title: Image-guided stereotactic spine radiosurgery on a conventional linear accelerator.
abstract: Stereotactic radiosurgery for spinal metastasis consists of a high radiation dose delivered to the tumor in 1 to 5 fractions. Due to the high radiation dose in a single or fewer treatments, the precision of tumor localization and dose delivery is of great concern. Many groups have published their experiences of spinal radiosurgery with the use of CyberKnife System (Accuray Inc.). In this study, we report in detail our approach to stereotactic spine radiosurgery (SSRS) using a conventional linear accelerator (Varian Trilogy), utilizing the features of kilovolt on-board imaging (kV-OBI) and cone beam computed tomography (CBCT) for image guidance. We present our experience in various aspects of the SSRS procedure, including patient simulation and immobilization, intensity-modulated radiation treatment (IMRT) planning and beam selection, portal dosimetry for patient planning quality assurance (QA), and the use of image guidance in tumor localization prior to and during treatment delivery.
authors.affiliation: Department of Radiation Oncology, Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA. jwang@ucsd.edu
authors.forename: Jia-Zhu
authors.initials: JZ
authors.lastname: Wang
authors.forename: Roger
authors.initials: R
authors.lastname: Rice
authors.forename: Arno
authors.initials: A
authors.lastname: Mundt
authors.forename: Ajay
authors.initials: A
authors.lastname: Sandhu
authors.forename: Kevin
authors.initials: K
authors.lastname: Murphy
mesh_terms: D004867:Equipment Design; D019544:Equipment Failure Analysis; D006801:Humans; D011859:Radiography; D016634:Radiosurgery / Q000295:instrumentation* / Q000379:methods*; D011879:Radiotherapy Dosage; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D016896:Treatment Outcome