2017_SBRT_Course Book

Spine SBRT as re-treatment

Planning

Set-up / imaging

Study

ss-IMRT

Stereotactic Daily MV-CT kV tracking kV tracking Daily MV-CT

Milker-Zabel 2003

Tomotherapy

Mahan 2005 Sahgal 2009

Cyberknife Cyberknife

Choi 2010

Tomotherapy

Sterzing 2010 Damast 2010

IMRT IMRT

Daily portal images or CBCT Daily CT on rails or CBCT

Garg 2011

Cyberknife Cyberknife

kV tracking kV tracking

Mahadevan 2011

Chang 2012

Evidence-based clinical practice: • IMRT treatment planning required

(100% agreement) (100% agreement)

• Daily IGRT required

ESTRO SBRT 2017 - Matthias Guckenberger

07.09.17

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Spine SBRT as re-treatment

Follow-up (months)

Myelopathy

Lcoal / pain control

# patients / cases

Study

0% 0% 0%

95%

Milker-Zabel 2003

18 / 19 12.3

15.2

100%

Mahan 2005 Sahgal 2009

8 / 8

70% 73% 63% 66%

25 / 37 7 42 / 51 7 36 / 36 7.5 94 / 97 12.1 59 / 63 13

n=1 G4

Choi 2010

0% 0%

Sterzing 2010 Damast 2010

n=2 G3 peripheral nerve injury 76%

Garg 2011

12

n=3 persistent radicular pain n=1 lower-extremity weakness

93%

Mahadevan 2011

60 / 81

0%

79%

Chang 2012

49 / 54 17.3

Evidence-based clinical practice: • Very low incidence of myelopathy • Nerve damage a more frequent toxicity • Promising local control 63 – 100%

ESTRO SBRT 2017 - Matthias Guckenberger

07.09.17

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