Stereotactic Body Radiation Therapy for Spinal Malignancies

Abstract

Stereotactic body radiation therapy and stereotactic radiosurgery have become important treatment options for the treatment of spinal malignancies. A better understanding of dose tolerances with more conformal technology have allowed administration of higher and more ablative doses. In this review, the framework for approaching a patient with spinal metastases and primary tumors will be discussed as well as details on the delivery of this treatment.

Personalized Radiation Therapy in Cancer Pain Management

“…Furthermore, the oligometastatic state in clinical practice has been defined when 1–5 distant metastases are found in a cancer patient [56]. Advances in radiation therapy planning software, custom patients immobilization, and sophisticated radiation delivery equipment utilizing multiple conformal beams or arc therapy with intensity modulation and image guidance, with each treatment allowing for accuracy within millimetres, facilitate obtaining a very precisely covered radiation target with extremely high biological doses of radiation delivered in 1 to few fractions [57] (Figure 2C). Single fraction radiation therapy is called “radiosurgery” whereas delivering multiple fractions—stereotactic body radiation therapy (SBRT).…”

“…Indications for SBRT include one to three vertebral metastases, less than 5 cm in diameter [52]. Symptomatic spinal cord compression may be a contraindication for the treatment, as the myelopathy after SBRT may increase [57]. Several doses per fraction are used, from single 15–24 Gy fractions to 18–36 Gy delivered in 1–5 fractions [57,58,59,60,61,62].…”

“…Symptomatic spinal cord compression may be a contraindication for the treatment, as the myelopathy after SBRT may increase [57]. Several doses per fraction are used, from single 15–24 Gy fractions to 18–36 Gy delivered in 1–5 fractions [57,58,59,60,61,62]. Of note, data concerning efficacy and safety of the treatment come from retrospective analyses [46,47,48,49,50,51].…”

“…About 40% of radiation oncologists in the US report that they use spine SBRT in their radiation departments and the single fraction is preferable due to greatest patient comfort and outpatient treatment convenience [63]. Unfortunately, many studies assessing the efficacy of spine SBRT report excellent local control (LC approximately 90%), while they do not provide information on pain control [57].…”

Full automation of spinal stereotactic radiosurgery and stereotactic body radiation therapy treatment planning using Varian Eclipse scripting

“…Current approaches to spine SRS/SBRT require generation of complex treatment plans using intensity‐modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) treatment delivery techniques. Spine SRS/SBRT targets are often adjacent to the spinal cord and esophagus, both organs at risk (OARs) where overdose can lead to unacceptable complications such as myelopathy and esophageal perforation 25,26 . In order to achieve adequate dose coverage on the target while limiting the dose to OARs, spine SRS treatment plans must have steep dose gradients.…”