open access

Vol 20, No 6 (2015)
Special Issue Papers
Published online: 2015-11-01
Submitted: 2014-09-08
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Spinal metastases: From conventional fractionated radiotherapy to single-dose SBRT

Carlo Greco, Oriol Pares, Nuno Pimentel, Elizabeth Moser, Vasco Louro, Xavier Morales, Barbara Salas, Zvi Fuks
DOI: 10.1016/j.rpor.2015.03.004
·
Rep Pract Oncol Radiother 2015;20(6):454-463.

open access

Vol 20, No 6 (2015)
Special Issue Papers
Published online: 2015-11-01
Submitted: 2014-09-08

Abstract

Aim

To review the recent evolution of spine SBRT with emphasis on single dose treatments.

Background

Radiation treatment of spine metastases represents a challenging problem in clinical oncology, because of the high risk of inflicting damage to the spinal cord. While conventional fractionated radiation therapy still constitutes the most commonly used modality for palliative treatment, notwithstanding its efficacy in terms of palliation of pain, local tumor control has been approximately 60%. This limited effectiveness is due to previous lack of technology to precisely target the tumor while avoiding the radiosensitive spinal cord, which constitutes a dose-limiting barrier to tumor cure.

Materials and methods

A thorough review of the available literature on spine SBRT has been carried out and critically assessed.

Results

Stereotactic body radiotherapy (SBRT) emerges as an alternative, non-invasive high-precision approach, which allows escalation of tumor dose, while effectively sparing adjacent uninvolved organs at risk. Engaging technological advances, such as on-line Cone Beam Computed Tomography (CBCT), coupled with Dynamic Multi-Leaf Collimation (DMLC) and rapid intensity-modulated (IMRT) beam delivery, have promoted an interactive image-guided (IGRT) approach that precisely conforms treatment onto a defined target volume with a rapid dose fall-off to collateral non-target tissues, such as the spinal cord. Recent technological developments allow the use of the high-dose per fraction mode of hypofractionated SBRT for spinal oligometastatic cancer, even if only a few millimeters away from the tumor.

Conclusion

Single-dose spine SBRT, now increasingly implemented, yields unprecedented outcomes of local tumor ablation and safety, provided that advanced technology is employed.

Abstract

Aim

To review the recent evolution of spine SBRT with emphasis on single dose treatments.

Background

Radiation treatment of spine metastases represents a challenging problem in clinical oncology, because of the high risk of inflicting damage to the spinal cord. While conventional fractionated radiation therapy still constitutes the most commonly used modality for palliative treatment, notwithstanding its efficacy in terms of palliation of pain, local tumor control has been approximately 60%. This limited effectiveness is due to previous lack of technology to precisely target the tumor while avoiding the radiosensitive spinal cord, which constitutes a dose-limiting barrier to tumor cure.

Materials and methods

A thorough review of the available literature on spine SBRT has been carried out and critically assessed.

Results

Stereotactic body radiotherapy (SBRT) emerges as an alternative, non-invasive high-precision approach, which allows escalation of tumor dose, while effectively sparing adjacent uninvolved organs at risk. Engaging technological advances, such as on-line Cone Beam Computed Tomography (CBCT), coupled with Dynamic Multi-Leaf Collimation (DMLC) and rapid intensity-modulated (IMRT) beam delivery, have promoted an interactive image-guided (IGRT) approach that precisely conforms treatment onto a defined target volume with a rapid dose fall-off to collateral non-target tissues, such as the spinal cord. Recent technological developments allow the use of the high-dose per fraction mode of hypofractionated SBRT for spinal oligometastatic cancer, even if only a few millimeters away from the tumor.

Conclusion

Single-dose spine SBRT, now increasingly implemented, yields unprecedented outcomes of local tumor ablation and safety, provided that advanced technology is employed.

Get Citation

Keywords

SBRT; SRS; Single-fraction; Stereotactic radiotherapy; Radiosurgery; IGRT

About this article
Title

Spinal metastases: From conventional fractionated radiotherapy to single-dose SBRT

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 20, No 6 (2015)

Pages

454-463

Published online

2015-11-01

DOI

10.1016/j.rpor.2015.03.004

Bibliographic record

Rep Pract Oncol Radiother 2015;20(6):454-463.

Keywords

SBRT
SRS
Single-fraction
Stereotactic radiotherapy
Radiosurgery
IGRT

Authors

Carlo Greco
Oriol Pares
Nuno Pimentel
Elizabeth Moser
Vasco Louro
Xavier Morales
Barbara Salas
Zvi Fuks

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