Dosimetric evaluation of 4 different treatment modalities for curative-intent stereotactic body radiation therapy for isolated thoracic spinal metastases

Yang, Jun; Ma, Lin; Wang, Xiaoshen; Xu, Wei; Xu, Cong; Xu, Su; Ju, Zhongjian; Du, Liqing; Cai, Baiqiang; Yang, Jack

doi:10.1016/j.meddos.2015.10.003

Cited by 10 publications

(10 citation statements)

References 34 publications

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“…Multiple studies have compared treatment planning quality among dynamic conformal arcs, static IMRT, VMAT and tomotherapy for spine 24, 25, 26. Matuszak et al .…”

Section: Discussionmentioning

confidence: 99%

Dosimetric study for spine stereotactic body radiation therapy: magnetic resonance guided linear accelerator versus volumetric modulated arc therapy

Yadav

Musunuru

Witt

et al. 2019

Radiology and Oncology

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Background Stereotactic body radiation therapy (SBRT) given in 1-5 fractions is an effective treatment for vertebral metastases. Real-time magnetic resonance-guided radiotherapy (MRgRT) improves soft tissue contrast, which translates into accurate delivery of spine SBRT. Here we report on clinical implementation of MRgRT for spine SBRT, the quality of MRgRT plans compared to TrueBeam based volumetric modulated arc therapy (VMAT) plans in the treatment of spine metastases and benefits of MRgRT MR scan. Patients and methods Ten metastatic lesions were included in this study for plan comparison. Lesions were spread across thoracic spine and lumbosacral spine. Three fraction spine SBRT plans: 27Gy to planning target volume (PTV) and 30Gy to gross tumor volume (GTV) were generated on the ViewRay MRIdian Linac system and compared to TrueBeamTM STx based VMAT plans. Plans were compared using metrics such as minimum dose, maximum dose, mean dose, ratio of the dose to 50% of the volume (R50), conformity index, homogeneity index and dose to the spinal cord. Results MRIdian plans achieved equivalent target coverage and spinal cord dose compared to VMAT plans. The maximum and minimum PTV doses and homogeneity index were equivalent for both planning systems. R50 was lower for MRIdian plans compared to VMAT plans, indicating a lower spread of intermediate doses with MRIdian system (5.16 vs. 6.11, p = 0.03). Conclusions MRgRT can deliver high-quality spine SBRT plans comparable to TrueBeam volumetric modulated arc therapy (VMAT) plans.

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“…Multiple studies have compared treatment planning quality among dynamic conformal arcs, static IMRT, VMAT and tomotherapy for spine 24, 25, 26. Matuszak et al .…”

Section: Discussionmentioning

confidence: 99%

Dosimetric study for spine stereotactic body radiation therapy: magnetic resonance guided linear accelerator versus volumetric modulated arc therapy

Yadav

Musunuru

Witt

et al. 2019

Radiology and Oncology

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“…stereotactic body radiotherapy [SBRT]) may augment the results of the primary treatment of metastatic spine lesions. SBRT delivers a high dose of radiation to metastatic lesions with a steep dose gradient that may spare adjacent neural structures, notably the cord and conus. MRI‐guided robotic linear accelerator (LINAC) radiotherapy is under development, and capable of focusing beams to within 1 mm of spatial accuracy.…”

Section: Radiologymentioning

confidence: 99%

Spinal Metastatic Disease: A Review of the Role of the Multidisciplinary Team

Curtin

Piggott

Murphy

et al. 2017

Orthopaedic Surgery

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Historically, a simple approach centered on palliation was applicable to the majority of patients with metastatic spinal disease. With advances in diagnosis and treatment, a more complicated algorithm has devolved requiring a multidisciplinary approach with institutional commitment and support. We performed a database review including pertinent articles exploring the multidisciplinary management of spinal metastatic disease. The wide variation in clinical presentation and tumor response to treatment necessitates a multidisciplinary approach that integrates the diagnosis and treatment of the cancer, symptom management, and rehabilitation for optimal care of patients with spinal metastases. Advances in the field of radiology have led to earlier and more focused diagnosis of spinal metastasis and acts to guide therapy. Advances in surgical techniques, neurophysiologic monitoring, and anesthetic expertise have allowed surgeons to perform more extensive procedures leading to improved outcomes and reduced morbidity. Radiation oncology input that is essential as external beam radiation therapy can provide significant pain relief. Non-operative measures may include bisphosphonate infusions, management of complications (e.g. hypercalcemia of malignancy), monoclonal antibody infusions, and chemotherapy if indicated in the treatment of the primary malignancy. Input from psychology services is necessary to address the biopsychosocial ramifications of spinal metastasis. Allied health professionals in the form of physiotherapists, social workers, and dieticians also contribute in maximizing patients' quality of life and well-being.

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“…For these reasons, CK is widely used for Stereotactic Body Radiation Therapy (SBRT) treatments of different anatomical sites. However, CK SBRT has poor delivery efficiency due to the large number of monitor units (MUs) and to the time required for the robot to move to different node positions [2][3][4][5][6]. The recent implementation of a multileaf collimator (MLC) (InCise™) gives the possibility to treat larger tumors and to reduce MUs and treatment times [7][8][9][10]; these characteristics make this collimator the preferred choice for treatment of large body lesions.…”

Section: Introductionmentioning

confidence: 99%

Performance assessment of a new optimization system for robotic SBRT MLC-based plans

Calusi

Doro²,

Cataldo³

et al. 2020

Physica Medica

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A B S T R A C TPurpose: To assess the performance of a new optimization system, VOLO, for CyberKnife MLC-based SBRT plans in comparison with the existing Sequential optimizer. Methods: MLC-plans were created for 25 SBRT cases (liver, prostate, pancreas and spine) using both VOLO and Sequential. Monitor units (MU), delivery time (DT), PTV coverage, conformity (nCI), dose gradient (R50%) and OAR doses were used for comparison and combined to obtain a mathematical score (MS) of plan quality for each solution. MS strength was validated by changing parameter weights and by a blinded clinical plan evaluation. The optimization times (OT) and the average segment areas (SA) were also compared. Results: VOLO solutions offered significantly lower mean DT (−19%) and MU (−13%). OT were below 15 min for VOLO, whereas for Sequential, values spanned from 8 to 160 min. SAs were significantly larger for VOLO: on average 10 cm 2 versus 7 cm 2 . VOLO optimized plans achieved a higher MS than Sequential for all tested parameter combinations. PTV coverage and OAR sparing were comparable for both groups of solutions. Although slight differences in R50% and nCI were found, the parameters most affecting MS were MU and DT. VOLO solutions were selected in 80% of cases by both physicians with 88% inter-observer agreement. Conclusions: The good performance of the VOLO optimization system, together with the large reduction in OT, make it a useful tool to improve the efficiency of CK SBRT planning and delivery. The proposed methodology for comparing different planning solutions can be applied in other contexts.

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Dosimetric evaluation of 4 different treatment modalities for curative-intent stereotactic body radiation therapy for isolated thoracic spinal metastases

Cited by 10 publications

References 34 publications

Dosimetric study for spine stereotactic body radiation therapy: magnetic resonance guided linear accelerator versus volumetric modulated arc therapy

Dosimetric study for spine stereotactic body radiation therapy: magnetic resonance guided linear accelerator versus volumetric modulated arc therapy

Spinal Metastatic Disease: A Review of the Role of the Multidisciplinary Team

Performance assessment of a new optimization system for robotic SBRT MLC-based plans

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