Spinal Cord Toxicity With High-dose, Single-fraction Spinal Stereotactic Radiosurgery

2012 ◽  
Vol 84 (3) ◽  
pp. S118
Author(s):  
B.W. Cox ◽  
A. Tom ◽  
Y. Yamada ◽  
M. Hunt ◽  
M. Lovelock ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Stereotactic Radiosurgery ◽  
High Dose ◽  
Single Fraction

Spinal Cord Tolerance After High Dose, De Novo, Single Fraction Spine Stereotactic Radiosurgery

2020 ◽  
Vol 108 (3) ◽  
pp. e748
Author(s):  
K. Diao ◽  
J. Song ◽  
P. Thall ◽  
G.J. McGinnis ◽  
D. Boyce-Fappiano ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Stereotactic Radiosurgery ◽  
De Novo ◽  
High Dose ◽  
Single Fraction ◽  
Spinal Cord Tolerance

Low risk of radiation myelopathy with relaxed spinal cord dose constraints in de novo, single fraction spine stereotactic radiosurgery

2020 ◽  
Vol 152 ◽  
pp. 49-55
Author(s):  
Kevin Diao ◽  
Juhee Song ◽  
Peter F. Thall ◽  
Gwendolyn J. McGinnis ◽  
David Boyce-Fappiano ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Stereotactic Radiosurgery ◽  
De Novo ◽  
Low Risk ◽  
Radiation Myelopathy ◽  
Single Fraction ◽  
Dose Constraints

A REVIEW OF IMAGE-GUIDED INTENSITY-MODULATED RADIOTHERAPY FOR SPINAL TUMORS

Neurosurgery ◽  
2007 ◽  
Vol 61 (2) ◽  
pp. 226-235 ◽  
Author(s):  
Yoshiya Yamada ◽  
D. Michael Lovelock ◽  
Mark H. Bilsky
Keyword(s):  
Spinal Cord ◽  
Intensity Modulated Radiotherapy ◽  
Spinal Tumors ◽  
Tumor Control ◽  
High Dose ◽  
Single Fraction ◽  
Image Guided ◽  
Intensity Modulated ◽  
Very High ◽  
Dose Radiation

Abstract OBJECTIVE A new paradigm for the radiotherapeutic management of paraspinal tumors has emerged. Intensity-modulated radiotherapy (IMRT) has gained wide acceptance as a way of delivering highly conformal radiation to tumors. IMRT is capable of sparing sensitive structures such as the spinal cord of high-dose radiation even if only several millimeters away from the tumor. Image-guided treatment tools such as cone beam computed tomography coupled with IMRT have reduced treatment errors associated with traditional radiotherapy, making highly accurate and conformal treatment feasible. METHODS This review discusses the physics of image-guided radiotherapy, including immobilization, the radiobiological implications of hypofractionation, as well as outcomes. Image-guided technology has improved the accuracy of IMRT to within 2 mm of error. Thus, the marriage of image guidance with IMRT (IG IMRT) has allowed the safe treatment of spinal tumors to a high dose without increasing the risk of radiation-related toxicity. With the use of near real-time image-guided verification, very-high-dose radiation has been given for tumors in standard fractionation, hypofractionated, and single fraction schedules to doses beyond levels traditionally believed safe in terms of spinal cord tolerance. RESULTS Clinical results, in terms of treatment-related toxicity and tumor control, have been very favorable. With follow-up periods extending beyond 30 months, tumor control rates with single fraction IG IMRT (1800–2400 cGy) are in excess of 90%, regardless of histology, and without serious sequelae such as radiation myelopathy. Patients also report correspondingly high rates of palliation. Excellent results, both in terms of tumor control and minimal toxicity, have been consistently reported in the literature. CONCLUSION IG IMRT represents a significant technological advance. Paraspinal IG IMRT is proof of principle, making it possible to give very-high-dose radiation within close proximity to the spinal cord. By reducing treatment-related uncertainties, margins around tumors can be shortened, thereby reducing the volume of normal tissue that must be irradiated to tumoricidal doses, reducing the likelihood of toxicity. Similarly, higher doses of radiation can be administered safely, improving the likelihood of eradication. Dose escalation can be done to increase the likelihood of tumor cell kill without increasing the dose given to nearby sensitive structures.

scholarly journals Dose-Response Effect and Dose-Toxicity in Stereotactic Radiotherapy for Brain Metastases: A Review

Cancers ◽  
2021 ◽  
Vol 13 (23) ◽  
pp. 6086
Author(s):  
Maxime Loo ◽  
Jean-Baptiste Clavier ◽  
Justine Attal Khalifa ◽  
Elisabeth Moyal ◽  
Jonathan Khalifa
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Local Control ◽  
Stereotactic Radiotherapy ◽  
Local Control Rate ◽  
Dose Effect ◽  
Published Data ◽  
High Dose ◽  
Single Fraction ◽  
Fractionation Schedule

For more than two decades, stereotactic radiosurgery has been considered a cornerstone treatment for patients with limited brain metastases. Historically, radiosurgery in a single fraction has been the standard of care but recent technical advances have also enabled the delivery of hypofractionated stereotactic radiotherapy for dedicated situations. Only few studies have investigated the efficacy and toxicity profile of different hypofractionated schedules but, to date, the ideal dose and fractionation schedule still remains unknown. Moreover, the linear-quadratic model is being debated regarding high dose per fraction. Recent studies shown the radiation schedule is a critical factor in the immunomodulatory responses. The aim of this literature review was to discuss the dose–effect relation in brain metastases treated by stereotactic radiosurgery accounting for fractionation and technical considerations. Efficacy and toxicity data were analyzed in the light of recent published data. Only retrospective and heterogeneous data were available. We attempted to present the relevant data with caution. A BED10 of 40 to 50 Gy seems associated with a 12-month local control rate >70%. A BED10 of 50 to 60 Gy seems to achieve a 12-month local control rate at least of 80% at 12 months. In the brain metastases radiosurgery series, for single-fraction schedule, a V12 Gy < 5 to 10 cc was associated to 7.1–22.5% radionecrosis rate. For three-fractions schedule, V18 Gy < 26–30 cc, V21 Gy < 21 cc and V23 Gy < 5–7 cc were associated with about 0–14% radionecrosis rate. For five-fractions schedule, V30 Gy < 10–30 cc, V 28.8 Gy < 3–7 cc and V25 Gy < 16 cc were associated with about 2–14% symptomatic radionecrosis rate. There are still no prospective trials comparing radiosurgery to fractionated stereotactic irradiation.

scholarly journals Esophageal Toxicity From High-Dose, Single-Fraction Paraspinal Stereotactic Radiosurgery

2012 ◽  
Vol 83 (5) ◽  
pp. e661-e667 ◽  
Author(s):  
Brett W. Cox ◽  
Andrew Jackson ◽  
Margie Hunt ◽  
Mark Bilsky ◽  
Yoshiya Yamada
Keyword(s):  
Stereotactic Radiosurgery ◽  
High Dose ◽  
Single Fraction

scholarly journals Dose-volume effects on brainstem dose tolerance in radiosurgery

2012 ◽  
Vol 117 (Special_Suppl) ◽  
pp. 189-196 ◽  
Author(s):  
Jinyu Xue ◽  
H. Warren Goldman ◽  
Jimm Grimm ◽  
Tamara LaCouture ◽  
Yan Chen ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Radiation Treatment ◽  
High Dose ◽  
Severe Toxicity ◽  
Volume Data ◽  
Single Fraction ◽  
Dose Volume ◽  
Hypofractionated Radiation ◽  
Dose Tolerance ◽  
Volume Effects

Object Dose-volume data concerning the brainstem in stereotactic radiosurgery (SRS) for trigeminal neuralgia (TN) were analyzed in relation to associated complications. The authors present their set of data and compare it with currently cited information on brainstem dose tolerance associated with conventional fractionated radiation therapy and hypofractionated radiation treatment of other diseases. Methods Stereotactic radiosurgery for TN delivers a much higher radiation dose to the brainstem in a single fraction than doses delivered by any other procedures. A literature survey of articles on radiosurgery for TN revealed no incidences of severe toxicity, unlike other high-dose procedures involving the brainstem. Published data on brainstem dose tolerance were investigated and compared with dose-volume data in TN radiosurgery. The authors also performed a biological modeling study of dose-volume data involving the brainstem in cases of TN treated with the Gamma Knife, CyberKnife, and linear accelerator–based systems. Results The brainstem may receive a maximum dose as high as 45 Gy during radiosurgery for TN. The major complication after TN radiosurgery is mild to moderate facial numbness, and few other severe toxic responses to radiation are observed. The biologically effective dose of 45 Gy in a single fraction is much higher than any brainstem dose tolerance currently cited in conventional fractionation or in single or hypofractionated radiation treatments. However, in TN radiosurgery, the dose falloff is so steep and the delivery so accurate that brainstem volumes of 0.1–0.5 cm3 or larger receive lower planned and delivered doses than those in other radiation-related procedures. Current models are suggestive, but an extensive analysis of detailed dose-volume clinical data is needed. Conclusions Patients whose TN is treated with radiosurgery are a valuable population in which to demonstrate the dose-volume effects of an extreme hypofractionated radiation treatment on the brainstem. The result of TN radiosurgery suggests that a very small volume of the brainstem can tolerate a drastically high dose without suffering a severe clinical injury. The authors believe that the steep dose gradient in TN radiosurgery plays a key role in the low toxicity experienced by the brainstem.

scholarly journals Stereotactic radiosurgery for spinal metastases with or without separation surgery

2015 ◽  
Vol 22 (4) ◽  
pp. 409-415 ◽  
Author(s):  
Berkeley G. Bate ◽  
Nickalus R. Khan ◽  
Brent Y. Kimball ◽  
Kyle Gabrick ◽  
Jason Weaver
Keyword(s):  
Spinal Cord ◽  
Disease Control ◽  
Stereotactic Radiosurgery ◽  
Neurological Outcome ◽  
Spinal Metastases ◽  
Surgical Decompression ◽  
High Dose ◽  
Tumor Histology ◽  
Oncological Resection ◽  
Radiographic Disease

OBJECT In patients with significant epidural spinal cord compression, initial surgical decompression and stabilization of spinal metastases, as opposed to radical oncological resection, provides a margin around the spinal cord that facilitates subsequent treatment with high-dose adjuvant stereotactic radiosurgery (SRS). If a safe margin exists between tumor and spinal cord on initial imaging, then high-dose SRS may be used as the primary therapy, eliminating the need for surgery. Selecting the appropriate approach has shown greater efficacy of tumor control, neurological outcome, and duration of response when compared with external beam radiotherapy, regardless of tumor histology. This study evaluates the efficacy of this treatment approach in a series of 57 consecutive patients. METHODS Patients treated for spinal metastases between 2007 and 2011 using the Varian Trilogy Linear Accelerator were identified retrospectively. Each received SRS, with or without initial surgical decompression and instrumentation. Medical records were reviewed to assess neurological outcome and surgical or radiation-induced complications. Magnetic resonance images were obtained for each patient at 3-month intervals posttreatment, and radiographic response was assessed as stability/regression or progression. End points were neurological outcome and local radiographic disease control at death or latest follow-up. RESULTS Fifty-seven patients with 69 lesions were treated with SRS for spinal metastases. Forty-eight cases (70%) were treated with SRS alone, and 21 (30%) were treated with surgery prior to SRS. A single fraction was delivered in 38 cases (55%), while a hypofractionated scheme was used in 31 (45%). The most common histological entities were renal cell, breast, and lung carcinomas. Radiographically, local disease was unchanged or regressed in 63 of 69 tumors (91.3%). Frankel score improved or remained stable in 68 of 69 cases (98.6%). CONCLUSIONS SRS, alone or as an adjunct following surgical decompression, provides durable local radiographic disease control while preserving or improving neurological function. This less-invasive alternative to radical spinal oncological resection appears to be effective regardless of tumor histology without sacrificing durability of radiographic or clinical response.

Five-Year Outcomes of High-Dose Single-Fraction Spinal Stereotactic Radiosurgery

2015 ◽  
Vol 93 (2) ◽  
pp. 361-367 ◽  
Author(s):  
Nelson Moussazadeh ◽  
Eric Lis ◽  
Evangelia Katsoulakis ◽  
Sweena Kahn ◽  
Marek Svoboda ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
High Dose ◽  
Single Fraction

Radiation treatment of spinal tumors using Cyberknife radiosurgery

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 1545-1545
Author(s):  
J. J. Liao ◽  
N. M. Nasr ◽  
G. J. Gagnon ◽  
F. C. Henderson ◽  
B. T. Collins ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Spinal Cord ◽  
Stereotactic Radiosurgery ◽  
Tumor Volume ◽  
Spinal Tumors ◽  
High Dose ◽  
Cyberknife Radiosurgery ◽  
Fractionated Stereotactic Radiosurgery

1545 Background: Morbidity associated with spinal tumors can leave patients with functional limitations, pain, and poor quality of life. Since the integrity of the spinal column and the spinal cord must be preserved, treatments are limited especially in the setting of previous radiotherapy. We describe our experience using Cyberknife fractionated stereotactic radiosurgery in the initial treatment and retreatment of spinal tumors and its impact on patient quality of life. Methods: 152 patients with primary or metastatic spinal tumors were treated to 228 spinal sites at Georgetown University Hospital from 2002 to 2005. Neurologic examination, pain assessment by visual analog scale (0–100), and quality of life evaluations by SF-12 survey (mental and physical health scores) were performed initially and at 1, 3, 6, 9, 12, 18, and 24 months following treatment. The primary endpoints were pain and quality of life. 44 patients (109 sites) received Cyberknife radiosurgery as a component of their initial management. The median dose delivered was 2400 cGy (range 1400–8000) in 1–5 fractions (median 3). Median tumor volume was 56 mm3 (range 0.65–457.26). 108 patients (119 sites) with recurrent/persistent disease and a history of prior conventional radiation to the spine received Cyberknife radiosurgery as retreatment. Previous radiation doses ranged from 2000–5940 cGy. The median retreatment dose delivered was 2100 cGy (range 750–3500) in 1–5 fractions (median 3). Median tumor volume was 107.2 mm3 (range 0.94–838.9). Results: Optimized treatment plans were designed with the goal of limiting spinal cord doses. Median follow up is 13 months. No complications have been observed, including treatment related myelitis. Across all patients, the mean initial pain score was 73. Mean pain scores decreased significantly after the first month to 49 and remained significantly lower (40–44) for over one year. SF-12 PCS (initial mean 33) and MCS scores (initial mean 47) remained stable during the duration of the study. Conclusions: Fractionated stereotactic radiosurgery using the CyberKnife is a safe and effective treatment capable of delivering high-dose radiation to primary and recurrent spinal tumors. Follow-up data demonstrates durable pain relief and stable quality of life. No significant financial relationships to disclose.

scholarly journals Esophageal Toxicity with High Dose, Single Fraction Paraspinal Stereotactic Radiosurgery

2011 ◽  
Vol 81 (2) ◽  
pp. S110
Author(s):  
B.W. Cox ◽  
A. Jackson ◽  
D. Cyran ◽  
M. Hunt ◽  
Y. Yamada
Keyword(s):  
Stereotactic Radiosurgery ◽  
High Dose ◽  
Single Fraction
Sign in / Sign up

Export Citation Format

Share Document