Single and Multifraction Spine Stereotactic Body Radiation Therapy and the Risk of Radiation Induced Myelopathy

Biomedical advances and future prospects of high-precision three-dimensional radiotherapy and four-dimensional radiotherapy

“…Recommended dose constraints in spinal SRS are also conservative like the brain: 14 Gy/1 Fr (EQD2 2 = 56 Gy) to 0.03 cc (radius = 2 mm) of spinal cord, 10 Gy/1 Fr (EQD2 2 = 30 Gy) to absolute spinal cord volumes smaller than 0.35 cc (radius = 4 mm), and 10 Gy/1 Fr to no more than 10% of the partial spinal cord volume (5–6 mm above the target spine to 5–6 mm below the target spine). 178 , 179 ) In recent RCT protocols, the dose constraint to the spinal cord in high-precision 3DXT was 17 Gy/2 Fr (EQD2 2 = 44.6 Gy), which is biologically similar to the dose constraint of 44 Gy/22 Fr (EQD2 2 = 44 Gy) in conventional 2DXT. 180 ) However, using the same dose constraints to the spinal cord, high-precision 3DXT was able to give 24 Gy/2 Fr (EQD2 2 = 84 Gy, EQD2 10 = 44 Gy) to vertebral metastatic tumors improving the therapeutic radio for pain at 3 months compared with the 2DXT, 20 Gy/5 Fr (EQD2 2 = 43.8 Gy, EQD2 10 = 31.3 Gy).…”

Tumor treating fields suppress tumor cell growth and neurologic decline in models of spinal metastases

“…In this context, the ideal treatment of spinal tumors should not disrupt the management of systemic disease. While radiation therapy is effective in the majority of patients with spinal metastases, recurrence after cEBRT is common and some patients develop multiply recurrent tumors not amenable to further radiation therapy (11,12). Although numerous therapeutic strategies for these patients have been described (13)(14)(15)(16)(17), these interventions are unlikely to prevent disease progression in radiation-refractory tumors.…”