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Stereotactic body radiotherapy for lesions of the spine and paraspinal regions.

Publication ,  Journal Article
Nelson, JW; Yoo, DS; Sampson, JH; Isaacs, RE; Larrier, NA; Marks, LB; Yin, F-F; Wu, QJ; Wang, Z; Kirkpatrick, JP
Published in: Int J Radiat Oncol Biol Phys
April 1, 2009

PURPOSE: To describe our experience and clinical strategy for stereotactic body radiotherapy (SBRT) of spinal lesions. METHODS AND MATERIALS: Thirty-two patients with 33 spinal lesions underwent computed tomography-based simulation while free breathing. Gross/clinical target volumes included involved portions of the vertebral body and paravertebral/epidural tumor. Planning target volume (PTV) expansion was 6 mm axially and 3 mm radially; the cord was excluded from the PTV. Biologic equivalent dose was calculated using the linear quadratic model with alpha/beta = 3 Gy. Treatment was linear accelerator based with on-board imaging; dose was adjusted to maintain cord dose within tolerance. Survival, local control, pain, and neurologic status were monitored. RESULTS: Twenty-one patients are alive at 1 year (median survival, 14 months). Median follow-up is 6 months for all patients (7 months for survivors). Mean previous radiotherapy dose to 22 patients was 35 Gy, and median interval was 17 months. Renal (31%), breast, and lung (19% each) were the most common histologic sites. Three SBRT fractions (range, one to four fractions) of 7 Gy (range, 5-16 Gy) were delivered. Median cord and target biologic equivalent doses were 70 Gy(3) and 34.3 Gy(10), respectively. Thirteen patients reported complete and 17 patients reported partial pain relief at 1 month. There were four failures (mean, 5.8 months) with magnetic resonance imaging evidence of in-field progression. No dosimetric parameters predictive of failure were identified. No treatment-related toxicity was seen. CONCLUSIONS: Spinal SBRT is effective in the palliative/re-treatment setting. Volume expansion must ensure optimal PTV coverage while avoiding spinal cord toxicity. The long-term safety of spinal SBRT and the applicability of the linear-quadratic model in this setting remain to be determined, particularly the time-adjusted impact of prior radiotherapy.

Duke Scholars

Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

April 1, 2009

Volume

73

Issue

5

Start / End Page

1369 / 1375

Location

United States

Related Subject Headings

  • Tumor Burden
  • Spinal Neoplasms
  • Spinal Cord
  • Relative Biological Effectiveness
  • Radiotherapy Planning, Computer-Assisted
  • Radiotherapy Dosage
  • Radiosurgery
  • Radiation Tolerance
  • Radiation Injuries
  • Palliative Care
 

Citation

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MLA
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Nelson, J. W., Yoo, D. S., Sampson, J. H., Isaacs, R. E., Larrier, N. A., Marks, L. B., … Kirkpatrick, J. P. (2009). Stereotactic body radiotherapy for lesions of the spine and paraspinal regions. Int J Radiat Oncol Biol Phys, 73(5), 1369–1375. https://doi.org/10.1016/j.ijrobp.2008.06.1949
Nelson, John W., David S. Yoo, John H. Sampson, Robert E. Isaacs, Nicole A. Larrier, Lawrence B. Marks, Fang-Fang Yin, Q Jackie Wu, Zhiheng Wang, and John P. Kirkpatrick. “Stereotactic body radiotherapy for lesions of the spine and paraspinal regions.Int J Radiat Oncol Biol Phys 73, no. 5 (April 1, 2009): 1369–75. https://doi.org/10.1016/j.ijrobp.2008.06.1949.
Nelson JW, Yoo DS, Sampson JH, Isaacs RE, Larrier NA, Marks LB, et al. Stereotactic body radiotherapy for lesions of the spine and paraspinal regions. Int J Radiat Oncol Biol Phys. 2009 Apr 1;73(5):1369–75.
Nelson, John W., et al. “Stereotactic body radiotherapy for lesions of the spine and paraspinal regions.Int J Radiat Oncol Biol Phys, vol. 73, no. 5, Apr. 2009, pp. 1369–75. Pubmed, doi:10.1016/j.ijrobp.2008.06.1949.
Nelson JW, Yoo DS, Sampson JH, Isaacs RE, Larrier NA, Marks LB, Yin F-F, Wu QJ, Wang Z, Kirkpatrick JP. Stereotactic body radiotherapy for lesions of the spine and paraspinal regions. Int J Radiat Oncol Biol Phys. 2009 Apr 1;73(5):1369–1375.
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

April 1, 2009

Volume

73

Issue

5

Start / End Page

1369 / 1375

Location

United States

Related Subject Headings

  • Tumor Burden
  • Spinal Neoplasms
  • Spinal Cord
  • Relative Biological Effectiveness
  • Radiotherapy Planning, Computer-Assisted
  • Radiotherapy Dosage
  • Radiosurgery
  • Radiation Tolerance
  • Radiation Injuries
  • Palliative Care