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. 2023 Dec 18:45:100716.
doi: 10.1016/j.ctro.2023.100716. eCollection 2024 Mar.

Practice and principles of stereotactic body radiation therapy for spine and non-spine bone metastases

Laura Burgess  1 , Eric Nguyen  2 , Chia-Lin Tseng  1 , Matthias Guckenberger  3 , Simon S Lo  4 , Beibei Zhang  1 , Michelle Nielsen  1 , Pejman Maralani  5 , Quynh-Nhu Nguyen  6 , Arjun Sahgal  1
Affiliations

Practice and principles of stereotactic body radiation therapy for spine and non-spine bone metastases

Laura Burgess et al. Clin Transl Radiat Oncol. .

Abstract

Radiotherapy is the dominant treatment modality for painful spine and non-spine bone metastases (NSBM). Historically, this was achieved with conventional low dose external beam radiotherapy, however, stereotactic body radiotherapy (SBRT) is increasingly applied for these indications. Meta-analyses and randomized clinical trials have demonstrated improved pain response and more durable tumor control with SBRT for spine metastases. However, in the setting of NSBM, there is limited evidence supporting global adoption and large scale randomized clinical trials are in need. SBRT is technically demanding requiring careful consideration of organ at risk tolerance, and strict adherence to technical requirements including immobilization, simulation, contouring and image-guidance procedures. Additional considerations include follow up practices after SBRT, with appropriate imaging playing a critical role in response assessment. Finally, there is renewed research into promising new technologies that may further refine the use of SBRT in both spinal and NSBM in the years to come.

Keywords: Non-spine bone metastases; Spine metastases; Stereotactic body radiation therapy.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [Chia-Lin Tseng: advisor/consulting fees from Sanofi and Abbvie, honoraria from Elekta and Abbvie, travel expenses and honoraria from Elekta, member of Elekta MR-Linac Research Consortium. Matthias Guckenberger: honoraria from AstraZeneca and research support from Siemens Healthineers, Viewray and AstraZeneca. Pejman Maralani: grant from Cancer Research Society of Canada. Simon S. Lo: member of Eleka Gamma Knife Icon Group, research support from Elekta (ended December 31, 2022), research support from Kuni Foundation, Hutchinson Center as Lead Academic Participating site, travel expenses for Japanese Society of Radiation Oncology, member of Board of Directors of Radiosurgery Society and Medical Director of Distinction in Practice in Stereotactic Radiotherapy Program, Assistant Councilor and Chair of CARROS Nominating Committee for American College of Radiology. Arjun Sahgal: grants from Elekta, Varian, Seagen Inc., BrainLAB, consulting fees from Varian, Elekta, BrainLAB, Merck, Abbvie, Roche, honoraria from AstraZeneca, Elekta, Varian, BrainLAB, Accuray, Seagen Inc., travel expenses from Elekta, Varian, BrainLAB, roles on leadership board as Vice President of International Stereotactic Radiosurgery Society and other interests as member of Elekta MR-Linac Research Consortium, member of Elekta Clinical Steering Committee, chair of Elekta Oligometastases Group and Elekta Gamma Knife Icon Group, co-chair of AO Spine Knowledge Forum Tumor].

Figures

Fig. 1
Fig. 1
Axial MRI of a vertebrae with the ISRC sectors (1) vertebral body, (2) left pedicle, (3) left transverse process and lamina, (4) spinous process, (5) right transverse process and lamina, (6) right pedicle.
Fig. 2
Fig. 2
A patient treated with SBRT spine for a L5 metastasis underwent volunteer MRL imaging. The CT simulation scan (A) shows a different positioning of the bowel than his MRL (B) scan in the same treatment position, highlighting the potential utility of MRL with variation in the position of bowel that impacts target coverage.
Fig. 3
Fig. 3
A painful metastasis to the right knee treated with 30 Gy in 5 fractions with GTV in orange. The CTV is in blue and is a 5 mm intraosseous expansion from GTV within contiguous bone and, given cortical disruption, a 5 mm extraosseous expansion was also added, as per contouring guidelines by Nguyen et al. The PTV is in green and is also a 5 mm expansion, as per institutional policy. These are displayed on the following sequences A) CT simulation B) T1-weighted MRI C) T2-weighted MRI. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
See this image and copyright information in PMC

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