A review of stereotactic body radiotherapy for the spine
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REVIEW PAPER
A review of stereotactic body radiotherapy for the spine James Rijken1,2 · Scott Crowe2,3 · Jamie Trapp2 · Tanya Kairn2,3 Received: 13 September 2019 / Accepted: 11 June 2020 © Australasian College of Physical Scientists and Engineers in Medicine 2020
Abstract Radiation therapy of the spine, as recourse for spinal tumours, is an effective method of achieving pain reduction and local control. Hypofractionated techniques like stereotactic body radiation therapy and especially stereotactic radiosurgery are quickly becoming more popular as studies are published demonstrating their superior outcomes. This review concerns aspects of spinal radiotherapy of interest to the clinical medical physicist, with a focus on stereotactic techniques. The literature surveyed is mostly from the last two decades, concentrating particularly on studies from the last few years. Clinical aspects of spinal disease are covered to give context to the development of different radiotherapy techniques and thus the changing suitability criteria of patients. The latest studies concerning the treatment pathway are reviewed and summarised—from simulation and prescription to contouring, treatment planning and treatment delivery. This then leads into a discussion of the accuracy and uncertainties surrounding different methods of immobilisation and image guidance. Treatment planning algorithms and approaches are also reviewed. Finally, we survey the most recent outcomes and statistics concerning failures, toxicity, survivability and control rates. With careful consideration of the latest literature, patients suffering from spinal disease have a good chance of positive outcomes following radiotherapy. Keywords Stereotactic · SBRT · SABR · Spine · Review · Radiotherapy
Introduction The effectiveness of radiotherapy treatment for the individual can be improved greatly through a review of relevant clinical trials to determine appropriate dose prescription and fractionation as well as constraints in dose to normal tissue. However, this mostly sits in the realm of the radiation oncologist. The physicist will implement these recommendations by the doctor into treatment planning protocols but the accuracy of any treatment delivery is still limited by a variety of factors that can influence patient outcome. This includes assessment of uncertainties relating to: the output of the treatment machine at various aperture sizes and the ability of the treatment machine to modulate its radiation * James Rijken [email protected] 1
Icon Cancer Centre, 480 Specialist Centre, Windsor Gardens, SA, Australia
2
Queensland University of Technology, Brisbane, QLD, Australia
3
Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
beam across a treatment target, measurement of small radiation fields outside of reference conditions, modelling of radiation beams in a treatment planning system employing analytic, numerical and stochastic methods, measurement of completed treatment plans as quality assurance for the overall treatment of
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