Prog Med Phys.  2014 Sep;25(3):176-184. 10.14316/pmp.2014.25.3.176.

Comparison of Dose Distribution in Spine Radiosurgery Plans: Simultaneously Integrated Boost and RTOG 0631 Protocol

• Park SY
• Oh D
• Park HC
• Kim JS
• Kim JS
• Shin EH
• Kim HY
• Jung SH
• Han Y

• KMID: 1910550
• DOI: http://doi.org/10.14316/pmp.2014.25.3.176

Abstract

In this study, we compareddose distributions from simultaneously integrated boost (SIB) method versus the RTOG 0631 protocol for spine radiosurgery. Spine radiosurgery plans wereperformed in five patients with localized spinal metastases from hepatocellular carcinoma. The computed tomography (CT) and T1- and T2-weighted magnetic resonance imaging (MRI) were fused for delineating of GTV and spinal cord. In SIB plan, the clinical target volume (CTV1) was included the whole compartments of the involved spine, while RTOG 0631 protocol defines the CTV2 as the involved vertebral body and both left and right pedicles. The CTV2 includes transverse process and posterior element according to the extent of GTV. The doses were prescribed 18 Gy to GTV and 10 Gy to CTV1 in SIB plan, while the prescription of RTOG 0631 protocol was applied 18 Gy to CTV2. The results of dose-volume histogram (DVH) showed that there were competitive in target coverage, while the doses of spinal cord andother normal organs were lower in SIB method than in RTOG 0631 protocol. The 85% irradiated volume of VB in RTOG 0631 protocol was similar to that in the SIB plan. However, the dose to normal organs in RTOG 0631 had a tendency to higher than that in SIB plan. The SIB plan might be an alternative method in case of predictive serious complications of surrounded normal organs. In conclusion, although both approaches of SIB or RTOG 0631 showed competitive planning results, tumor control probability (TCP) and normal tissue complication probability (NTCP) through diverse clinical researches should be analyzed in the future.

Keyword

Spinal metastases; Spine radiosurgery; Simultaneously integrated boost; RTOG 0631 protocol

MeSH Terms

Carcinoma, Hepatocellular
Humans
Magnetic Resonance Imaging
Neoplasm Metastasis
Prescriptions
Radiosurgery*
Spinal Cord
Spine*

Figure

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  Fig. 1. Target volume delineation (a) SIB method vs. (b) RTOG 0631 Protocol.

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  Fig. 2. Comparison of volume delineation on CT images for constraint (a) SIB method vs. (b) RTOG 0631 Protocol.

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  Fig. 3. DVH comparisons: SIB method vs. RTOG 0631 Protocol. Case 4: DVH for Target and OAR of T11 (b∼c) Case 4 vs. case 3: DVH for spinal cord and OAR (d∼e): DVH for target and entire Vertebral Body.

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  Fig. 4. Dose distribution: (a) SIB Method vs. (b) RTOG 0631 Protocol.

Reference

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