title: New approach for treatment of vertebral metastases using intensity-modulated radiotherapy.
abstract: OBJECTIVE
  To perform aggressive radiotherapy for vertebral metastases. Using very steep dose gradients from intensity-modulated radiotherapy (IMRT), a protocol based on the concept of partial volume dose to the spinal cord was evaluated.
  
  
  METHODS
  50 patients with vertebral metastases were treated using IMRT. In previously unirradiated cases, where a prescribed dose of 80 Gy (BED10) was delivered, the constraint to the spinal cord should be less than 100 Gy (BED2). For previously irradiated cases, on the other hand, the dose is the same as in the previously unirradiated case; however, constraints for the spinal cord are a cumulative BED2 of less than 150 Gy, BED2 of less than 100 Gy in each instance, and a treatment gap of more than 6 months. There were 6 patients considered for a partial volume dose to the spinal cord. They all received higher BED2, ranging from 51-157 Gy of D1cc.
  
  
  RESULTS
  Among the 24 patients who survived longer than 1 year, there was 1 case of transient radiation myelitis. There were no other cases of spinal cord sequelae.
  
  
  CONCLUSIONS
  Based on the present results, we recommend a BED2 of 100 Gy or less at D1cc as a constraint for the spinal cord in previously unirradiated cases, and a cumulative BED2 of 150 Gy or less at D1cc in previously irradiated cases, when the interval was not shorter than 6 months and the BED2 for each session was 100 Gy or less. The prescribed BED10 of 80 Gy could be safely delivered to the vertebral lesions.
authors.affiliation: Miyakojima IGRT Clinic, Osaka, Japan. toinoue@osaka-igrt.or.jp
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Inoue
authors.forename: Ryoong-Jin
authors.initials: RJ
authors.lastname: Oh
authors.forename: Hiroya
authors.initials: H
authors.lastname: Shiomi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009187:Myelitis / Q000209:etiology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000532:radiotherapy; D010166:Palliative Care; D011832:Radiation Injuries / Q000209:etiology; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D013116:Spinal Cord / Q000528:radiation effects; D013125:Spinal Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*