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Analytical setup margin for spinal stereotactic body radiotherapy based on measured errors.

Audrey Copeland1, Addie Barron2, Jonas Fontenot2,3

  • 1Department of Physics and Astronomy, Louisiana State University and Agricultural and Mechanical College, Baton Rouge, LA, USA. audreycopeland19@gmail.com.

Radiation Oncology (London, England)
|December 8, 2021
PubMed
Summary
This summary is machine-generated.

A 2.4 mm setup margin in the superior/inferior direction is recommended for spinal stereotactic body radiation therapy (SBRT). This margin ensures at least 90% clinical target volume coverage for most patients while minimizing spinal cord dose.

Keywords:
MarginPTVSBRTSpineStereotactic

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Radiotherapy Planning

Background:

  • Spinal stereotactic body radiation therapy (SBRT) lacks consensus on optimal margin size.
  • Existing margins address individual errors but not combined effects.
  • Accurate margin determination is crucial for effective spinal SBRT.

Purpose of the Study:

  • To determine a setup margin for five-fraction spinal SBRT.
  • To achieve at least 90% clinical target volume (CTV) coverage with prescription dose for ≥90% of patients.
  • To limit spinal cord dose to ≤30 Gy point dose or ≤23 Gy to 10% of the subvolume.

Main Methods:

  • Quantified random and systematic errors: intrafraction motion, residual setup error, and end-to-end system accuracy.
  • Measured patient surface displacement for intrafraction motion.
  • Re-registered daily cone-beam CT setup images for residual setup error.
  • Assessed phantom dose profiles for end-to-end system accuracy.
  • Validated margin recommendation using 140 simulated patient plans.

Main Results:

  • An analytical margin of 2.4 mm was generated.
  • Applying this margin in the superior/inferior direction achieved ≥90% CTV coverage for 96% of simulated patients.
  • Minimal negative impact on spinal cord dose levels was observed.

Conclusions:

  • A 2.4 mm superior/inferior margin is supported for spinal SBRT.
  • This margin ensures adequate CTV coverage in the presence of treatment errors.
  • Findings are applicable to dual-arc VMAT spinal SBRT with vacuum bag immobilization.