TY - JOUR
T1 - Spinal Cord Dose Tolerance to Stereotactic Body Radiation Therapy
AU - Sahgal, Arjun
AU - Chang, Joe H.
AU - Ma, Lijun
AU - Marks, Lawrence B.
AU - Milano, Michael T.
AU - Medin, Paul
AU - Niemierko, Andrzej
AU - Soltys, Scott G.
AU - Tomé, Wolfgang A.
AU - Wong, C. Shun
AU - Yorke, Ellen
AU - Grimm, Jimm
AU - Jackson, Andrew
N1 - Funding Information:
Disclosures: A.S. reports research grants from Elekta AB, Varian Medical Systems, and Brainlab and honoraria and travel support for past educational seminars from Elekta AB, Varian Medical Systems, Brainlab, Accuray, and AbbVie. A.S. is the lead of the Elekta North America Gamma Knife Consortium and Consortium for Oligometastases Research, a clinical steering committee member for the Elekta MR-linac Consortium, and a consultant for Elekta AB and previously Roche. A.S. is also a member of the medical advisory board for VIECURE and is an officer for the International Stereotactic Radiosurgery Society. M.T.M. reports royalties from UpToDate. P.M. reports fees from Brainlab. S.G.S. reports personal fees from Inovio Pharmaceuticals, Inc. W.A.T. reports research grants from Varian, Inc, Accuracy, Inc, and Chrysalis Biotherapeutics, Inc. J.G. reports research grants from Accuray and NovoCure and a DVH Evaluator patent. A.J. reports a position in the Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York.
Publisher Copyright:
© 2019 The Authors
PY - 2021/5/1
Y1 - 2021/5/1
N2 - Spinal cord tolerance data for stereotactic body radiation therapy (SBRT) were extracted from published reports, reviewed, and modelled. For de novo SBRT delivered in 1 to 5 fractions, the following spinal cord point maximum doses (Dmax) are estimated to be associated with a 1% to 5% risk of radiation myelopathy (RM): 12.4 to 14.0 Gy in 1 fraction, 17.0 Gy in 2 fractions, 20.3 Gy in 3 fractions, 23.0 Gy in 4 fractions, and 25.3 Gy in 5 fractions. For reirradiation SBRT delivered in 1 to 5 fractions, reported factors associated with a lower risk of RM include cumulative thecal sac equivalent dose in 2 Gy fractions with an alpha/beta of 2 (EQD22) Dmax ≤70 Gy; SBRT thecal sac EQD22 Dmax ≤25 Gy, thecal sac SBRT EQD22 Dmax to cumulative EQD22 Dmax ratio ≤0.5, and a minimum time interval to reirradiation of ≥5 months. Larger studies containing complete institutional cohorts with dosimetric data of patients treated with spine SBRT, with and without RM, are required to refine RM risk estimates.
AB - Spinal cord tolerance data for stereotactic body radiation therapy (SBRT) were extracted from published reports, reviewed, and modelled. For de novo SBRT delivered in 1 to 5 fractions, the following spinal cord point maximum doses (Dmax) are estimated to be associated with a 1% to 5% risk of radiation myelopathy (RM): 12.4 to 14.0 Gy in 1 fraction, 17.0 Gy in 2 fractions, 20.3 Gy in 3 fractions, 23.0 Gy in 4 fractions, and 25.3 Gy in 5 fractions. For reirradiation SBRT delivered in 1 to 5 fractions, reported factors associated with a lower risk of RM include cumulative thecal sac equivalent dose in 2 Gy fractions with an alpha/beta of 2 (EQD22) Dmax ≤70 Gy; SBRT thecal sac EQD22 Dmax ≤25 Gy, thecal sac SBRT EQD22 Dmax to cumulative EQD22 Dmax ratio ≤0.5, and a minimum time interval to reirradiation of ≥5 months. Larger studies containing complete institutional cohorts with dosimetric data of patients treated with spine SBRT, with and without RM, are required to refine RM risk estimates.
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U2 - 10.1016/j.ijrobp.2019.09.038
DO - 10.1016/j.ijrobp.2019.09.038
M3 - Article
C2 - 31606528
AN - SCOPUS:85074778645
SN - 0360-3016
VL - 110
SP - 124
EP - 136
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 1
ER -
