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International Spine Radiosurgery Consortium Consensus Guidelines for Target Volume Definition in Spinal Stereotactic Radiosurgery

Journal Article · · International Journal of Radiation Oncology, Biology and Physics
 [1];  [2];  [3];  [4];  [5];  [6];  [7];  [8]; ;  [9];  [10];  [2]; ;  [11];  [12];
  1. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)
  2. Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)
  3. Department of Surgery, Division of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)
  4. Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)
  5. Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan (United States)
  6. Department of Neurosurgery, University of Virginia School of Medicine, Charlottesville, Virginia (United States)
  7. Department of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, UPMC Presbyterian, Pittsburgh, Pennsylvania (United States)
  8. Department of Radiation Oncology, University of Southern California Keck School of Medicine, Health Sciences Campus, Los Angeles, California (United States)
  9. Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States)
  10. Department of Radiation Oncology, Princess Margaret Hospital and the Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario (Canada)
  11. Department of Radiation Oncology, University of Pittsburgh Medical Center, UPMC Presbyterian, Pittsburgh, Pennsylvania (United States)
  12. Department of Neurosurgery, Stanford University School of Medicine, Stanford, California (United States)
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Purpose: Spinal stereotactic radiosurgery (SRS) is increasingly used to manage spinal metastases. However, target volume definition varies considerably and no consensus target volume guidelines exist. This study proposes consensus target volume definitions using common scenarios in metastatic spine radiosurgery. Methods and Materials: Seven radiation oncologists and 3 neurological surgeons with spinal radiosurgery expertise independently contoured target and critical normal structures for 10 cases representing common scenarios in metastatic spine radiosurgery. Each set of volumes was imported into the Computational Environment for Radiotherapy Research. Quantitative analysis was performed using an expectation maximization algorithm for Simultaneous Truth and Performance Level Estimation (STAPLE) with kappa statistics calculating agreement between physicians. Optimized confidence level consensus contours were identified using histogram agreement analysis and characterized to create target volume definition guidelines. Results: Mean STAPLE agreement sensitivity and specificity was 0.76 (range, 0.67-0.84) and 0.97 (range, 0.94-0.99), respectively, for gross tumor volume (GTV) and 0.79 (range, 0.66-0.91) and 0.96 (range, 0.92-0.98), respectively, for clinical target volume (CTV). Mean kappa agreement was 0.65 (range, 0.54-0.79) for GTV and 0.64 (range, 0.54-0.82) for CTV (P<.01 for GTV and CTV in all cases). STAPLE histogram agreement analysis identified optimal consensus contours (80% confidence limit). Consensus recommendations include that the CTV should include abnormal marrow signal suspicious for microscopic invasion and an adjacent normal bony expansion to account for subclinical tumor spread in the marrow space. No epidural CTV expansion is recommended without epidural disease, and circumferential CTVs encircling the cord should be used only when the vertebral body, bilateral pedicles/lamina, and spinous process are all involved or there is extensive metastatic disease along the circumference of the epidural space. Conclusions: This report provides consensus guidelines for target volume definition for spinal metastases receiving upfront SRS in common clinical situations.
OSTI ID:
22149387
Journal Information:
International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 5 Vol. 83; ISSN IOBPD3; ISSN 0360-3016
Country of Publication:
United States
Language:
English

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