ABSTRACT
Spine SBRT is a resource-intensive treatment modality requiring extensive experience and expertise, as well as multidisciplinary involvement of radiation oncologists, medical physicists, neurosurgeons, and radiation therapists. Given the high dose per fraction delivered in spine SBRT and the proximity of the spinal cord, it is imperative to achieve accuracy of 1-2 mm (Sahgal et al., 2008). In order to perform spine SBRT safely and e‰ectively, the following components are essential: a linear accelerator equipped with a multileaf
Long predicted life expectancy Poor expected survival KPS ≥ 70 KPS 40-60 Radioresistant histology Radiosensitive histology ≥3-5 mm separation from spinal cord Spinal cord compression Prior conventional EBRT Prior spine SBRT to same level Limited spine metastases Multilevel or di‰use spine metastasis Oligometastatic disease Mechanical spine instability Well-controlled systemic disease Poorly controlled systemic disease Post-separation surgery Active connective tissue disease
collimator and onboard image guidance with cone beam CT (CBCT), a body immobilization system, and a sophisticated treatment planning system. Alternatively, a system such as CyberKnife (Accuray Inc., Sunnyvale, CA), which utilizes a linear accelerator mounted on a robotic arm, can be utilized. We will discuss each of these components in further detail.
