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Stereotactic Body Radiation Therapy (SBRT) for Spinal Tumors

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Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy

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Abstract

Bony metastases frequently involve the spine and can cause significant morbidity with pain and neurologic compromise. A shift toward hypofractionated radiotherapy delivered over 1 to 5 fractions has taken place to provide increased long-term local control and pain relief. Patients with radioresistant histologies and oligometastatic disease, and/or patients who have had previous radiotherapy to the region, should be considered for spine stereotactic body radiotherapy (SBRT). Evaluation at presentation should include an assessment of spine stability and the extent of epidural disease. Potentially unstable or frankly unstable metastases and high-grade epidural disease should have a spine surgical consult prior to SBRT. If surgery is needed, SBRT can be delivered in the postoperative setting. Spine SBRT is performed with the patient immobilized in a near-rigid body immobilization device, simulation with thin-slice CT and volumetric thin-slice axial T1 and T2 MR images for subsequent image fusion, and delivery with an image-guided linac delivery apparatus. Guidelines for patient selection and contouring are well described, and OAR constraints from both evidence-based toxicity analyses and multicenter randomized controlled trials are available. Patients need to be followed up closely with spine MRI for tumor progression, pseudoprogression, and side effects of radiotherapy which can include vertebral compression fracture.

Disclosure: Dr. Arjun Sahgal has received honorarium for past educational seminars from Medtronic, Elekta AB, Accuray Inc., and Varian Medical Systems and research grants from Elekta AB. Dr. Sahgal also belongs to the Elekta MR Linac Research Consortium. Zain Husain has received research funding from Merck.

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Abbreviations

6DOF:

6 Degrees of Freedom

BED:

Biologically Effective Dose

CBCT:

Cone-Beam Computed Tomography

cRT:

Conventional External Beam Radiation Therapy

CT:

Computed Tomography

CTV:

Clinical Target Volume

DVH:

Dose-volume Histogram

fx(s):

Fraction(s)

GTV:

Gross Tumor Volume

MESCC:

Malignant Epidural Spinal Cord Compression

mo:

Month

nBED Gy2/2:

2Gy Equivalent Dose

Pmax:

Point Max

PRV:

Planning Organ-at-Risk Volume

PTV:

Planning Target Volume

RCC:

Renal Cell Carcinoma

SBRT:

Stereotactic Body Radiotherapy

SINS:

Spinal Instability Neoplastic Score

SRS:

Stereotactic Radiosurgery

VCF:

Vertebral Compression Fracture

yr:

Year

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Author information

Authors and Affiliations

  1. Sunnybrook Odette Cancer Centre, Department of Radiation Oncology, Toronto, ON, Canada

    Salman Faruqi & Hany Soliman

  2. University of Toronto, Toronto, ON, Canada

    Salman Faruqi & Hany Soliman

  3. Sunnybrook Health Sciences Centre, Department of Radiation Oncology, Toronto, ON, Canada

    Chia-Lin Tseng

  4. University of Toronto, Department of Radiation Oncology, Toronto, ON, Canada

    Chia-Lin Tseng & Sten Myrehaug

  5. Sunnybrook Health Sciences Centre, Department of Orthopedic Surgery, Toronto, ON, Canada

    Jeremie Stephane Larouche

  6. University of Toronto, Department of Surgery, Toronto, ON, Canada

    Jeremie Stephane Larouche & Leodante da Costa

  7. Sunnybrook Health Sciences Centre, Department of Neurosurgery, Toronto, ON, Canada

    Leodante da Costa & Victor Yang

  8. University of Toronto, Department of Neurosurgery, Toronto, ON, Canada

    Victor Yang

  9. Centre Hospitalier de l’Université de Montréal (CHUM), Department of Radiation Oncology, Montréal, QC, Canada

    Giuseppina Laura Masucci

  10. Université de Montréal, Department of Radiology, Radiation Oncology, and Nuclear Medicine, Montréal, QC, Canada

    Giuseppina Laura Masucci

  11. University of Washington Medical Center, Department of Radiation Oncology, Seattle, WA, USA

    Simon S. Lo

  12. University of Washington School of Medicine, Department of Radiation Oncology, Seattle, WA, USA

    Simon S. Lo

  13. University of Southern California Comprehensive Cancer Center, Department of Radiation Oncology, Los Angeles, CA, USA

    Eric L. Chang

  14. Keck School of Medicine of the University of Southern California, Department of Radiation Oncology, Los Angeles, CA, USA

    Eric L. Chang

  15. Smilow Cancer Hospital, Department of Radiation Oncology, New Haven, CT, USA

    Zain Husain

  16. Yale University, Department of Radiation Oncology, New Haven, CT, USA

    Zain Husain

  17. Sunnybrook Health Sciences Centre, Department of Radiology, Toronto, ON, Canada

    Pejman Maralani

  18. University of Toronto, Department of Medical Imaging, Toronto, ON, Canada

    Pejman Maralani

  19. Sunnybrook Health Sciences Centre, Odette Cancer Center, Department of Radiation Oncology, Toronto, ON, Canada

    Sten Myrehaug

  20. Sunnybrook Odette Cancer Centre, Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada

    Arjun Sahgal

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  1. Salman Faruqi
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  8. Simon S. Lo
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Correspondence to Arjun Sahgal .

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Editors and Affiliations

  1. Mayo Clinic, Radiation Oncology, Mayo Clinic School of Medicine Radiation Oncology, Jacksonville, FL, USA

    Daniel M. Trifiletti

  2. Department of Radiation Oncology, Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA

    Samuel T. Chao

  3. Sunnybrook Odette Cancer Centre, Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada

    Arjun Sahgal

  4. University of Virginia, Departments of Neurological Surgery and Radiation Oncology, Charlottesville, VA, USA

    Jason P. Sheehan

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Faruqi, S. et al. (2019). Stereotactic Body Radiation Therapy (SBRT) for Spinal Tumors. In: Trifiletti, D., Chao, S., Sahgal, A., Sheehan, J. (eds) Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy. Springer, Cham. https://doi.org/10.1007/978-3-030-16924-4_23

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  • DOI: https://doi.org/10.1007/978-3-030-16924-4_23

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