Comparison of Dose Distribution in Spine Radiosurgery Plans: Simultaneously Integrated Boost and RTOG 0631 Protocol

Su Yeon Park; Dongryul Oh; Hee Chul Park; Jin Sung Kim; Jong Sik Kim; Eun Hyuk Shin; Hye Young Kim; Sang Hoon Jung; Youngyih Han

doi:10.14316/pmp.2014.25.3.176

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Park, Oh, Park, Kim, Kim, Shin, Kim, Jung, and Han: Comparison of Dose Distribution in Spine Radiosurgery Plans: Simultaneously Integrated Boost and RTOG 0631 Protocol

Original Article

Progress in Medical Physics 2014;25(3):176-184.

Published online: 20 September 2014

DOI: https://doi.org/10.14316/pmp.2014.25.3.176

Comparison of Dose Distribution in Spine Radiosurgery Plans: Simultaneously Integrated Boost and RTOG 0631 Protocol

Su Yeon Park, Dongryul Oh, Hee Chul Park, Jin Sung Kim, Jong Sik Kim, Eun Hyuk Shin, Hye Young Kim, Sang Hoon Jung, Youngyih Han

Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Correspondence: Dongryul Oh(dongryul.oh@samsung.com) Tel: 82-2-3410-2613, Fax:82-2-3410-2619

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (NRF-2012R1A1A–2042414).

This study was supported by Samsung Medical Center Grant [GFO1130081] and this study was supported by a grant of the Korea Healthcare Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (HI10C2020).

Received 18 August 2014 Revised 17 September 2014 Accepted 18 September 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

In this study, we compareddose distributions from simultaneously integrated boost (SIB) method versus the RTOG 0631 protocol for spine radiosurgery. Spine radiosurgery plans wereperformed in five patients with localized spinal metastases from hepatocellular carcinoma. The computed tomography (CT) and T1- and T2-weighted magnetic resonance imaging (MRI) were fused for delineating of GTV and spinal cord. In SIB plan, the clinical target volume (CTV1) was included the whole compartments of the involved spine, while RTOG 0631 protocol defines the CTV2 as the involved vertebral body and both left and right pedicles. The CTV2 includes transverse process and posterior element according to the extent of GTV. The doses were prescribed 18 Gy to GTV and 10 Gy to CTV1 in SIB plan, while the prescription of RTOG 0631 protocol was applied 18 Gy to CTV2. The results of dose-volume histogram (DVH) showed that there were competitive in target coverage, while the doses of spinal cord andother normal organs were lower in SIB method than in RTOG 0631 protocol. The 85% irradiated volume of VB in RTOG 0631 protocol was similar to that in the SIB plan. However, the dose to normal organs in RTOG 0631 had a tendency to higher than that in SIB plan. The SIB plan might be an alternative method in case of predictive serious complications of surrounded normal organs. In conclusion, although both approaches of SIB or RTOG 0631 showed competitive planning results, tumor control probability (TCP) and normal tissue complication probability (NTCP) through diverse clinical researches should be analyzed in the future.

Keywords: Spinal metastases, Spine radiosurgery, Simultaneously integrated boost, RTOG 0631 protocol

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Fig. 1.

Target volume delineation (a) SIB method vs. (b) RTOG 0631 Protocol.

Fig. 2.

Comparison of volume delineation on CT images for constraint (a) SIB method vs. (b) RTOG 0631 Protocol.

Fig. 3.

DVH comparisons: SIB method vs. RTOG 0631 Protocol. Case 4: DVH for Target and OAR of T11 (b∼c) Case 4 vs. case 3: DVH for spinal cord and OAR (d∼e): DVH for target and entire Vertebral Body.

Fig. 4.

Dose distribution: (a) SIB Method vs. (b) RTOG 0631 Protocol.

Table 1.

Clinical information in all patients for stereotactic body radiation therapy planning study.

Case	Gender	Age	Primary	Level	GTV location	Impending SC compression	Sx
1	M	64	HCC	L2	VB	Y	No
2	M	57	HCC	T9	VB+pedicles	Y	Back pain
3	M	60	HCC	T8	VB	Y	Back pain
4	M	62	HCC	T11	VB+pedicles	Y	Back pain
5	M	62	HCC	L1	VB	N	Back pain

GTV: gross tumor volume, M: male, HCC: hepatocellular carcinoma, VB: vertebral body, SC: spinal cord, Sx: symptom.

Table 2.

Spinal cord (Cauda equine) dose constraints used in SBRT.

	10% volume of partial cord	0.35 cc of whole spinal cord	Maximum dose (0.03cc)
Spinal cord dose (Gy)	＜10 (12)	＜10 (12)	＜14 (16)

(): Cauda equine tolerance dose.

Table 3.

OAR dose constraints used in SBRT.

	Organ	Constraints
1	Esophagus	＜0.03 cc, 14 Gy
		＜5 cc, 119 Gy
2	Ipsilateral Brachial	＜0.03 cc, 17.5 Gy
3	Plexus	＜3 cc, 14 Gy
4	Heart/Pericardium	＜0.03 cc, 22 Gy
		＜15 cc, 16 Gy
5	Trachea/Larynx	＜0.03 cc, 13 Gy
		＜4 cc, 8.5 Gy
6	Gastroduodenum	＜0.03 cc, 16 Gy
		＜5 cc, 11.2 Gy
7	Skin	＜0.03 cc, 26 Gy
		＜10 cc, 23 Gy
8	Small Bowel	＜0.03 cc, 11.4 Gy
		＜5 cc, 11.9 Gy
9	Large Bowel	＜0.03 cc, 18.4 Gy
		＜20 cc, 14.3 Gy

Table 4.

Dosimetric results for the target and organs at risk (OAR): SIB method vs. RTOG 0631 protocol.

Criteria	Criteria	SIB method		RTOG 0631 protocol
Criteria	Criteria	Mean	SD	Mean	SD
Target volume (cc)		16.84	11.26	51.00	15.63
Dmax (0.03 cc, Gy)		20.98	0.63	21.51	0.86
Dmean (Gy)		19.23	0.17	19.99	0.55
V18 Gy (%)	＞90%	86.28	5.97	91.56	5.06
GTV (cc)
Dmax (0.03 cc, Gy)		20.98	0.63	21.38	0.86
Dmean (Gy)		19.23	0.17	19.98	0.71
V18 Gy (%)	＞90%	86.28	5.97	88.85	7.19
Esophagus
Dmax (0.03 cc, Gy)	＜14 Gy	8.93	1.14	10.98	1.03
V11.9 Gy (cc)	＜5 cc	0.00	0.00	0.00	0.00
Duodenum
Dmax (0.03 cc, Gy)	＜16 Gy	6.68	3.06	10.31	3.77
V11.2 Gy (cc)	＜5 cc	0.00	0	0.12	0.16
Entire vertebral body (cc)		87.40	36.33	87.40	36.33
Dmax (0.03 cc, Gy)		21.00	0.63	21.47	0.88
Dmean (Gy)		14.55	1.19	17.18	0.71
D80% (Gy)		11.12	0.94	13.19	2.83
D90% (Gy)		10.02	0.18	9.05	2.26
V8 Gy (%)		98.51	1.94	92.85	5.62
V10 Gy (%)		90.07	1.63	85.89	6.44
Irradiated volume (cc)
5.4 Gy (30%)		544.83	182.17	796.85	159.85
8 Gy		246.29	90.12	366.16	91.9
9 Gy (50%)		180.61	60.06	290.59	76.62
10 Gy		129.68	14.3	238.2	63.31
14.4 Gy (80%)		42.9	18.32	129.26	33.21
16.2 Gy (90%)		30.69	15.37	103.21	25.67
18 Gy		19.99	11.31	76.22	17.67

SIB: simultaneously integrated boost, RTOG: Radiation Therapy Oncology Group, Target volume: CTV1 is the same meaning of target volume in SIB type and CTV2 in RTOG 0631 protocol, SD: Standard deviation.

Table 5.

Dosimetric results for partial spinal cord.

	SIB type			RTOG 0631 protocol
	Criteria	Mean	Range	Mean	Range
Dmax (0.03 cc)	＜14 Gy	11.50	11.1∼11.80	11.34	10.30∼12.00
V10	＜10%	07.41	3.71∼8.68	06.97	00.98∼10.49

Dmax: Maximum dose is receiving dose to the 0.3 cc of the partial volume of the spinal cord; SIB: simultaneously integrated boost; RTOG: Radiation Therapy Oncology Group.

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