title: Technique for stereotactic body radiotherapy for spinal metastases.
abstract: Stereotactic body radiotherapy (SBRT) is an emerging technique for spinal tumours that is a natural succession to brain radiosurgery. The spine is an ideal site for SBRT due to its relative immobility and the potential clinical benefits of high dose delivery, particularly to optimise local control and avoid disease progression that can result in spinal cord compression. However, the proximity of the tumour to the spinal cord, with the potential for radiation myelopathy if the dose is delivered inaccurately or if the spinal cord dose limit is set too high, demands technical accuracy with radiation myelopathy a feared complication. Spine SBRT has been delivered with either a robotic-based linac system such as the Cyberknife, or with linac-based systems equipped with a multileaf collimator and image guidance system. Regardless of the technology, spine SBRT demands sophisticated treatment planning and delivery. This case-based technical review outlines the SBRT apparatus, planning and treatment delivery in use at the University of Toronto, Toronto, Canada.
authors.affiliation: Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada.
authors.forename: Matthew
authors.initials: M
authors.lastname: Foote
authors.forename: Daniel
authors.initials: D
authors.lastname: Letourneau
authors.forename: Derek
authors.initials: D
authors.lastname: Hyde
authors.forename: Eric
authors.initials: E
authors.lastname: Massicotte
authors.forename: Raja
authors.initials: R
authors.lastname: Rampersaud
authors.forename: Michael
authors.initials: M
authors.lastname: Fehlings
authors.forename: Charles
authors.initials: C
authors.lastname: Fisher
authors.forename: Stephen
authors.initials: S
authors.lastname: Lewis
authors.forename: Nancy La
authors.initials: NL
authors.lastname: Macchia
authors.forename: Eugene
authors.initials: E
authors.lastname: Yu
authors.forename: Normand J
authors.initials: NJ
authors.lastname: Laperriere
authors.forename: Arjun
authors.initials: A
authors.lastname: Sahgal
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000532:radiotherapy* / Q000556:secondary*; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D016634:Radiosurgery / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D013125:Spinal Neoplasms / Q000532:radiotherapy* / Q000556:secondary*