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• W2896657131 abstract "The foci of this study is to compare the dosimetric and delivery characteristics using single isocenter technique for the multiple spine lesions of varying sizes and locations in spine SBRT. Ten representative patients with 2 dorsal spinal vertebral segments each who earlier underwent single fraction SBRT using individual target seperate isocenter technique (Sep-Iso) comprised of study population. All representative image datasets were Re-planned using the single-isocenter multi-target technique (Sin-Iso) using unflat beams VMAT coplanar arcs. The isocenter is placed at the centre of mass of all targets with all volumes being weighted equally. However, no Specific cut-off threshold for the distance between targets were applied. Prescription dose for all targets of 18 Gy to cover 90% of target volume using normal tissue and target constraints from RTOG-0631 were planned. All patients underwent treatment on C-Arm linac and intraop rotational errors were eliminated using 6 DOF robotics & pretreatment, Intrafraction and posttreatment imaging. Dosimetric parameters analysed included conformity index (CI), gradient index (GI), heterogeneity index (HI), and the absolute volume of tissue receiving 50% of the prescription dose and critical organ dose volume limits. Treatment time and total monitor units (MUs) were also recorded. Descriptive statistics & paired T test were used for data Analysis. Between 2 plans, Sin-Iso & Sep-Iso, there was no observed difference in Target dose coverage, CI (1.9,2.2) & HI (1.22,1.25) however the gradient index was high in Sin-Iso (5.9, 4.7) (p=0.03). For OAR’s, Both plans had a comparable greater max. cord dose, critical volume lung dose and cardiac dose (p=0.67). The mean total number of monitor units (MUs) & OTT was 50% less in the Sin-Iso VMAT plans (p=0.001). The median distance between the 2 targets is 6.5cm ( Range: 4-9.5cms). There is a clear trade-off between dosimetric quality of small and large targets (p=0.01) that should be considered carefully when placing the isocenter. Multi-lesion, single-isocenter Spine SBRT planning technique demonstrated good plan quality and is promising approach for radiosurgical treatment of two spinal targets for well-suited patients given the advantage in reduced treatment time delivery, as majority of this patients have bothersome pain. Key challenge while using single iso- technique for multiple spinal targets is the greater setup accuracy than what is required for conventional SBRT and crucial to this is the requirement of 6-DOF robotics as the risk of compromised coverage increases with increasing rotational error and increasing distance between targets. Dose estimates may be used to guide treatment planning or determine if patient setup is sufficiently accurate for treatment when using Sin-Iso technique." @default.
• W2896657131 created "2018-10-26" @default.
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• W2896657131 date "2018-11-01" @default.
• W2896657131 modified "2023-09-27" @default.
• W2896657131 title "Single-Isocenter Volumetric Modulated SBRT for Multiple Spinal Targets – Plan Quality and Challenges" @default.
• W2896657131 doi "https://doi.org/10.1016/j.ijrobp.2018.07.1446" @default.
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