A review of published reports of spinal cord tolerance after stereotactic body radiation therapy was performed. This report presents several dose-response models, recommends dose limits for the spinal cord, and outlines standards for future reporting Spinal cord tolerance data for stereotactic body radiation therapy (SBRT) were extracted from published reports, reviewed, and modelled. For de novo SBRT delivered in 1 to 5 fractions, the following spinal cord point maximum doses (D max) are estimated to be associated with a 1% to 5% risk of radiation myelopathy (RM): 12.4 to 14.0 Gy in 1 fraction, 17.0 Gy in 2 fractions, 20.3 Gy in 3 fractions, 23.0 Gy in 4 fractions, and 25.3 Gy in 5 fractions. For reirradiation SBRT delivered in 1 to 5 fractions, reported factors associated with a lower risk of RM include cumulative thecal sac equivalent dose in 2 Gy fractions with an alpha/beta of 2 (EQD2 2) D max 70 Gy; SBRT thecal sac EQD2 2 D max 25 Gy, thecal sac SBRT EQD2 2 D max to cumulative EQD2 2 D max ratio 0.5, and a minimum time interval to reirradiation of !5 months. Larger studies containing complete institutional cohorts with dosimetric data of
Hypoxia-targeted radiotherapy dose painting for head and neck cancer using FMISO PET is technically feasible, increases the TCP without increasing the NTCP, and increases the UTCP. This approach is superior to uniform dose escalation.
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