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Title: Generalizable Class Solutions for Treatment Planning of Spinal Stereotactic Body Radiation Therapy

Abstract

Purpose: Spinal stereotactic body radiation therapy (SBRT) continues to emerge as an effective therapeutic approach to spinal metastases; however, treatment planning and delivery remain resource intensive at many centers, which may hamper efficient implementation in clinical practice. We sought to develop a generalizable class solution approach for spinal SBRT treatment planning that would allow confidence that a given plan provides optimal target coverage, reduce integral dose, and maximize planning efficiency. Methods and Materials: We examined 91 patients treated with spinal SBRT at our institution. Treatment plans were categorized by lesion location, clinical target volume (CTV) configuration, and dose fractionation scheme, and then analyzed to determine the technically achievable dose gradient. A radial cord expansion was subtracted from the CTV to yield a planning CTV (pCTV) construct for plan evaluation. We reviewed the treatment plans with respect to target coverage, dose gradient, integral dose, conformality, and maximum cord dose to select the best plans and develop a set of class solutions. Results: The class solution technique generated plans that maintained target coverage and improved conformality (1.2-fold increase in the 95% van't Riet Conformation Number describing the conformality of a reference dose to the target) while reducing normal tissue integral dose (1.3-foldmore » decrease in the volume receiving 4 Gy (V{sub 4Gy}) and machine output (19% monitor unit (MU) reduction). In trials of planning efficiency, the class solution technique reduced treatment planning time by 30% to 60% and MUs required by {approx}20%: an effect independent of prior planning experience. Conclusions: We have developed a set of class solutions for spinal SBRT that incorporate a pCTV metric for plan evaluation while yielding dosimetrically superior treatment plans with increased planning efficiency. Our technique thus allows for efficient, reproducible, and high-quality spinal SBRT treatment planning.« less

Authors:
; ; ; ;  [1]; ; ;  [2];  [3]; ;  [1];  [4]
  1. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
  2. Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
  3. Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
  4. Department of Radiation Oncology, University of Southern California Keck School of Medicine, Norris Cancer Hospital, Los Angeles, California (United States)
Publication Date:
OSTI Identifier:
22149611
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 84; Journal Issue: 3; Other Information: Copyright (c) 2012 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; EFFICIENCY; EVALUATION; FRACTIONATED IRRADIATION; IMPLEMENTATION; INTEGRAL DOSES; METASTASES; METRICS; PATIENTS; PLANNING; RADIOTHERAPY

Citation Formats

Weksberg, David C., Palmer, Matthew B., Vu, Khoi N., Rebueno, Neal C., Sharp, Hadley J., Luo, Dershan, Yang, James N., Shiu, Almon S., Rhines, Laurence D., McAleer, Mary Frances, Brown, Paul D., and Chang, Eric L., E-mail: eric.L.chang@usc.edu. Generalizable Class Solutions for Treatment Planning of Spinal Stereotactic Body Radiation Therapy. United States: N. p., 2012. Web. doi:10.1016/J.IJROBP.2011.12.060.
Weksberg, David C., Palmer, Matthew B., Vu, Khoi N., Rebueno, Neal C., Sharp, Hadley J., Luo, Dershan, Yang, James N., Shiu, Almon S., Rhines, Laurence D., McAleer, Mary Frances, Brown, Paul D., & Chang, Eric L., E-mail: eric.L.chang@usc.edu. Generalizable Class Solutions for Treatment Planning of Spinal Stereotactic Body Radiation Therapy. United States. doi:10.1016/J.IJROBP.2011.12.060.
Weksberg, David C., Palmer, Matthew B., Vu, Khoi N., Rebueno, Neal C., Sharp, Hadley J., Luo, Dershan, Yang, James N., Shiu, Almon S., Rhines, Laurence D., McAleer, Mary Frances, Brown, Paul D., and Chang, Eric L., E-mail: eric.L.chang@usc.edu. Thu . "Generalizable Class Solutions for Treatment Planning of Spinal Stereotactic Body Radiation Therapy". United States. doi:10.1016/J.IJROBP.2011.12.060.
@article{osti_22149611,
title = {Generalizable Class Solutions for Treatment Planning of Spinal Stereotactic Body Radiation Therapy},
author = {Weksberg, David C. and Palmer, Matthew B. and Vu, Khoi N. and Rebueno, Neal C. and Sharp, Hadley J. and Luo, Dershan and Yang, James N. and Shiu, Almon S. and Rhines, Laurence D. and McAleer, Mary Frances and Brown, Paul D. and Chang, Eric L., E-mail: eric.L.chang@usc.edu},
abstractNote = {Purpose: Spinal stereotactic body radiation therapy (SBRT) continues to emerge as an effective therapeutic approach to spinal metastases; however, treatment planning and delivery remain resource intensive at many centers, which may hamper efficient implementation in clinical practice. We sought to develop a generalizable class solution approach for spinal SBRT treatment planning that would allow confidence that a given plan provides optimal target coverage, reduce integral dose, and maximize planning efficiency. Methods and Materials: We examined 91 patients treated with spinal SBRT at our institution. Treatment plans were categorized by lesion location, clinical target volume (CTV) configuration, and dose fractionation scheme, and then analyzed to determine the technically achievable dose gradient. A radial cord expansion was subtracted from the CTV to yield a planning CTV (pCTV) construct for plan evaluation. We reviewed the treatment plans with respect to target coverage, dose gradient, integral dose, conformality, and maximum cord dose to select the best plans and develop a set of class solutions. Results: The class solution technique generated plans that maintained target coverage and improved conformality (1.2-fold increase in the 95% van't Riet Conformation Number describing the conformality of a reference dose to the target) while reducing normal tissue integral dose (1.3-fold decrease in the volume receiving 4 Gy (V{sub 4Gy}) and machine output (19% monitor unit (MU) reduction). In trials of planning efficiency, the class solution technique reduced treatment planning time by 30% to 60% and MUs required by {approx}20%: an effect independent of prior planning experience. Conclusions: We have developed a set of class solutions for spinal SBRT that incorporate a pCTV metric for plan evaluation while yielding dosimetrically superior treatment plans with increased planning efficiency. Our technique thus allows for efficient, reproducible, and high-quality spinal SBRT treatment planning.},
doi = {10.1016/J.IJROBP.2011.12.060},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 3,
volume = 84,
place = {United States},
year = {2012},
month = {11}
}