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Conclusion: Both single and multifraction regimens are safe and efficacious in spine SBRT for spinal metastases. There may be advantages to hypofractionated treatment over single-fraction regimens with respect to toxicity.
NCCN: Continuing Education
Ongoing investigation is underway to define optimal dose and fractionation schedules. Stereotactic spine radiosurgery : Review of safety and efficacy with respect to dose and fractionation.
N2 - Background: Stereotactic body radiotherapy SBRT is an emerging treatment option for spinal metastases with demonstrated efficacy in the upfront, postoperative, and re-treatment settings, as well as for tumor histologies considered radioresistant. AB - Background: Stereotactic body radiotherapy SBRT is an emerging treatment option for spinal metastases with demonstrated efficacy in the upfront, postoperative, and re-treatment settings, as well as for tumor histologies considered radioresistant.
Stereotactic spine radiosurgery Review of safety and efficacy with respect to dose and fractionation. School of Medicine.
Abstract Background: Stereotactic body radiotherapy SBRT is an emerging treatment option for spinal metastases with demonstrated efficacy in the upfront, postoperative, and re-treatment settings, as well as for tumor histologies considered radioresistant. Fingerprint Dose Fractionation.
In our study, we have shown the dosimetric results of a representative set of cases planned with multiple delivery platforms. These do not by any means encompass the wide variety of cases seen in clinical practice, nor do the 40 plans generated in our study represent the capabilities of other planning teams.
In addition, we recognize that small inaccuracies in patient setup and variability in actual treatment delivery can have serious and significant consequences that could far exceed the differences between modalities that are presented here. Indeed, evaluation of the relative ability of each of these systems to accurately deliver these treatment plans is critical in determining whether there is any real advantage to one over another. In an associated quality assurance analysis study, 11 both ion chamber and film were used to measure delivered dose for all plans on each modality presented here.
The results of these measurements were exceptional, specifically that all ion chamber measurements were within 3. Finally, while we identified situations in which some systems provide a dosimetric advantage in treatment plan characteristics for a particular SBRT spine treatment, it is not clear if these differences would translate into a clinical advantage. We believe that the ability of CK to achieve overall superior dosimetric results comes from use of the smallest aperture and a greater number of possible beam orientations. The difference between the Vero and TrueBeam results could be attributed to the number of beams since 13 coplanar beams were used for the Vero plans and only two arcs were used for the TrueBeam plans.
Both machines have an MLC leaf width of 5mm. Also, Burghelea et al. The main objective of this study was to meet or exceed the dose constrains of RTOG protocol. Each institution was able to choose optimization and machine parameters according to their clinical practice. The results presented here may be influenced by the difference in dose grid size used by each platform.
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Depending on the goals of treatment, the order of importance of the treatment plan metrics we reported might vary. For example, in the case of a terminal patient with significant difficulty lying in the treatment position, the physician might decide that a short treatment time is more important than a sharp dose gradient or the potential risk of late neurologic complications.
However, a patient with a better prognosis might tolerate the treatment well, and in that case lower doses to critical structures would justify a longer treatment time. While all treatment modalities tested were able to create and very accurately deliver treatment plans meeting the dose constraints of RTOG , we observed variations that may impact system selection based on individualized treatment goals. Certain modalities performed better than the others for specific target shapes and locations.
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Vero and CK excelled in treating small volume targets. CK had the sharpest dose falloff and achieved the lowest overall spinal cord doses at the expense of longest treatment time. These findings could provide guidance in the process of determining which of the available modalities would be preferable for the treatment of spine metastases.
Volume 18 , Issue 1. If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account. If the address matches an existing account you will receive an email with instructions to retrieve your username. Adrian Nalichowski Corresponding Author E-mail address: nalichoa karmanos.neitomedera.tk
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Stereotactic Spine Radiosurgery (SRS)
Please review our Terms and Conditions of Use and check box below to share full-text version of article. Figure 1 Open in figure viewer PowerPoint. Figure 2 Open in figure viewer PowerPoint. Figure 3 Open in figure viewer PowerPoint. Figure 4 Open in figure viewer PowerPoint. Benefits include:. Learn more about Gamma Knife Perfexion.
Radiation Therapy for Spine Tumors | Memorial Sloan Kettering Cancer Center
CyberKnife delivers beams of high-dose radiation with extreme accuracy, which offers new hope to patients who have inoperable or surgically complex tumors. It can be used to treat benign and malignant tumors anywhere in the body, including:. Its robotic design allows surgeons to manipulate the system to focus radiation to the shape of each tumor, effectively targeting the tumor and avoiding the surrounding healthy tissue. CyberKnife can administer larger and more accurate doses of radiation over a shorter period of time.
It uses image-guidance software to detect any movement by the patient, even motions as miniscule as breathing, and adjust the treatment accordingly. It causes very few side effects, and most patients are able to return to their normal activities immediately following treatment. Learn more about CyberKnife Robotic Radiosurgery. Rhode Island Hospital is only hospital in the state to offer TrueBeam cancer treatment—a state-of-the-art form of radiosurgery that treats cancerous and noncancerous conditions by shaping its radiation beam to the tumor.
This precise beam ensures that the maximum prescribed dose of radiation is delivered to the entire tumor, while protecting healthy tissue. Because TrueBeam delivers one of the highest dose rates to treat tumors deep inside the body or brain, it offers options to those with clinical conditions once considered untreatable and for whom surgery is not recommended.