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
25
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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
26
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