2017_SBRT_Course Book

Dose and fractionation

Significantly improved LC after 5 x 6Gy Compared to 5 x 4Gy

Damast IJROBP 2010

Ø Use of fractionated protocols Ø 30Gy in 5 Fx, but still 25% recurrences within 12 months

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Spine SBRT as re-treatment

# patients / cases

Dose 1st RT course (median)

Interval (median months)

Reirradiation TD / fraction (median)

Accumulated dose (median)

Study

Milker-Zabel 2003

18 / 19

38Gy 30Gy 36Gy 40Gy 30Gy 30Gy 30Gy 30Gy

18

39.6Gy / 22 30Gy / 15 24Gy / 3 20Gy / 2 30Gy / 10 20-30Gy / 5 27-30Gy / 3-5 24-30Gy / 3-5

NS

Mahan 2005 Sahgal 2009

8 / 8

NS

48Gy

25 / 37 42 / 51 36 / 36 94 / 97 59 / 63 60 / 81 49 / 54

11 19 18

NS

Choi 2010

76Gy 45Gy

Sterzing 2010 Damast 2010

NS NS

54.3Gy

Garg 2011

NS NS

Mahadevan 2011

20 25

Chang 2012

39.2Gy

27Gy / 3

83.4Gy

Evidence-based clinical practice: • 1 st RT course with ~30Gy and ~12 months interval • Fractionated re-irradiation: • 30Gy in 5 fractions • 3 / 5 studies did not assume spinal cord recovery

ESTRO SBRT 2017 - Matthias Guckenberger

07.09.17

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