Intensity-modulated Stereotactic Radiotherapy of Paraspinal Tumors: A Preliminary Report

Bilsky, Mark H.; Yamada, Yoshiya; Yenice, Kamil M.; Lovelock, Michael; Hunt, Margie; Gutin, Philip H.; Leibel, Steven A.

doi:10.1227/01.neu.0000114263.01917.1e

Cited by 140 publications

(76 citation statements)

References 49 publications

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“…In order to limit dose to the spinal cord, modulated treatment techniques are used to produce complex dose distributions that spare organs at risk 4, 5, 6. SBRT spine treatment can be delivered using a number of treatment machines like helical tomotherapy units, robotic radiosurgery systems or on a linac utilizing intensity‐modulated radiotherapy (IMRT) or volumetric‐modulated arc therapy (VMAT).…”

Section: Introductionmentioning

confidence: 99%

Improving accuracy for stereotactic body radiotherapy treatments of spinal metastases

Rijken

Jordan

Crowe

et al. 2018

J Applied Clin Med Phys

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PurposeUse of SBRT techniques is now a relatively common recourse for spinal metastases due to good local control rates and durable pain control. However, the technique has not yet reached maturity for gantry‐based systems, so work is still required in finding planning approaches that produce optimum conformity as well as delivery for the slew of treatment planning systems and treatment machines.MethodsA set of 32 SBRT spine treatment plans based on four vertebral sites, varying in modality and number of control points, were created in Pinnacle. These plans were assessed according to complexity metrics and planning objectives as well as undergoing treatment delivery QA on an Elekta VersaHD through ion chamber measurement, ArcCheck, film‐dose map comparison and MLC log‐file reconstruction via PerFraction.ResultsAll methods of QA demonstrated statistically significant agreement with each other (r = 0.63, P < 0.001). Plan complexity and delivery accuracy were found to be independent of MUs (r = 0.22, P > 0.05) but improved with the number of control points (r = 0.46, P < 0.03); with use of 90 control points producing the most complex and least accurate plans. The fraction of small apertures used in treatment had no impact on plan quality or accuracy (r = 0.29, P > 0.05) but rather more complexly modulated plans showed poorer results due to MLC leaf position inaccuracies. Plans utilizing 180 and 240 control points produced optimal plan coverage with similar complexity metrics to each other. However, plans with 240 control points demonstrated slightly better delivery accuracy, with fewer MLC leaf position discrepancies.ConclusionIn contrast to other studies, MU had no effect on delivery accuracy, with the most impactful parameter at the disposal of the planner being the number of control points utilized.

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Section: Introductionmentioning

confidence: 99%

Improving accuracy for stereotactic body radiotherapy treatments of spinal metastases

Rijken

Jordan

Crowe

et al. 2018

J Applied Clin Med Phys

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“…The rationale for SAbR of the spine is demonstrated in excellent pain control, bone marrow sparing in adjacent vertebrae, and a conventional, short treatment course and recovery time 1 , 2 , 3 , 4 , 5 , 6 . With ablative dose delivery, treatment efficacy is balanced with dose‐related toxicity to the spinal cord, requiring a sharp dose gradient outside the target region.…”

Section: Introductionmentioning

confidence: 99%

Dosimetric comparison of Acuros XB with collapsed cone convolution/superposition and anisotropic analytic algorithm for stereotactic ablative radiotherapy of thoracic spinal metastases

Zhen

Hrycushko

Lee

et al. 2015

J Applied Clin Med Phys

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The aim of this study is to compare the recent Eclipse Acuros XB (AXB) dose calculation engine with the Pinnacle collapsed cone convolution/superposition (CCC) dose calculation algorithm and the Eclipse anisotropic analytic algorithm (AAA) for stereotactic ablative radiotherapy (SAbR) treatment planning of thoracic spinal (T‐spine) metastases using IMRT and VMAT delivery techniques. The three commissioned dose engines (CCC, AAA, and AXB) were validated with ion chamber and EBT2 film measurements utilizing a heterogeneous slab‐geometry water phantom and an anthropomorphic phantom. Step‐and‐shoot IMRT and VMAT treatment plans were developed and optimized for eight patients in Pinnacle, following our institutional SAbR protocol for spinal metastases. The CCC algorithm, with heterogeneity corrections, was used for dose calculations. These plans were then exported to Eclipse and recalculated using the AAA and AXB dose calculation algorithms. Various dosimetric parameters calculated with CCC and AAA were compared to that of the AXB calculations. In regions receiving above 50% of prescription dose, the calculated CCC mean dose is 3.1%–4.1% higher than that of AXB calculations for IMRT plans and 2.8%–3.5% higher for VMAT plans, while the calculated AAA mean dose is 1.5%–2.4% lower for IMRT and 1.2%–1.6% lower for VMAT. Statistically significant differences (p<0.05) were observed for most GTV and PTV indices between the CCC and AXB calculations for IMRT and VMAT, while differences between the AAA and AXB calculations were not statistically significant. For T‐spine SAbR treatment planning, the CCC calculations give a statistically significant overestimation of target dose compared to AXB. AAA underestimates target dose with no statistical significance compared to AXB. Further study is needed to determine the clinical impact of these findings.PACS number: 87.55.D‐, 87.53.Ly

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“…Stereotactic radiosurgery for tumors of the spine has more recently been demonstrated to be accurate, safe, and efficacious. 19,22,23,[25][26][27][28][29][30][31][32][33] The CyberKnife was first developed for the treatment of both benign and malignant intracranial lesions. 48,61,62 Treatment outcome has been similar to the results of conventional frame-based radiosurgery.…”

Section: Figurementioning

confidence: 99%

“…28 Since Hamilton et al 29 first described the possibility of a linear-acceleratorbased spinal stereotactic radiosurgery in 1995, multiple centers have attempted to pursue large fraction conformal radiation delivery to spinal lesions using a variety of technologies. 19,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] Treatment of spinal lesions by stereotactic conformal radiotherapy and intensity-modulated radiation therapy (IMRT) have shown promising clinical results. Several clinical studies have described stereotactic radiosurgery (SRS) for the treatment of brain metastases specifically from breast carcinoma as an effective treatment associated with a low complication rate.…”

mentioning

confidence: 99%

“…[37][38][39][40][41][42] Other researchers have previously shown the feasibility and clinical efficacy of spinal hypofractionated stereotactic body radiotherapy for breast metastases. 19,[21][22][23][24][25][26][27]43 Our previous work has demonstrated both the feasibility as well as the clinical efficacy of spinal radiosurgery for a variety of both benign and malignant lesions using an image-guided frameless SRS delivery system known as the CyberKnife Image-Guided Radiosurgery System (Accuray, Sunnyvale, CA). [22][23][24]26 The purpose of this study was to evaluate the clinical outcomes of radiosurgery for the treatment of metastases to the spine from breast carcinoma to see if such a radiosurgery technique parallels the efficacy that has been demonstrated for the treatment of intracranial breast metastases.…”

mentioning

confidence: 99%

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Single‐fraction radiosurgery for the treatment of spinal breast metastases

Gerszten

Burton

Welch

et al. 2005

Cancer

126

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BACKGROUNDThe spine is the most common site of bony metastases in patients with osseous breast carcinoma metastases. Spine metastases are the source of significant pain and occasionally neurologic deficit in this patient population. Conventional external beam radiotherapy lacks the precision to allow delivery of large single‐fraction doses of radiation and simultaneously limit the dose to radiosensitive structures such as the spinal cord. This study evaluated the clinical efficacy of the treatment of spinal breast carcinoma metastases with a single‐fraction radiosurgical technique.METHODSIn this prospective cohort evaluation, 68 breast carcinoma metastases to the spine in 50 patients were treated with a single‐fraction radiosurgery technique with a follow‐up period of 6–48 months, median 16 months. The most common indication for radiosurgery treatment was pain in 57 lesions, as a primary treatment modality in 8 patients, and for radiographic tumor progression, as a postsurgical boost, and for a progressive neurologic deficit in 1 patient each.RESULTSTumor volume ranged from 0.8–197 cm3 (mean, 27.7 cm3). Maximum tumor dose was maintained at 15–22.5 Gy (mean, 19 Gy). No radiation‐induced toxicity occurred during the follow‐up period (6–48 mo). Long‐term axial and radicular pain improvement occurred in 55 of 57 (96%) patients who were treated primarily for pain. Long‐term radiographic tumor control was seen in all patients who underwent radiosurgery as their primary treatment modality, for radiographic tumor progression, or as a postsurgical treatment.CONCLUSIONSSpinal radiosurgery was found to be feasible, safe, and clinically effective for the treatment of spinal metastases from breast carcinoma. The results indicate the potential of radiosurgery in the treatment of patients with spinal breast metastases, especially those with solitary sites of spine involvement, to improve long‐term palliation. Cancer 2005. © 2005 American Cancer Society.

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Intensity-modulated Stereotactic Radiotherapy of Paraspinal Tumors: A Preliminary Report

Cited by 140 publications

References 49 publications

Improving accuracy for stereotactic body radiotherapy treatments of spinal metastases

Improving accuracy for stereotactic body radiotherapy treatments of spinal metastases

Dosimetric comparison of Acuros XB with collapsed cone convolution/superposition and anisotropic analytic algorithm for stereotactic ablative radiotherapy of thoracic spinal metastases

Single‐fraction radiosurgery for the treatment of spinal breast metastases

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