The Canadian Association of Radiation Oncology Scope of Practice Guidelines for Lung, Liver and Spine Stereotactic Body Radiotherapy

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

“…SBRT has emerged as an attractive method of dose escalation (BED ~40–80 Gy 10 ) while respecting spinal cord tolerance through advanced planning techniques using image‐guided (IG) intensity‐modulated radiation therapy (IMRT) 17, 18, 19, 20, 21. SBRT can be delivered on multiple platforms with IMRT including multileaf collimator (MLC) equipped on most treatment units, TomoTherapy, or CyberKnife.…”

A Multinational Report on Methods for Institutional Credentialing for Spine Radiosurgery

“…Others have published practice guidelines endorsed by governing organizations for the performance of SBRT to serve as an educational tool designed to assist practitioners in providing appropriate care for patients [32]. With respect to spine SRS, it is worthy to mention the recent scope of practice guidelines endorsed by the Canadian Association of Radiation Oncology as they were focused on spine, lung and liver SBRT [26]. Within this document are recommendations as to the role of the radiation oncologist, suggestions as to training recommendations and an overview of quality assurance measures for departments to consider when initiating such a program.…”

Current Status And The Future Of Spine Radiosurgery

“…In the past, we simply delivered a dose of radiation aimed to achieve short term pain relief without the intention of long-term local tumor and pain control. The doses of 20 Gy in 5 fractions, 30 Gy in 10 fractions and 8 Gy in 1 fraction are most common, and were chosen based on the limiting factor of spinal cord tolerance.With advances in radiation technology that includes sophisticated body immobilization devices, intensity modulated radiotherapy (IMRT), image-guided radiotherapy (IGRT) and robotic technology we are now able to dose escalate spinal metastases, and deposit 2 to 6 times the biologically effective dose as compared to conventional radiation while still sparing the spinal cord to a safe dose [1,2]. Spine SRS is based on routinely treating with 16-24 Gy in 1 fraction, 24 Gy in 2 fractions, and 24-30 Gy in 3 fractions, with the intent to improve long-term local tumor control rates and increase the rate of both complete pain relief and long-term pain control [2,3].…”

“…Significant research has been completed to guide the community with respect to evidence based inclusion and exclusion criteria [4], there have been scope of practice guidelines specific to spine SRS published by the Canadian Association of Radiation Oncology (CARO) SBRT task force [1], there are international consensus guidelines to assist in target volume delineation [5], and we are now learning more about the potential long-term complications of this treatment from the predominantly retrospective reviews of institutional experiences that adopted this technique early on in its development. Some of the critical areas of toxicity that patients would not otherwise be exposed to with conventional radiation, include a risk of radiation myelopathy [6][7][8], vertebral compression fracture (VCF) [9] and serious esophageal complications [10].…”