.
- A follow-up imaging appointment, typically a CT or PET-CT scan, is scheduled six to eight weeks after the last session to assess how the tumor has responded. Additional scans are arranged every few months after that.
- For lung SBRT, patients are monitored for signs of radiation pneumonitis, including new cough, fever, or shortness of breath. These symptoms should be reported promptly to the care team rather than waited out.
- For liver or abdominal SBRT, blood tests to check liver and kidney function are usually repeated within a few weeks of finishing treatment.
- For spine SBRT, a neurological check, meaning an assessment of strength, sensation, and reflexes, is typically part of the follow-up schedule.
- Skin in the treatment area may remain slightly red or sensitive for several weeks. Gentle washing with mild soap is usually recommended; tight clothing over the area is best avoided.
- Alcohol and smoking are best minimized during the recovery period, as both can slow tissue healing.
- Patients whose prostate was treated may be advised about bladder and bowel habits to watch for in the weeks following treatment.
- The oncology team will coordinate with any referring physician or general practitioner to share scan results and decide on the next step, which may include systemic therapy, surveillance, or no further treatment.
Cost & What Determines It
The cost of SBRT varies considerably from one country and hospital to another, and even between patients treated at the same center, because the price is built from many procedure-specific components that differ for every case.
- Tumor location and complexity: a tumor deep in the spine or adjacent to a critical organ requires more complex planning and longer machine time than a straightforward lung lesion.
- Number of treatment fractions: a single-session treatment costs less than a five-session course because machine time, staff time, and quality checks are repeated at each session.
- Type of delivery technology: different radiation delivery systems carry different facility costs, and not every hospital offers every option.
- Simulation and planning work: the CT simulation scan, any additional MRI or PET-CT needed for planning, and the hours of medical physics planning are typically billed separately from the treatment itself.
- Immobilization devices: custom-made body molds or frames used to hold the patient in position are often charged individually.
- Hospital class and country: private specialist cancer centers in high-income countries charge considerably more than hospitals in countries with lower operating costs, even for the same technology.
- Pre-treatment tests: blood panels, pulmonary function tests, cardiac assessments, and biopsy review fees add to the total.
- Medications during and after treatment: anti-nausea drugs, steroids to manage inflammation, and any antibiotics prescribed during the course are usually billed separately.
- Follow-up imaging: the CT or PET-CT scans done weeks after treatment to confirm response are almost never included in the treatment price.
Hospital packages for SBRT, when offered, typically include the simulation session, the planning work, the treatment sessions themselves, and basic nursing care during each visit. What tends to be billed separately includes pre-treatment diagnostic scans, specialist consultations before and after treatment, medications, and all follow-up imaging.
Indonesian patients traveling abroad for SBRT should be aware that BPJS Kesehatan does not cover treatment received outside Indonesia, and most Indonesian private health insurance policies also exclude overseas care. Patients generally pay out of pocket or through a private international health insurance plan that explicitly covers treatment abroad. Before booking travel or accommodation, requesting a written cost estimate from the treating hospital, broken down by each component, is the most reliable way to understand the full financial commitment and avoid unexpected charges on arrival.
Frequently Asked Questions
How many sessions does SBRT take?
SBRT is usually delivered in 1 to 5 sessions, which is far fewer than standard radiotherapy that can run for several weeks. Your radiation oncologist (a doctor who specialises in treating cancer with radiation) will decide the exact number based on the size and location of the tumour.
What does SBRT feel like during treatment?
Most people feel nothing unusual while the radiation beam is being delivered, because the process itself is painless. Each session typically takes between 30 and 90 minutes in the treatment room, though the actual beam-on time is much shorter. Some people notice fatigue or mild skin sensitivity in the treated area over the course of treatment.
How soon will SBRT start working?
The radiation begins affecting tumour cells immediately, but visible results on scans often take weeks to months to appear. Your doctor will schedule follow-up imaging at set intervals to track how the tumour is responding. Some patients notice symptom relief relatively early, while others see gradual changes over a longer period.
How much does SBRT cost?
The cost varies depending on the number of treatment sessions prescribed, the complexity of the tumour's location, the type of machine used, and the class of the hospital. A written estimate from the hospital you choose is the most reliable way to understand what you will actually pay.
This page is general information, not a substitute for medical advice. Every case is different. Your doctor decides what is right for you.
