title: Intensity modulated stereotactic body radiation therapy for single or multiple vertebral metastases with spinal cord compression.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the efficacy and toxicity of intensity modulated radiation therapy with simultaneous integrated boost (SIB-IMRT) for single or multiple vertebral metastases (VM) with spinal cord compression using tomotherapy.
  
  
  METHODS
  Thirty patients with 40 VM were treated with SIB-IMRT as initial radiation therapy. Either 40 Gy in 8 fractions or 48 Gy in 16 fractions was prescribed depending on the Katagiri prognostic index. The radiation doses to the spinal cord and other risk organs were reduced to tolerance levels using intensity modulation. One to 4 lesions in consecutive vertebrae were treated in 1 course of SIB-IMRT. Radiologic and physical examinations were performed at 1-3 month intervals after SIB-IMRT. The Barthel index (BI) and numerical rating scale (NRS) were used to evaluate activities of daily living (ADL) and pain status, respectively.
  
  
  RESULTS
  The median follow-up period was 8 months. The NRS significantly dropped at 1 month after SIB-IMRT (P < .0001) and the effect continued for over 2 months. No significant BI decrease was observed at 2 months after SIB-IMRT (P = .7). The 1-year local control rate was 84% (95% confidence interval, 70%-100%). No grade≥2 neurologic toxicity resulting from SIB-IMRT was observed.
  
  
  CONCLUSIONS
  SIB-IMRT could be successfully applied to VM with spinal cord compression in up to 4 consecutive vertebrae. Good ADL preservation and pain control were achieved with acceptable toxicity.
authors.affiliation: Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Department of Radiation Oncology, Yokohama CyberKnife Center, Yokohama, Japan. Electronic address: taro8864@yahoo.co.jp.
authors.forename: Taro
authors.initials: T
authors.lastname: Murai
authors.affiliation: Department of Radiation Oncology, JA Suzuka General Hospital, Suzuka, Japan.
authors.forename: Rumi
authors.initials: R
authors.lastname: Murata
authors.affiliation: Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Manabe
authors.affiliation: Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Chikao
authors.initials: C
authors.lastname: Sugie
authors.affiliation: Department of Radiation Oncology, JA Suzuka General Hospital, Suzuka, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tamura
authors.affiliation: Department of Radiation Oncology, JA Suzuka General Hospital, Suzuka, Japan.
authors.forename: Hiroya
authors.initials: H
authors.lastname: Ito
authors.affiliation: Department of Radiation Oncology, JA Suzuka General Hospital, Suzuka, Japan.
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Miyoshi
authors.affiliation: Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Yuta
authors.initials: Y
authors.lastname: Shibamoto
mesh_terms: D000368:Aged; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011446:Prospective Studies; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods; D013117:Spinal Cord Compression / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D013125:Spinal Neoplasms / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D013131:Spine / Q000473:pathology / Q000601:surgery