Stereotactic Radiosurgery Utilizing a Linear Accelerator

Colombo, Federico; Benedetti, A.; Pozza, F; Zanardo, A.; Avanzo, Renzo Carlo; Chierego, G.; Marchetti, Cristina

doi:10.1159/000101117

Cited by 46 publications

(38 citation statements)

References 5 publications

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“…Since Hamilton et al [63] fi rst described the possibility of linear-accelerator-based spinal stereotactic radiosurgery in 1995, multiple centers have attempted to pursue large-fraction conformal radiation delivery to spinal lesions using a variety of technologies [21, 24-29, 38, 47, 63-71] . There has been a rapid increase in the use of radiosurgery as a treatment alternative for malignant tumors involving the spine [8,21,25,26,28,29,36,37,72,73] . Unlike conventional radiation therapy that delivers a full dose to both the vertebral body and the spinal cord, radiosurgery allows for the delivery of a single high-dose fraction of radiation to the target tissue while sparing most of the adjacent spinal cord.…”

Section: Discussionmentioning

confidence: 99%

Radiosurgery for the Treatment of Spinal Melanoma Metastases

Gerszten

Burton

Quinn

et al. 2005

Stereotact Funct Neurosurg

121

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Background: The role of stereotactic radiosurgery in treating metastatic melanoma involving the spine has previously been limited. Conventional external beam radiotherapy lacks the precision to allow delivery of large single-fraction doses of radiation and simultaneously to limit the dose delivered to radiosensitive structures such as the spinal cord. This study evaluated the clinical efficacy of radiosurgery for the treatment of melanoma spinal metastases in 28 patients.Methods: Thirty-six melanoma spine metastases were treated with a single-session radiosurgery technique (1 cervical, 11 thoracic, 13 lumbar, and 11 sacral) with a follow-up period of 3–43 months (median 13 months). Tumor volume ranged from 4.1 to 153 cm³ (mean 47.6 cm³). Twenty-three of the 36 lesions had received prior external beam irradiation. Results: Maximum tumor dose was maintained at 17.5–25 Gy (mean 21.7 Gy). Spinal cord volume receiving >8 Gy ranged from 0.0 to 0.7 cm³ (mean 0.26 cm³); spinal canal volume at the cauda equina level receiving >8 Gy ranged from 0.0 to 3.5 cm³ (mean 0.98 cm³). No radiation-induced toxicity occurred during the follow-up period. Axial and radicular pain improved in 27 of 28 patients (96%) who were treated primarily for pain. Long-term tumor control was seen in 3 of 4 cases treated primarily for radiographic tumor progression. Two patients went on to require open surgical intervention for tumor progression resulting in neurological deficit. Conclusions: Spinal radiosurgery offers a therapeutic modality for the safe delivery of large dose fractions of radiation therapy in a single fraction for the management of spinal metastases in patients with advanced melanoma that are often poorly controlled with alternative conventional external beam radiation therapy, and is successful even in patients with previously irradiated lesions.

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Section: Discussionmentioning

confidence: 99%

Radiosurgery for the Treatment of Spinal Melanoma Metastases

Gerszten

Burton

Quinn

et al. 2005

Stereotact Funct Neurosurg

121

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Section: Discussionmentioning

confidence: 99%

“…Authors of recent studies involving hypofractionated or single-dose treatments for spinal metastases have reported results that were comparable with those achieved using conventional fractionation. 10,19 Furthermore, hypofractionation or single-dose radiation decreases the treatment duration, is more convenient for patients, and is less costly.The use of multiple radiation beams requires extremely precise control of patient position and movement of the LINAC. Current stereotactic radiotherapy surgery is limited to cases of intracranial disease because precise localization can be achieved only by neurosurgical frames fixed to the patient's skull.…”

mentioning

confidence: 99%

Feasibility of frameless single-fraction stereotactic radiosurgery for spinal lesions

Gerszten

Ozhasoglu

Burton

et al. 2002

FOC

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Object The role of stereotactic radiosurgery for the treatment of intracranial lesions is well established. Its use for the treatment of spinal lesions has been limited by the availability of effective target-immobilizing devices. In this study the authors evaluated the CyberKnife Real-Time Image-Guided Radiosurgery System for spinal lesion treatment involving a single-fraction radiosurgical technique. Methods This frameless image-guided radiosurgery system uses the coupling of an orthogonal pair of x-ray cameras to a dynamically manipulated robot-mounted linear accelerator possessing six degrees of freedom, which guides the therapy beam to the target without the use of frame-based fixation. Cervical lesions were located and tracked relative to osseous skull landmarks; lower spinal lesions were tracked relative to percutaneously placed gold fiducial bone markers. Fifty-six spinal lesions in 46 consecutive patients were treated using single-fraction radiosurgery (26 cervical, 15 thoracic, and 11 lumbar, and four sacral). There were 11 benign and 45 metastatic lesions. Tumor volume ranged from 0.3 to 168 ml (mean 26.7 ml). Thirty-one lesions had previously received external-beam radiotherapy with maximum spinal cord doses. Dose plans were calculated based on computerized tomography scans acquired using 1.25-mm slices. Tumor dose was maintained at 12 to 18 Gy to the 80% isodose line; spinal cord lesions receiving greater than 8 Gy ranged from 0 to 1.3 ml (mean 0.3 ml). All patients tolerated the procedure in an outpatient setting. No acute radiation-induced toxicity or new neurological deficits occurred during the follow-up period. Axial and radicular pain improved in all patients who were symptomatic prior to treatment. Conclusions Spinal stereotactic radiosurgery involving a frameless image-guided system was found to be feasible and safe. The major potential benefits of radiosurgical ablation of spinal lesions are short treatment time in an outpatient setting with rapid recovery and symptomatic response. This procedure offers a successful alternative therapeutic modality for the treatment of a variety of spinal lesions not amenable to open surgical techniques; the intervention can be performed in medically untreatable patients, lesions located in previously irradiated sites, or as an adjunct to surgery.

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“…Investigators started exploring the clinical use of radiosurgery for a variety of indications. While proton beam radiosurgery for arteriovenous malformation [3][4][5] was being used by some pioneers, others started using modified LINAC-based radiosurgery [6][7][8][9] . The first report of LINAC-based radiosurgery was published in 1983 by Betti and Derechinsky [8] .…”

Section: Methodsmentioning

confidence: 99%

Intracranial Radiosurgery: An Effective and Disruptive Innovation in Neurosurgery

Niranjan

Madhavan²,

Pc³

et al. 2011

Stereotact Funct Neurosurg

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Physicians are guided by the teachings of their chosen field, standards of accepted practice, peer pressure, prior training, and other sources of bias. When potential bias begins to impact recommendations for care in the field of tumor management, physicians may fail to realize the importance of emerging medical innovations. Some of these ultimately turn out to be ‘disruptive innovations.’ These innovations are more often than not both low risk and cost effective. But the leaders in the field often initially ignore these newer technologies in favor of more mature existing technologies. However, over time these technologies gradually improve and become mainstream management practices. Intracranial radiosurgery is one such innovation which was not embraced by the neurosurgical community in the beginning. Nowadays, a wide variety of brain and body disorders are treated with radiosurgery. Acoustic neuromas and brain metastases are examples of rapidly growing indications of radiosurgery. In this report, the authors describe the emergence of stereotactic radiosurgery as a disruptive innovation in the field of medicine.

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Stereotactic Radiosurgery Utilizing a Linear Accelerator

Cited by 46 publications

References 5 publications

Radiosurgery for the Treatment of Spinal Melanoma Metastases

Radiosurgery for the Treatment of Spinal Melanoma Metastases

Feasibility of frameless single-fraction stereotactic radiosurgery for spinal lesions

Intracranial Radiosurgery: An Effective and Disruptive Innovation in Neurosurgery

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