Image-guided robotic radiosurgery for spinal metastases

Gibbs, Iris C.; Kamnerdsupaphon, Pimkhuan; Ryu, Mi-Ryeong; Dodd, Robert; Kiernan, Michaela; Chang, Steven D.; Adler, John R.

doi:10.1016/j.radonc.2006.11.023

Cited by 181 publications

(106 citation statements)

References 40 publications

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“…Radiation myelopathy has been reported in patients with no prior radiation who were being treated with SBRT. 18,51 This is significant, because the risk is nearly zero for 30 Gy in 10 fractions delivered with EBRT. This complication has reemerged in the literature as a result of the lack of knowledge with respect to the tolerance of the spinal cord to high-dose-per-fraction radiation.…”

Section: Late Toxicitymentioning

confidence: 99%

Stereotactic body radiotherapy for spinal metastases: current status, with a focus on its application in the postoperative patient

Sahgal

Bilsky

Chang³

et al. 2011

SPI

180

103

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Stereotactic body radiotherapy (SBRT) for spinal metastases is an emerging therapeutic option aimed at delivering high biologically effective doses to metastases while sparing the adjacent normal tissues. This technique has emerged following advances in radiation delivery that include sophisticated radiation treatment planning software, body immobilization devices, and capabilities of detecting and correcting patient positional deviations with imageguided radiotherapy. There are limited clinical data specifically supporting the role of SBRT as a superior alternative to conventional radiation in the postoperative patient. The focus of this review was to examine the evidence pertaining to spine SBRT in the treatment of spinal metastases and to provide a comprehensive analysis of published patterns of failure, with emphasis on the postoperative patient.

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Section: Late Toxicitymentioning

confidence: 99%

Stereotactic body radiotherapy for spinal metastases: current status, with a focus on its application in the postoperative patient

Sahgal

Bilsky

Chang³

et al. 2011

SPI

180

103

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“…In the largest prospective study of spine SBRT by Gerszten, 336 cases were treated primarily to relieve pain, and they achieved significant pain improvement in 290 patients (86%). Nelson, Gibbs, and Ryu, have also reported pain reduction in greater than 80% of patients in their studies (Gerszten et al 2007;Nelson et al, 2009;Gibbs et al, 2007;Ryu et al, 2008), much improved over the 60% in conventional radiotherapy (Wu et al, 2003;Chow et al, 2007). Not only do more people experience pain relief with SBRT, but the pain relief is reported to be more durable.…”

Section: Stereotactic Body Radiotherapy (Sbrt): a More Effective Higmentioning

confidence: 91%

“…Multiple studies have used SBRT to safely deliver high doses of radiation to spinal metastases while significantly limiting dose to the spinal cord and achieving local control rates of >80% at one year (Gerszten et al, 2007;Nelson et al, 2009;Gibbs et al, 2007). Fractionations in these studies have ranged from 1 to 5 fractions delivering 4 -24 Gy per individual fraction, with total doses between 10 to 30 Gy (Gerszten et al, 2007;Nelson et al, 2009;Gibbs et al, 2007). In the largest prospective study of spine SBRT by Gerszten, 336 cases were treated primarily to relieve pain, and they achieved significant pain improvement in 290 patients (86%).…”

Section: Stereotactic Body Radiotherapy (Sbrt): a More Effective Higmentioning

confidence: 99%

“…Ryu found the median duration of pain relief to be 13.6 months with SBRT (Ryu et al, 2008), which is a dramatic improvement compared to the average 3 to 6 months of palliation with conventional therapy (Gaze et al, 1997;Foro Arnalot et al, 2008). Additionally, spinal SBRT treatments have been effective in achieving local control in tumors typically resistant to radiotherapy, such as renal cell carcinoma and melanoma, reportedly due in part to radiation injury to the tumor vasculature (Gerszten et al, 2007;Gibbs et al, 2007;Ryu et al, 2008;Gagnon et al, 2009). …”

Section: Stereotactic Body Radiotherapy (Sbrt): a More Effective Higmentioning

confidence: 99%

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STAT RAD: A Potential Real-Time Radiation Therapy Workflow

Wilson¹,

Sheng²,

Yang³

et al. 2012

Modern Practices in Radiation Therapy

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“…To estimate the spinal cord myelopathy NTCP, we used the DVH Evaluator (DiversiLabs, Biomérieux, Durham, NC) and published literature for spinal cord tolerances 21 , 22 resulting in spinal cord limits of

{normalV}_{18 Gy} < 0.1 cc

and

{normalV}_{16 Gy} < 1 cc

. We then represcribed the dose so that the spinal cord

{normalV}_{18 Gy}

was lower than or equal to 0.1 cc and the spinal cord

{normalV}_{16 Gy}

was lower than or equal to 1 cc and noted the PTV

D_{95 %}

, the dose received by 95% of the PTV.…”

Section: Methodsmentioning

confidence: 99%

Inverse treatment planning for spinal robotic radiosurgery: an international multi‐institutional benchmark trial

Blanck

Wang

Baus

et al. 2016

J Applied Clin Med Phys

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Stereotactic radiosurgery (SRS) is the accurate, conformal delivery of high‐dose radiation to well‐defined targets while minimizing normal structure doses via steep dose gradients. While inverse treatment planning (ITP) with computerized optimization algorithms are routine, many aspects of the planning process remain user‐dependent. We performed an international, multi‐institutional benchmark trial to study planning variability and to analyze preferable ITP practice for spinal robotic radiosurgery. 10 SRS treatment plans were generated for a complex‐shaped spinal metastasis with 21 Gy in 3 fractions and tight constraints for spinal cord (normalV14Gy<2 cc, normalV18Gy<0.1 cc) and target (coverage >95%). The resulting plans were rated on a scale from 1 to 4 (excellent‐poor) in five categories (constraint compliance, optimization goals, low‐dose regions, ITP complexity, and clinical acceptability) by a blinded review panel. Additionally, the plans were mathematically rated based on plan indices (critical structure and target doses, conformity, monitor units, normal tissue complication probability, and treatment time) and compared to the human rankings. The treatment plans and the reviewers' rankings varied substantially among the participating centers. The average mean overall rank was 2.4 (1.2‐4.0) and 8/10 plans were rated excellent in at least one category by at least one reviewer. The mathematical rankings agreed with the mean overall human rankings in 9/10 cases pointing toward the possibility for sole mathematical plan quality comparison. The final rankings revealed that a plan with a well‐balanced trade‐off among all planning objectives was preferred for treatment by most participants, reviewers, and the mathematical ranking system. Furthermore, this plan was generated with simple planning techniques. Our multi‐institutional planning study found wide variability in ITP approaches for spinal robotic radiosurgery. The participants', reviewers', and mathematical match on preferable treatment plans and ITP techniques indicate that agreement on treatment planning and plan quality can be reached for spinal robotic radiosurgery.PACS number(s): 87.55.de

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Image-guided robotic radiosurgery for spinal metastases

Cited by 181 publications

References 40 publications

Stereotactic body radiotherapy for spinal metastases: current status, with a focus on its application in the postoperative patient

Stereotactic body radiotherapy for spinal metastases: current status, with a focus on its application in the postoperative patient

STAT RAD: A Potential Real-Time Radiation Therapy Workflow

Inverse treatment planning for spinal robotic radiosurgery: an international multi‐institutional benchmark trial

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