SBRT planning for spinal metastasis: indications from a large multicentric study

Marco Esposito, Laura Masi, Margherita Zani, Raffaela Doro, David Fedele, Cristina Garibaldi, Stefania Clemente, Christian Fiandra, Francesca Romana Giglioli, Carmelo Marino, Laura Orsingher, Serenella Russo, Michele Stasi, Lidia Strigari, Elena Villaggi, Pietro Mancosu

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: The dosimetric variability in spine stereotactic body radiation therapy (SBRT) planning was investigated in a large number of centres to identify crowd knowledge-based solutions.

METHODS: Two spinal cases were planned by 48 planners (38 centres). The required prescription dose (PD) was 3 × 10 Gy and the planning target volume (PTV) coverage request was: VPD > 90% (minimum request: VPD > 80%). The dose constraints were: planning risk volume (PRV) spinal cord: V18Gy < 0.35 cm3, V21.9 Gy < 0.03 cm3; oesophagus: V17.7 Gy < 5 cm3, V25.2 Gy < 0.03 cm3. Planners who did not fulfil the protocol requirements were asked to re-optimize the plans, using the results of planners with the same technology. Statistical analysis was performed to assess correlations between dosimetric results and planning parameters. A quality index (QI) was defined for scoring plans.

RESULTS: In all, 12.5% of plans did not meet the protocol requirements. After re-optimization, 98% of plans fulfilled the constraints, showing the positive impact of knowledge sharing. Statistical analysis showed a significant correlation (p < 0.05) between the homogeneity index (HI) and PTV coverage for both cases, while the correlation between HI and spinal cord sparing was significant only for the single dorsal PTV case. Moreover, the multileaf collimator leaf thickness correlated with the spinal cord sparing. Planners using comparable delivery/planning system techniques produced different QI, highlighting the impact of the planner's skills in the optimization process.

CONCLUSION: Both the technology and the planner's skills are fundamentally important in spine SBRT planning optimization. Knowledge sharing helped to follow the plan objectives.

Original languageEnglish
Pages (from-to)226-235
Number of pages10
JournalStrahlentherapie und Onkologie
Volume195
Issue number3
DOIs
Publication statusPublished - Mar 2019

Keywords

  • Clinical Competence
  • Correlation of Data
  • Humans
  • Organs at Risk/radiation effects
  • Quality Assurance, Health Care/methods
  • Radiation Injuries/prevention & control
  • Radiometry
  • Radiosurgery/methods
  • Radiotherapy Planning, Computer-Assisted/methods
  • Radiotherapy, Conformal/methods
  • Radiotherapy, Intensity-Modulated/methods
  • Spinal Cord/radiation effects
  • Spinal Neoplasms/radiotherapy

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