The surface-guided radiotherapy (SGRT) technique improves patient positioning with submillimeter accuracy compared with the conventional positioning technique of lasers using three-point tattoos. SGRT provides solutions to considerations that arise from the conventional setup technique, such as variability in tattoo position and the psychological impact of the tattoos. Moreover, SGRT provides monitoring of intrafractional motion. Purpose: This literature review covers the basics of SGRT systems and examines whether SGRT can replace the traditional positioning technique. In addition, it investigates SGRT’s potential in reducing positioning times, factors affecting SGRT accuracy, the effectiveness of live monitoring, and the impact on patient dosage. Materials and Methods: This study focused on papers published from 2016 onward that compared SGRT with the traditional positioning technique and investigated factors affecting SGRT accuracy and effectiveness. Results/Conclusions: SGRT provides the same or better results regarding patient positioning. The implementation of SGRT can reduce overall treatment time. It is an effective technique for detecting intrafraction patient motion, improving treatment accuracy and precision, and creating a safe and comfortable environment for the patient during treatment.

Background/Objectives: The use of stereotactic body radiotherapy (SBRT) for centrally and ultra-centrally located early-stage non-small cell lung cancer (NSCLC) remains clinically challenging due to the proximity of critical mediastinal organs at risk and the limited prospective evidence, particularly for ultra-central disease. Real-world data are needed to better define the safety and efficacy of SBRT when delivered according to contemporary protocol-based planning principles. Methods: This retrospective cohort study included patients treated at two radiotherapy centers, with centralized follow-up and outcome adjudication at a single academic institution. We evaluated patients with centrally or ultra-centrally located, early-stage NSCLC treated with SBRT according to dose-fractionation and planning principles derived from the NRG Oncology/RTOG 0813 protocol. Tumors were classified as central or ultra-central according to the International Association for the Study of Lung Cancer and HILUS definitions, respectively. The prescribed dose was 50 Gy in five fractions. Primary endpoints were treatment-related toxicity and local progression-free survival (LPFS). Secondary endpoints included overall survival (OS), progression-free survival (PFS), and dosimetric outcomes. Survival endpoints were analyzed using the Kaplan–Meier method. Results: Seventy-eight patients were included, of whom 52 had centrally located and 26 ultra-centrally located tumors. Median follow-up was 57 months. The overall objective response rate was 92.3%. The estimated 4-year LPFS was 97.4% for the entire cohort, with rates of 100% for central and 91.6% for ultra-central tumors (p < 0.001). Four-year OS was 98.7%, with no treatment-related deaths observed. Treatment-related toxicity was minimal, with grade ≥ 2 events occurring in only one patient (1.3%) and no grade ≥ 3 toxicity. All treatment plans met predefined organ-at-risk dose constraints. Conclusions: In this real-world cohort, SBRT delivered according to RTOG 0813 planning principles achieved excellent local control with minimal clinically relevant toxicity in patients with centrally and ultra-centrally located early-stage NSCLC. These findings support the safe implementation of SBRT in carefully selected patients when stringent organ-at-risk constraints and conservative treatment planning are employed.

Introduction: Stereotactic radiosurgery is a highly precise radiotherapy technique widely used for the management of brain metastases. While VMAT enables highly conformal dose distributions, it is often associated with increased plan complexity and longer delivery times. Optimized dynamic conformal arc therapy (OptDCA) represents a less complex alternative that may achieve comparable dosimetric performance. In this retrospective study, dosimetric quality, deliverability, and plan complexity of VMAT and OptDCA were compared for single-isocenter SRS of multiple brain metastases. Materials and Methods: Thirty patients previously treated with VMAT were randomly selected and replanned using OptDCA with identical beam arrangements. Plan quality was evaluated using the Paddick conformity index, gradient index, target coverage, MUs, and brain V12Gy and V20Gy. Deliverability was assessed using gamma passing rates, and plan complexity was quantified using multiple complexity metrics. Results: VMAT achieved a slightly higher CI (0.72 vs. 0.71) but required a higher number of MUs (5376 vs. 4820), while no significant differences were observed in GI or target coverage. OptDCA demonstrated significantly higher GPR (median 96.95% vs. 91.1%) and consistently lower plan complexity. Significant correlations were observed between GPR and several complexity metrics for both techniques. Conclusion: Overall, OptDCA provides comparable plan quality to VMAT, while offering improved deliverability and reduced complexity, making it a viable alternative technique.