Precision required for dose-escalated treatment of spinal metastases and implications for image-guided radiation therapy (IGRT)

  • Guckenberger M
  • Meyer J
  • Wilbert J
 et al. 
  • 31


    Mendeley users who have this article in their library.
  • 44


    Citations of this article.


Introduction: To evaluate the precision required in dose-escalated IMRT treatment of spinal metastases and paraspinal tumors. Methods: In IMRT treatment plans of nine patients with spinal metastases (n = 7) and paraspinal tumors (n = 2) translational patient positioning errors (0-10 mm) and rotational errors (0-7.5°) were simulated. The dose to the spinal cord (D5spine) resulting from these simulations was evaluated and NTCP for spinal cord necrosis was calculated. All patient set-up errors observed during treatment were simulated and the influence on D5spinewas investigated. Results: To keep the dose distribution to the spinal cord within ±5% (±10%) of the prescribed dose, maximum tolerable errors of 1 mm (2 mm) in the transversal plane, 4 mm (7 mm) in superior-inferior direction and maximum rotations of 3.5° (5°) were calculated on average. The translational and rotational component of clinically observed set-up errors increased D5spineby 23 ± 14% and 3 ± 2% on average, respectively. Conclusion: Steep dose gradients of IMRT planning require very high precision. In selected patients correction of both translational and rotational errors may be beneficial. © 2007 Elsevier Ireland Ltd. All rights reserved.

Author-supplied keywords

  • Cone-beam CT
  • Image-guided radiotherapy (IGRT)
  • Intensity-modulated radiotherapy (IMRT)
  • Rotational set-up errors
  • Spinal metastasis

Get free article suggestions today

Mendeley saves you time finding and organizing research

Sign up here
Already have an account ?Sign in

Find this document


Cite this document

Choose a citation style from the tabs below

Save time finding and organizing research with Mendeley

Sign up for free