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The current status and future of radiotherapy for spinal bone metastases.

Ejima Y, Matsuo Y, Sasaki R - J Orthop Sci (2015)

Bottom Line: SBRT and IMRT are particularly well suited for the treatment of spinal bone metastases when they are localized or require re-irradiation, and may provide superior tumor control.Predicting the prognosis of patients with bone metastases and assessing spinal instability are both important when selecting the optimal RT method and deciding whether to perform surgery.The proper care of spinal bone metastases patients requires an interdisciplinary treatment approach.

View Article: PubMed Central - PubMed

Affiliation: Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuouku, Kobe, Hyogo, 650-0017, Japan.

ABSTRACT
The management of spinal bone metastases is complex. In this review, the efficacy, methodology, and utilization of radiotherapy (RT) for spinal bone metastases are discussed. A number of randomized trials have evaluated the efficacy of 8 Gy, single-fraction RT for the palliation of painful bone metastases. However, RT for metastatic spinal cord compression has not been evaluated with respect to its optimal dose, palliative potential, or its ability to improve motor function. Two highly sophisticated RT techniques - stereotactic body RT (SBRT) and intensity-modulated RT (IMRT) - have recently been adapted for the treatment of spinal bone metastases, and both have the potential to achieve excellent control while minimizing acute and late toxicity. SBRT and IMRT are particularly well suited for the treatment of spinal bone metastases when they are localized or require re-irradiation, and may provide superior tumor control. Predicting the prognosis of patients with bone metastases and assessing spinal instability are both important when selecting the optimal RT method and deciding whether to perform surgery. The proper care of spinal bone metastases patients requires an interdisciplinary treatment approach.

No MeSH data available.


Related in: MedlinePlus

Upperpanels the CyberKnife apparatus (left); a 3-dimensional rendered image (right) blue lines indicate beam directions. Lowerpanels Xsight, the image-guidance system used in the CyberKnife system, enables the automatic tracking of skeletal structures (left). Representative dose distribution (right)
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Fig1: Upperpanels the CyberKnife apparatus (left); a 3-dimensional rendered image (right) blue lines indicate beam directions. Lowerpanels Xsight, the image-guidance system used in the CyberKnife system, enables the automatic tracking of skeletal structures (left). Representative dose distribution (right)

Mentions: Recently, two sophisticated RT techniques, stereotactic body RT (SBRT; including stereotactic radiosurgery and stereotactic RT) and intensity-modulated RT (IMRT) have been adapted for the treatment of spinal bone metastases. SBRT uses more beams from many more directions than conventional opposed-field RT and consequently delivers much higher doses in a hypofractionated manner (either as a single fraction or as a smaller number of fractions). IMRT makes it possible to deliver optimal radiation doses safely to an irregularly shaped target while minimizing the dose to the surrounding normal structures. In order to achieve a high standard of targeting precision, these approaches require that the exact location and shape of the tumor be determined using imaging techniques (Fig. 1). In general, the term “spinal SBRT” refers to the use of both IMRT techniques and SBRT. The most important additional benefit of spinal SBRT is the possibility of achieving excellent dose coverage of the target, while avoiding the spinal cord, which is often the major limiting factor when delivering high-dose RT (Figs. 1, 2). Multiple retrospective studies have demonstrated that SBRT could feasibly be used to treat spinal metastases, and could control target lesions with only low toxicity [8, 9]. The local control rate based on imaging and/or pain management criteria was reported to be greater than 80 %, with only rare cases of toxicity.Fig. 1


The current status and future of radiotherapy for spinal bone metastases.

Ejima Y, Matsuo Y, Sasaki R - J Orthop Sci (2015)

Upperpanels the CyberKnife apparatus (left); a 3-dimensional rendered image (right) blue lines indicate beam directions. Lowerpanels Xsight, the image-guidance system used in the CyberKnife system, enables the automatic tracking of skeletal structures (left). Representative dose distribution (right)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4518067&req=5

Fig1: Upperpanels the CyberKnife apparatus (left); a 3-dimensional rendered image (right) blue lines indicate beam directions. Lowerpanels Xsight, the image-guidance system used in the CyberKnife system, enables the automatic tracking of skeletal structures (left). Representative dose distribution (right)
Mentions: Recently, two sophisticated RT techniques, stereotactic body RT (SBRT; including stereotactic radiosurgery and stereotactic RT) and intensity-modulated RT (IMRT) have been adapted for the treatment of spinal bone metastases. SBRT uses more beams from many more directions than conventional opposed-field RT and consequently delivers much higher doses in a hypofractionated manner (either as a single fraction or as a smaller number of fractions). IMRT makes it possible to deliver optimal radiation doses safely to an irregularly shaped target while minimizing the dose to the surrounding normal structures. In order to achieve a high standard of targeting precision, these approaches require that the exact location and shape of the tumor be determined using imaging techniques (Fig. 1). In general, the term “spinal SBRT” refers to the use of both IMRT techniques and SBRT. The most important additional benefit of spinal SBRT is the possibility of achieving excellent dose coverage of the target, while avoiding the spinal cord, which is often the major limiting factor when delivering high-dose RT (Figs. 1, 2). Multiple retrospective studies have demonstrated that SBRT could feasibly be used to treat spinal metastases, and could control target lesions with only low toxicity [8, 9]. The local control rate based on imaging and/or pain management criteria was reported to be greater than 80 %, with only rare cases of toxicity.Fig. 1

Bottom Line: SBRT and IMRT are particularly well suited for the treatment of spinal bone metastases when they are localized or require re-irradiation, and may provide superior tumor control.Predicting the prognosis of patients with bone metastases and assessing spinal instability are both important when selecting the optimal RT method and deciding whether to perform surgery.The proper care of spinal bone metastases patients requires an interdisciplinary treatment approach.

View Article: PubMed Central - PubMed

Affiliation: Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuouku, Kobe, Hyogo, 650-0017, Japan.

ABSTRACT
The management of spinal bone metastases is complex. In this review, the efficacy, methodology, and utilization of radiotherapy (RT) for spinal bone metastases are discussed. A number of randomized trials have evaluated the efficacy of 8 Gy, single-fraction RT for the palliation of painful bone metastases. However, RT for metastatic spinal cord compression has not been evaluated with respect to its optimal dose, palliative potential, or its ability to improve motor function. Two highly sophisticated RT techniques - stereotactic body RT (SBRT) and intensity-modulated RT (IMRT) - have recently been adapted for the treatment of spinal bone metastases, and both have the potential to achieve excellent control while minimizing acute and late toxicity. SBRT and IMRT are particularly well suited for the treatment of spinal bone metastases when they are localized or require re-irradiation, and may provide superior tumor control. Predicting the prognosis of patients with bone metastases and assessing spinal instability are both important when selecting the optimal RT method and deciding whether to perform surgery. The proper care of spinal bone metastases patients requires an interdisciplinary treatment approach.

No MeSH data available.


Related in: MedlinePlus