Proposal of human spinal cord reirradiation dose based on collection of data from 40 patients

Nieder, Carsten; Grosu, Anca L.; Andratschke, Nicolaus; Molls, M.

doi:10.1016/j.ijrobp.2004.06.016

Cited by 145 publications

(89 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The majority of trials and institutions favour radiosurgical (single fraction) techniques owing to patient comfort and an outpatient, single-fraction treatment in the context of limited life expectancy. Although the local tumour and pain control have been reported in 80-90% of the patients with low rates of severe toxicity owing to the immediate proximity of vertebral metastases to the spinal cord, the single fraction dose deliverable is limited by the tolerance of the spinal cord, [6][7][8]. Consequently, many study protocols exclude tumours within a distance of ,3 mm to the spinal cord, including the current randomised Radiation Therapy Oncology Group (RTOG) 0631 trial [9], which compares radiosurgery (16 Gy in one fraction) with conventional radiotherapy (8 Gy in one fraction).…”

mentioning

confidence: 99%

Comparison of deliverable IMRT and VMAT for spine metastases using a simultaneous integrated boost

Lee

Bedford²,

McNair³

et al. 2013

BJR

View full text Add to dashboard Cite

Objective: To effectively treat spine metastases, significant dose must be delivered to regions surrounding the spinal cord. We present a study comparing both step-and-shoot intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) techniques to deliver a concomitant hypofractionated prescription dose to the diseased region and to the involved vertebrae.Methods: Seven-field IMRT and a single arc VMAT were inversely planned on five (two cervical and three thoracic) spinal metastatic patients. Planning target volumes PTVm (macroscopic) and PTVe (elective involved vertebrae) and associated organs at risk were localised. Mean doses of 35 Gy to PTVm and 20 Gy to PTVe were prescribed in five fractions. Dose statistics, estimated delivery time and results of verification using Delta 4 (ScandiDos, Uppsala, Sweden) were compared.Results: Deliverable plans were achieved with both IMRT and VMAT. The coverage to PTV was similar for both IMRT and VMAT (p50.5) and the dose to the regions adjacent to the spinal cord was 1% higher with VMAT (p50.04). The mean delivery time for VMAT was 3.5min compared with 10.5min for IMRT. Fewer monitor units were required to deliver IMRT than to deliver VMAT. The median (range) percentage of measured points with a g-index ,1 with 3%/3 mm was 100 (99.9-100)% for IMRT and 100 (88.5-100)% for VMAT.Conclusion: Both VMAT and IMRT can deliver the concomitant hypofractionated regime proposed, and both offer different benefits in dose delivery. IMRT is currently preferred for its superior pre-treatment verification results and shorter planning times. Advances in knowledge:This study explores the feasibility of delivering tumouricidal doses of radiation to metastatic spine disease in the vicinity of the spinal cord.

show abstract

mentioning

confidence: 99%

Comparison of deliverable IMRT and VMAT for spine metastases using a simultaneous integrated boost

Lee

Bedford²,

McNair³

et al. 2013

BJR

View full text Add to dashboard Cite

show abstract

“…While recurrent pain in spinal bones can be successfully alleviated with external beam radiotherapy re-treatment, optimal dosage and fractionation are still under investigation [5]. Nieder et al collected data from 40 individual patients who received re-irradiation of the spinal cord, published in eight different reports, and mentioned that the risk of radiationinduced myelopathy appears to be small after cumulative doses of ≤135.5 Gy 2 when the interval is not less than 6 months and the dose of each course is ≤98 Gy 2 [6]. However, the cumulative dose was calculated from prescribed doses without the absolute correctness of the doses to the spinal cord.…”

Section: Discussionmentioning

confidence: 99%

Variability in the Point to Which Single Direct Field Irradiation is Prescribed for Spinal Bone Metastases: A Survey of Practice Patterns in Japan

Nakamura¹,

Shikama

Wada³

et al. 2012

International Journal of Radiation Oncology*Biology*Physics

View full text Add to dashboard Cite

Direct single fields are commonly used in radiotherapy for spinal bone metastases, and it is crucial to define the point for which the dose is prescribed. According to the guidelines from the International Bone Metastases Consensus Working Party (IBMCWP) updated in 2010, different opinions exist on whether this therapy should be prescribed to the mid-vertebral or anterior vertebral body. To our knowledge, no previous studies have surveyed practice patterns regarding this discrepancy. Therefore, we performed an Internet-based survey of members of the Japanese Radiation Oncology Study Group (JROSG) to investigate the current practice patterns in Japan. The respondents mentioned the point to which they prescribed radiotherapy for a single direct field. A total of 52 radiation oncologists from 50 institutions (36% of JROSG institutions) responded. Respondent prescription for radiotherapy varied widely. Only 21% and 6% of respondents prescribed irradiation to the mid-vertebral body and anterior vertebral body, respectively. A larger proportion of respondents (27%) prescribed irradiation to the spinal cord (center of the spinal canal). Still another group of respondents (27%) stated that they never use a single direct field. In conclusion, the point to which irradiation dosages are prescribed varies widely for a single direct field in cases of spinal bone metastases. This variation may lead some radiation oncologists to misunderstand the tolerance dosage of the spinal cord, especially in cases of reirradiation. Thus, careful consideration is required before any prescriptions are made.

show abstract

“…Nieder ve ark. [3,4] ise spinal bölgeye başlan-gıç tedavisi olarak 98 Gy BED değerinin aşılmaması ve iki radyoterapi arası sürenin 6 aydan uzun olması durumunda, kümülatif BED değerinin 135 Gy altında tutulmasının toksisite açısından güvenilir olduğunu bildirmişlerdir.…”

Section: Discussionunclassified

“…[2][3][4][5] Bu çalışmada, CyberKnife ile ikinci seri radyoterapi uyguladığımız 21 olguda SRS'nin etkinlik ve tolerebilitesini ve kümülatif BED değerleri ile toksisite ilişkisini araştırdık.…”

Section: Introductionunclassified

Second series of reirradiation in metastatic spinal cases with CyberKnife

Koçak¹,

Ozseker²,

Mayadağlı³

et al. 2011

J Kartal TR

View full text Add to dashboard Cite

ÖzetAmaç: 2009-2011 yılları arasında spinal veya paraspinal metastazı nedeniyle daha önce radyoterapi uygulanan 21 hasta, stereotaktik radyocerrahi (SRS) ile tekrar tedavi edildi ve retrospektif olarak değerlendirildi. Gereç ve Yöntem:Tüm hastalar aynı bölgeden daha önce-den konvansiyonel fraksiyon eksternal radyoterapi almış-tı. SRS ortalama dozu 14 Gy ve ortalama fraksiyon sayısı 2 idi. Hastaların medyan yaşı 53 idi. Hastalar medyan 8 ay takip edildi.Bulgular: Tüm hastalar için ortalama sağkalım süresi 11.7 aydı. SRS sonrası 2. ayda yapılan ilk değerlendirmede 6 (%28.6) hastada parsiyel yanıt alındı; 14 (%66.7) hasta stabil, 1 (%4.8) hasta ise progrese idi. Takip süresi sonunda ise 2., 3., 6. ve 11. aylarda olmak üzere 4 (%19) hastada lokal progresyon gelişti. Bir hastada SRS sonrası 8. ayda alt ekstremitede minimal parestezi gelişti.Sonuç: Sonuç olarak, daha önce spinal radyoterapi görmüş hastalarda SRS kabul edilebilir toksisite sonuçlarıyla uygulanabilinir bir tedavi seçeneğidir.

show abstract

Proposal of human spinal cord reirradiation dose based on collection of data from 40 patients

Cited by 145 publications

References 17 publications

Comparison of deliverable IMRT and VMAT for spine metastases using a simultaneous integrated boost

Comparison of deliverable IMRT and VMAT for spine metastases using a simultaneous integrated boost

Variability in the Point to Which Single Direct Field Irradiation is Prescribed for Spinal Bone Metastases: A Survey of Practice Patterns in Japan

Second series of reirradiation in metastatic spinal cases with CyberKnife

Contact Info

Product

Resources

About