Stereotactic Body Radiosurgery for Spinal Metastases: A Critical Review

Sahgal, Arjun; Larson, David A.; Chang, Eric L.

doi:10.1016/j.ijrobp.2008.02.060

Cited by 277 publications

(192 citation statements)

References 49 publications

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“…Cone beam CT scans were then performed with Varian onboard imaging (OBI). All quality assurance procedures were in compliance with the standard SBRT treatment delivery technique following AAPM guidelines 27, 28. Specifically, the Winston‐Lutz test was performed daily before SBRT treatments confirming coincidence of the radiation isocenter and mechanical isocenter 31…”

Section: Methodsmentioning

confidence: 99%

“…Volumetric Modulated Arc Therapy (VMAT) is an elegant technique of delivering IMRT that allows for shorter treatment times achieved by optimizing MLC positions and dose rate while the gantry rotates around the patient with the beam‐on 23, 24, 25. SBRT to the spine has been demonstrated to be feasible and safe in a phase I study; however, concerns over the possibility of vertebral compression fracture and radiation‐induced myelitis remain and are an active area of investigation 26, 27, 28. Techniques for planning and immobilization are of special interest in regards to limiting toxicity by keeping treatment times and intrafraction motion to a minimum 29, 30.…”

Section: Introductionmentioning

confidence: 99%

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Volumetric modulated arc therapy treatment planning of thoracic vertebral metastases using stereotactic body radiotherapy

Mallory

Pokhrel

Badkul

et al. 2018

J Applied Clin Med Phys

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Purpose/ObjectivesTo retrospectively evaluate the plan quality, treatment efficiency, and accuracy of volumetric modulated arc therapy (VMAT) plans for thoracic spine metastases using stereotactic body radiotherapy (SBRT).Materials/MethodsSeven patients with thoracic vertebral metastases treated with noncoplanar hybrid arcs (NCHA) (1 to 2 3D‐conformal partial arcs +7 to 9 IMRT beams) were re‐optimized with VMAT plans using three coplanar arcs. Tumors were located between T2 and T7 and PTVs ranged between 24.3 and 240.1 cc (median 48.1 cc). All prescriptions were 30 Gy in 5 fractions with 6 MV beams treated using the Novalis Tx linac equipped with high definition multileaf collimators (HDMLC). MR images were fused with planning CTs for target and OAR contouring. Plans were compared for target coverage using conformality index (CI), homogeneity index (HI), D90, D98, D2, and Dmedian. Normal tissue sparing was evaluated by comparing doses to the spinal cord (Dmax, D0.35, and D1.2 cc), esophagus (Dmax and D5 cc), heart (Dmax, D15 cc), and lung (V5 and V10). Data analysis was performed with a two‐sided t‐test for each set of parameters. Dose delivery efficiency and accuracy of each VMAT plan was assessed via quality assurance (QA) using a MapCHECK device. The Beam‐on time (BOT) was recorded, and a gamma index was used to compare dose agreement between the planned and measured doses.Results VMAT plans resulted in improved CI (1.02 vs. 1.36, P = 0.05), HI (0.14 vs. 0.27, P = 0.01), D98 (28.4 vs. 26.8 Gy, P = 0.03), D2 (32.9 vs. 36.0 Gy, P = 0.02), and Dmedian (31.4 vs. 33.7 Gy, P = 0.01). D90 was improved but not statistically significant (30.4 vs. 31.0 Gy, P = 0.38). VMAT plans showed statistically significant improvements in normal tissue sparing: Esophagus Dmax (22.5 vs. 27.0 Gy, P = 0.03), Esophagus 5 cc (17.6 vs. 21.5 Gy, P = 0.02), and Heart Dmax (13.1 vs. 15.8 Gy, P = 0.03). Improvements were also observed in spinal cord and lung sparing as well but were not statistically significant. The BOT showed significant reduction for VMAT, 4.7 ± 0.6 min vs. 7.1 ± 1 min for NCHA (not accounting for couch kicks). VMAT plans demonstrated an accurate dose delivery of 95.5 ± 1.0% for clinical gamma passing rate of 3%/3 mm criteria, which was similar to NCHA plans.Conclusions VMAT plans have shown improved dose distributions and normal tissue sparing compared to NCHA plans. Significant reductions in treatment time could potentially minimize patient discomfort and intrafraction movement errors. VMAT planning for SBRT is an attractive option for the treatment of metastases to thoracic vertebrae, and further investigation using alternative fractionation schedules is warranted.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Volumetric modulated arc therapy treatment planning of thoracic vertebral metastases using stereotactic body radiotherapy

Mallory

Pokhrel

Badkul

et al. 2018

J Applied Clin Med Phys

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“…Although the issue of dose-pain response has not been fully established yet, several prospective studies indicate that a single dose of [8][9][10] Gy is equivalent to the classically used regimen of fractionated 30 Gy in 10 fractions. [2][3][4][5] However, long-term control of symptoms, even for favorable histologies is, at best, approximately 60%, with a median duration of palliation of approximately 4 months.…”

Section: Introductionmentioning

confidence: 99%

“…Such safety margins frequently capture significant portions of the spinal cord, which restricts the treatment dose to levels lower than required for tumor ablation. 8,9 The technological revolution of image-guided treatment delivery systems, entailing new abilities to visualize the tumor during treatment with on-board imaging and to employ computer-driven technology to readjust tumor targeting on-line have promoted new standards of tumor ablation with ionizing radiation. It is now possible to achieve an extreme precision of target coverage with tumoricidal dose levels, while sparing the cord even if only a few millimeters away from the tumor.…”

Section: Introductionmentioning

confidence: 99%

Spinal metastases: From conventional fractionated radiotherapy to single-dose SBRT

Greco

Parés

Pimentel

et al. 2015

Reports of Practical Oncology & Radiotherapy

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“…Patients could benefit from hypofractionated or single‐fraction schedules 10 , 11 , 12 . Outcome data show high rates of local control and pain control for spine metastases treated with SBRT, and suggest better efficacy than with conventional palliative radiotherapy 11 , 13 , 14 …”

Section: Introductionmentioning

confidence: 99%

Intensity‐modulated radiotherapy versus proton radiotherapy versus carbon ion radiotherapy for spinal bone metastases: a treatment planning study

Rief

Chaudhri

Tonndorf-Martini

et al. 2015

J Applied Clin Med Phys

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Outcomes for selected patients with spinal metastases may be improved by dose escalation using stereotactic body radiotherapy (SBRT). As target geometry is complex, we compared SBRT plans using step‐and‐shoot intensity‐modulated radiotherapy (IMRT), carbon ion RT, and proton RT. We prepared plans treating cervical, thoracic, and lumbar metastases for three different techniques — IMRT, carbon ion, and proton plans — to deliver a median single 24 Gy fraction such that at least 90% of the planning target volume (PTV) received more than 18 Gy and were compared for PTV coverage, normal organ sparing, and estimated delivery time. PTV coverage did not show significant differences for the techniques, spinal cord dose sparing was lowered with the particle techniques. For the cervical lesion spinal cord maximum dose, dose of 1% (D1), and percent volume receiving 10 Gy (normalV10Gy) were 11.9 Gy, 9.1 Gy, and 0.5% in IMRT. This could be lowered to 4.3 Gy, 2.5 Gy, and 0% in carbon ion planning and to 8.1 Gy, 6.1 Gy, and 0% in proton planning. Regarding the thoracic lesion no difference was found for the spinal cord. For the lumbar lesion maximum dose, D1 and percent volume receiving 5 Gy (normalV5Gy) were 13.4 Gy, 8.9 Gy, and 8.9% for IMRT; 1.8 Gy, 0.7 Gy, and 0% for carbon ions; and 0 Gy,<0.01 Gy, and 0% for protons. Estimated mean treatment times were shorter in particle techniques (6–7 min vs. 12–14 min with IMRT). This planning study indicates that carbon ion and proton RT can deliver high‐quality PTV coverage for complex treatment volumes that surround the spinal cord.PACS number: 87.55.dk

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Stereotactic Body Radiosurgery for Spinal Metastases: A Critical Review

Cited by 277 publications

References 49 publications

Volumetric modulated arc therapy treatment planning of thoracic vertebral metastases using stereotactic body radiotherapy

Volumetric modulated arc therapy treatment planning of thoracic vertebral metastases using stereotactic body radiotherapy

Spinal metastases: From conventional fractionated radiotherapy to single-dose SBRT

Intensity‐modulated radiotherapy versus proton radiotherapy versus carbon ion radiotherapy for spinal bone metastases: a treatment planning study

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