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Published on: April 17, 2012
Direct-to-Unit Stereotactic Magnetic Resonance Imaging-Guided Adaptive Radiation Therapy for Spine Metastasis
Weiren Liu1, Eric D Morris1, Joshua P Schiff2
1Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
Purpose:
This study evaluated the feasibility of a direct-to-unit stereotactic magnetic resonance imaging-guided adaptive radiation therapy (SMART) workflow for spine metastases.
Methods And Materials:
Ten patients with spinal metastases were prospectively enrolled. Preplans were created using diagnostic imaging, with patients proceeding directly to magnetic resonance imaging-guided adaptive treatment using online adaptation and bulk density override for dose calculation. Feasibility was defined as successful completion of the first fraction on the initial on-table attempt in ≥70% of patients. Toxicity, dosimetric outcomes, and clinical response were assessed.
Results:
Delivery of first fraction on first attempt was successful 90% of the time. Of 36 total fractions, 10 required online adaptation. The median treatment time per fraction was 87 minutes. Acute toxicity was limited to grade 1 to 2 fatigue. At a median follow-up of 14 months, local control was 90% at 3 months and 67% at 6 months.
Conclusions:
Direct-to-unit SMART is a feasible and safe approach for spine stereotactic body radiation therapy, allowing treatment without conventional simulation.
