Multifractionated image-guided and stereotactic intensity-modulated radiotherapy of paraspinal tumors: A preliminary report Journal Article
| Authors: | Yamada, Y.; Lovelock, D. M.; Yenice, K. M.; Bilsky, M. H.; Hunt, M. A.; Zatcky, J.; Leibel, S. A. |
| Article Title: | Multifractionated image-guided and stereotactic intensity-modulated radiotherapy of paraspinal tumors: A preliminary report |
| Abstract: | Purpose: The use of image-guided and stereotactic intensity-modulated radiotherapy (IMRT) techniques have made the delivery of high-dose radiation to lesions within close proximity to the spinal cord feasible. This report presents clinical and physical data regarding the use of IMRT coupled with noninvasive body frames (stereotactic and image-guided) for multifractionated radiotherapy. Methods and Materials: The Memorial Sloan-Kettering Cancer Center (Memorial) stereotactic body frame (MSBF) and Memorial body cradle (MBC) have been developed as noninvasive immobilizing devices for paraspinal IMRT using stereotactic (MSBF) and image-guided (MBC) techniques. Patients were either previously irradiated or prescribed doses beyond spinal cord tolerance (54 Gy in standard fractionation) and had unresectable gross disease involving the spinal canal. The planning target volume (PTV) was the gross tumor volume with a 1 cm margin. The PTV was not allowed to include the spinal cord contour. All treatment planning was performed using software developed within the institution. Isocenter verification was performed with an in-room computed tomography scan (MSBF) or electronic portal imaging devices, or both. Patients were followed up with serial magnetic resonance imaging every 3-4 months, and no patients were lost to follow-up. Kaplan-Meier statistics were used for analysis of clinical data. Results: Both the MSBF and MBC were able to provide setup accuracy within 2 mm. With a median follow-up of 11 months, 35 patients (14 primary and 21 secondary malignancies) underwent treatment. The median dose previously received was 3000 cGy in 10 fractions. The median dose prescribed for these patients was 2000 cGy/5 fractions (2000-3000 cGy), which provided a median PTV V100 of 88%. In previously unirradiated patients, the median prescribed dose was 7000 cGy (5940-7000 cGy) with a median PTV V100 of 90%. The median Dmax to the cord was 34% and 68% for previously irradiated and never irradiated patients, respectively. More than 90% of patients experienced palliation from pain, weakness, or paresthesia; 75% and 81% of secondary and primary lesions, respectively, exhibited local control at the time of last follow-up. No cases of radiation-induced myelopathy or radiculopathy have thus far been encountered. Conclusions: Precision stereotactic and image-guided paraspinal IMRT allows the delivery of high doses of radiation in multiple fractions to tumors within close proximity to the spinal cord while respecting cord tolerance. Although preliminary, the clinical results are encouraging. © 2005 Elsevier Inc. |
| Keywords: | adult; controlled study; treatment outcome; aged; middle aged; major clinical study; paresthesia; intensity modulated radiation therapy; treatment planning; cancer radiotherapy; nuclear magnetic resonance imaging; follow up; magnetic resonance imaging; accuracy; computer assisted tomography; pain; radiation; tumor volume; radiotherapy dosage; radiotherapy; imaging system; medical instrumentation; prescription; intensity-modulated radiotherapy; tumors; radiation dose fractionation; spinal cord; spinal cord tumor; spinal neoplasms; data analysis; muscle weakness; radiotherapy planning, computer-assisted; radiotherapy, conformal; kaplan meier method; equipment design; patient treatment; computer program; technique; diseases; spinal cord disease; imaging techniques; intensity-modulated radiotherapy (imrt); radiculopathy; electronics; image-guided radiotherapy; paraspinal tumors; computer software; planning target volume (ptv); drug dosage; vertebral canal; multifractionated radiotherapy; memorial body cradle |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 62 |
| Issue: | 1 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2005-05-01 |
| Start Page: | 53 |
| End Page: | 61 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2004.09.006 |
| PUBMED: | 15850902 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 59" - "Export Date: 24 October 2012" - "CODEN: IOBPD" - "Source: Scopus" |
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