Radiotherapy and Radiosurgery for Metastatic Spine Disease

Gerszten, Peter C.; Mendel, Ehud; Yamada, Yoshiya

doi:10.1097/brs.0b013e3181b8b6f5

Cited by 293 publications

(98 citation statements)

References 104 publications

(130 reference statements)

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“…Initial clinical results from prospective single institution, and more recently, multi‐institutional clinical trials of SABR have documented high rates of tumor control coupled with a low incidence of serious toxicity despite the high‐dose fractions of radiation being delivered. In the setting of early stage lung cancer, three‐year local control rates of 88% to 97% have been reported 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 …”

Section: Introductionmentioning

confidence: 99%

Commissioning and initial stereotactic ablative radiotherapy experience with Vero

Solberg

Medin

Ramirez

et al. 2014

J Applied Clin Med Phys

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The purpose of this study is to describe the comprehensive commissioning process and initial clinical performance of the Vero linear accelerator, a new radiotherapy device recently installed at UT Southwestern Medical Center specifically developed for delivery of image‐guided stereotactic ablative radiotherapy (SABR). The Vero system utilizes a ring gantry to integrate a beam delivery platform with image guidance systems. The ring is capable of rotating ± 60° about the vertical axis to facilitate noncoplanar beam arrangements ideal for SABR delivery. The beam delivery platform consists of a 6 MV C‐band linac with a 60 leaf MLC projecting a maximum field size of 15×15 cm2 at isocenter. The Vero planning and delivery systems support a range of treatment techniques, including fixed beam conformal, dynamic conformal arcs, fixed gantry IMRT in either SMLC (step‐and‐shoot) or DMLC (dynamic) delivery, and hybrid arcs, which combines dynamic conformal arcs and fixed beam IMRT delivery. The accelerator and treatment head are mounted on a gimbal mechanism that allows the linac and MLC to pivot in two dimensions for tumor tracking. Two orthogonal kV imaging subsystems built into the ring facilitate both stereoscopic and volumetric (CBCT) image guidance. The system is also equipped with an always‐active electronic portal imaging device (EPID). We present our commissioning process and initial clinical experience focusing on SABR applications with the Vero, including: (1) beam data acquisition; (2) dosimetric commissioning of the treatment planning system, including evaluation of a Monte Carlo algorithm in a specially‐designed anthropomorphic thorax phantom; (3) validation using the Radiological Physics Center thorax, head and neck (IMRT), and spine credentialing phantoms; (4) end‐to‐end evaluation of IGRT localization accuracy; (5) ongoing system performance, including isocenter stability; and (6) clinical SABR applications.PACS number: 87.53.Ly

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Section: Introductionmentioning

confidence: 99%

Commissioning and initial stereotactic ablative radiotherapy experience with Vero

Solberg

Medin

Ramirez

et al. 2014

J Applied Clin Med Phys

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“…Approximately 50 to 70% of patients with bone metastases responds with pain decrease after conventional radiotherapy compared to 85 to 100% patients treated with radiosurgery or stereotactic body radiotherapy [23]. High level of pain control was also observed in our group with analgesic effect seen in over 90% of patients.…”

Section: Discussionmentioning

confidence: 48%

CyberKnife stereotactic radiosurgery and stereotactic ablative radiation therapy of patients with prostate cancer bone metastases.

Napieralska¹,

Miszczyk²,

Stąpór-Fudzińska³

2016

neo

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The aim of the study was to evaluate the effectiveness and toxicity of CyberKnife (CK) stereotactic radiosurgery (SRS) and stereotactic ablative radiation therapy (SABR) of patients with prostate cancer bone metastases. Analysis of prognostic and predictive factors was also performed.Material consisted of 51 patients with 71 bone oligometastases treated using CK SRS/SABR. In half of the patients single lesion was treated, in half 2-5 lesions. Median PSA concentration at the time of metastasis detection was 5.75 ng/ml. Total dose of 6-45Gy (median 20) was delivered with 1-5 fractions of 6-15 Gy (median 9). Biologic equivalent dose (BED) (α/ β=1.6) over 100 Gy was delivered to 45 lesions (63%) in 38 patients (75%).In statistical analysis Kaplan-Meier method, log-rank test and the Cox proportional hazard model were used. One-, two-and three-year overall survival (OS) was 90%, 76% and 70%, respectively. All patients having PSA concentration lower that 1 ng/ml at last control lived at least three years. One-, two-and three-year local control (LC) was 97%, 70% and 30%. Patients with PSA below 20 ng/ml at the time of metastasis detection had better local control of lesions and lower PSA at the last control. Median of PSA concentration after CK based SRS/SABR remains stable during first 12 months of follow-up, dropped during the next months and at last control was comparable to initial level. Median PSA at last control in patients without disease progression was 1.67ng/ml and 20 patients had PSA below 1.0ng/ml. At the last control 59% of patients had no other metastases. Rapid pain decrease was observed in analysed group and during each control about 90% of patients had pain relief. No major toxicity was observed, 3 patients suffered from fracture of irradiated bone. SRS/SABR of prostate cancer bone oligometastases provides good LC of lesions, excellent pain control without additional toxicity. Patients with PSA concentration below 20ng/ml at the time of metastasis detection have better LC and PSA concentration response.

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“…The goal of local radiotherapy in the treatment of spinal tumors has been palliation of pain, prevention of pathologic fractures, and halting progression of or reversing neurologic compromise (24) . Stereotactic body radiotherapy is being increasingly used in the management of metastatic spine tumors, 5 , 13 and may have a role in selected patients. A primary factor that limits radiation dose for local vertebral tumor control with conventional radiotherapy is the relatively low tolerance of the spinal cord to radiation (25) .…”

Section: Discussionmentioning

confidence: 99%

“…Radiosurgery can be used in primary or salvage treatment of spinal metastases, improving local disease control and patient symptoms 3 , 4 . Stereotactic body radiotherapy (SBRT) is being increasingly used in the management of localized spine metastases 5 , 6 , 7 . The optimal treatment of individual patients with spinal metastases should include consideration of their neurologic status, anatomical extent of disease, general health, age, and quality of life 1 , 8 .…”

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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Radiotherapy and Radiosurgery for Metastatic Spine Disease

Cited by 293 publications

References 104 publications

Commissioning and initial stereotactic ablative radiotherapy experience with Vero

Commissioning and initial stereotactic ablative radiotherapy experience with Vero

CyberKnife stereotactic radiosurgery and stereotactic ablative radiation therapy of patients with prostate cancer bone metastases.

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

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