Advances and Prospects of Stereotactic Radiosurgery and Stereotactic Ablative Body Radiotherapy: Evolving Paradigms in Precision Oncology

ABSTRACT Stereotactic radiosurgery (SRS) and stereotactic ablative body radiotherapy (SABR) have revolutionized precision oncology by delivering high‐dose, conformal radiation with submillimeter accuracy. These advancements have transformed the management of early‐stage, locally advanced, and oligometastatic cancers, as well as select non‐oncologic conditions. This review examines technological innovations, from frame‐based Gamma Knife to MRI‐guided adaptive systems, and presents clinical evidence demonstrating local control rates exceeding 80% in non‐small cell lung cancer, hepatocellular carcinoma, and renal cell carcinoma, alongside survival benefits in oligometastatic disease. The integration of immune checkpoint inhibitors has further enhanced systemic efficacy, with emerging trials highlighting radiation‐induced immunomodulation. Additionally, precision imaging techniques have reduced treatment‐related toxicities, while single‐fraction regimens have streamlined delivery without compromising therapeutic outcomes. Beyond oncology, SRS/SABR have demonstrated efficacy in treating arteriovenous malformations and providing pain palliation. However, challenges remain, including site‐specific toxicities and the need for standardized dosimetry. These issues underscore the necessity for prospective trials to optimize fractionation schemes, refine patient selection through biomarker‐guided approaches, and explore multimodal strategies, solidifying SRS/SABR as cornerstone technologies in personalized cancer care.