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• W2002528361 abstract "For some patients who have adjacent or in-field recurrence following stereotactic body radiotherapy (SBRT) for spinal tumors, repeat SBRT is a reasonable option. With this approach, small volumes of the spinal cord or cauda equina (SC/CE) may be exposed to cumulative doses that exceed its tolerance. Using simple addition of individual endpoints from each plan and cumulative endpoints from a composite plan, we studied the differences in cumulative dose assessment for the SC/CE and its potential clinical implications. We studied 10 consecutive patients who underwent repeat SBRT with in-field or adjacent recurrence after initial SBRT. Cumulative doses were calculated either by adding dosimetric endpoints from the two treatment plans or by creating a voxel by voxel composite dose plan via rigid image registration using MIM Software v5.1. For each treatment, the adjacent SC/CE was contoured as organs at risk (OAR) on MRI and CT images with 3 mm cranial and caudal extensions. The overlap region of the SC/CE between the two treatment plans was also contoured as an independent structure (OAR overlap). Merged SC/CE was defined as the combination of the OAR contours from each of the two treatment plans. Dosimetric endpoints included maximum point dose (MPD), D0.1cc, V10Gy and V12Gy. For each plan, the following dose constraints were clinically accepted: 14 Gy MPD and V10 < 10% for the spinal cord (SC) and 16 Gy MPD and V12 < 10% for the cauda equina (CE). Wilcoxon signed-rank test was used to assess differences between these dosimetric endpoints. The median time to retreatment was 109 days (range, 6 - 427) and the median follow-up was 9.2 months (3.8 - 25.5). No Grade 3 or 4 toxicities were observed. Compared to the composite plan, the simple addition method overestimated the MPD and D0.1cc of both the OAR overlap (23.1 Gy vs. 18.9 Gy, p = 0.001 and 19.1 Gy vs. 15.5 Gy, p = 0.001, respectively) and the merged SC/CE (24.5 Gy vs. 20.0 Gy, p = 0.006 and 21.6 Gy vs. 16.3 Gy, p = 0.01, respectively). In contrast, the V10 and V12 were underestimated for the merged SC (8.2% vs. 25.2%, p = 0.03) and the merged CE (11.0% vs. 32.0%, p = 0.06), respectively. Composite MPD of OAR overlap exceeded clinical dose constraints for patients treated near the CE (mean = 21.9 Gy, p = 0.03), but not near the SC (mean = 15.9 Gy, p = 0.15). One patient developed a foot drop. Her composite MPD was 28.6 Gy and D0.1cc was 27.9 Gy to the OAR overlap while the V12 of the CE was 16%. Retreatment with SBRT for adjacent or in-field retreatment of spinal metastases is relatively safe. However, attention must be paid to the cumulative dose parameters from the composite dose plan because simple endpoint addition of two plans may lead to inaccurate estimation of the actual cumulative dose to the OARs." @default.
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• W2002528361 date "2011-10-01" @default.
• W2002528361 modified "2023-10-14" @default.
• W2002528361 title "3D Composite Dose is Necessary to Assess Cumulative Spinal Cord Dose for Retreatment of Spinal Tumors with Stereotactic Body Radiotherapy" @default.
• W2002528361 doi "https://doi.org/10.1016/j.ijrobp.2011.06.1910" @default.
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