title: Clinical practice of image-guided spine radiosurgery--results from an international research consortium.
abstract: BACKGROUND
  Spinal radiosurgery is a quickly evolving technique in the radiotherapy and neurosurgical communities. However, the methods of spine radiosurgery have not been standardized. This article describes the results of a survey about the methods of spine radiosurgery at five international institutions.
  
  
  METHODS
  All institutions are members of the Elekta Spine Radiosurgery Research Consortium and have a dedicated research and clinical focus on image-guided radiosurgery. The questionnaire consisted of 75 items covering all major steps of spine radiosurgery.
  
  
  RESULTS
  Strong agreement in the methods of spine radiosurgery was observed. In particular, similarities were observed with safety and quality assurance playing an important role in the methods of all institutions, cooperation between neurosurgeons and radiation oncologists in case selection, dedicated imaging for target- and organ-at-risk delineation, application of proper safety margins for the target volume and organs-at-risk, conformal planning and precise image-guided treatment delivery, and close clinical and radiological follow-up. In contrast, three major areas of uncertainty and disagreement were identified: 1) Indications and contra-indications for spine radiosurgery; 2) treatment dose and fractionation and 3) tolerance dose of the spinal cord.
  
  
  CONCLUSIONS
  Results of this study reflect the current practice of spine radiosurgery in large academic centers. Despite close agreement was observed in many steps of spine radiosurgery, further research in form of retrospective and especially prospective studies is required to refine the details of spinal radiosurgery in terms of safety and efficacy.
authors.affiliation: Department of Radiation Oncology, University Hospital Wuerzburg, Wuerzburg, Germany. Guckenberger_M@klinik.uni-wuerzburg.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Guckenberger
authors.forename: Reinhart A
authors.initials: RA
authors.lastname: Sweeney
authors.forename: John C
authors.initials: JC
authors.lastname: Flickinger
authors.forename: Peter C
authors.initials: PC
authors.lastname: Gerszten
authors.forename: Ronald
authors.initials: R
authors.lastname: Kersh
authors.forename: Jason
authors.initials: J
authors.lastname: Sheehan
authors.forename: Arjun
authors.initials: A
authors.lastname: Sahgal
mesh_terms: D006801:Humans; D016634:Radiosurgery / Q000379:methods* / Q000592:standards; D013116:Spinal Cord / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods* / Q000592:standards; D011795:Surveys and Questionnaires