title: Spine radiosurgery: lessons learned from the first 100 treatment sessions.
abstract: OBJECTIVE Local therapy to spine tumors has been shown to be effective in selected cases. Spinal radiosurgery (SRS) is an evolving radiotherapy regimen allowing for noninvasive, highly efficacious local treatment. The learning curve can compromise the results of any newly employed technology and should be studied to minimize its effects. In this paper the first 100 SRSs performed at several medical centers are presented and analyzed for the effects of the learning curve on outcome. METHODS A retrospective analysis was undertaken to evaluate data from patients treated with SRS at Sheba Medical Center and Assuta Medical Centers in the period from September 2011 to February 2016. Medical history, clinical and neurological findings, pathological diagnoses, SRS variables, complications, and follow-up data were collected and analyzed. Local control rates were calculated, and local treatment failure cases were qualitatively studied. RESULTS One hundred treatment sessions were performed for 118 lesions at 179 spinal levels in 80 patients. The complication rate was low and did not correlate with a learning curve. Mean follow-up time was 302 days, and the overall local control rate was 95%. The local control rate was dose dependent and increased from 87% (among 35 patients receiving a dose of 16 Gy) to 97% (among 65 patients receiving a dose of 18 Gy). The 6 treatment failure cases are discussed in detail. CONCLUSIONS Spinal radiosurgery is a safe and effective treatment. Comprehensive education of the treating team and continuous communication are essential to limit the effects of the learning curve on outcome.
authors.affiliation: 1Stereotactic Radiosurgery Unit and.|2Spine Surgery Unit, Talpiot Medical Leadership Program, Department of Neurosurgery, Sheba Medical Center, Ramat Gan.|3Sackler Medical School, Tel-Aviv University.
authors.forename: Ran
authors.initials: R
authors.lastname: Harel
authors.affiliation: 4Department of Radiotherapy, Assuta Medical Centers, Tel-Aviv; and.
authors.forename: Raphael
authors.initials: R
authors.lastname: Pfeffer
authors.affiliation: 4Department of Radiotherapy, Assuta Medical Centers, Tel-Aviv; and.
authors.forename: Daphne
authors.initials: D
authors.lastname: Levin
authors.affiliation: 4Department of Radiotherapy, Assuta Medical Centers, Tel-Aviv; and.
authors.forename: Efrat
authors.initials: E
authors.lastname: Shekel
authors.affiliation: 4Department of Radiotherapy, Assuta Medical Centers, Tel-Aviv; and.
authors.forename: Dan
authors.initials: D
authors.lastname: Epstein
authors.affiliation: 5Radiation Oncology Unit, Oncology Institute, Sheba Medical Center, Ramat Gan, Israel.
authors.forename: Lev
authors.initials: L
authors.lastname: Tsvang
authors.affiliation: 5Radiation Oncology Unit, Oncology Institute, Sheba Medical Center, Ramat Gan, Israel.
authors.forename: Maoz
authors.initials: M
authors.lastname: Ben Ayun
authors.affiliation: 5Radiation Oncology Unit, Oncology Institute, Sheba Medical Center, Ramat Gan, Israel.
authors.forename: Dror
authors.initials: D
authors.lastname: Alezra
authors.affiliation: 3Sackler Medical School, Tel-Aviv University.|5Radiation Oncology Unit, Oncology Institute, Sheba Medical Center, Ramat Gan, Israel.
authors.forename: Leor
authors.initials: L
authors.lastname: Zach
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: ATRT = atypical teratoid/rhabdoid tumor; CBCT = cone-beam CT; CTV = clinical target volume; Dmax = maximum cord point dose; IMRT = intensity-modulated radiotherapy; NST = nerve sheath tumor; SRS = spinal radiosurgery; VMAT = volumetric modulated arc therapy; learning curve; spine radiosurgery; spine tumors