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Ehsan H. Balagamwala, Lilyana Angelov, Shlomo A. Koyfman, John H. Suh, Chandana A. Reddy, Toufik Djemil, Grant K. Hunter, Ping Xia and Samuel T. Chao

patients who have neurological compromise but are not surgical candidates, urgent CRT can be used to treat cord compression. 8 , 22 Renal cell carcinoma has a historical reputation of being a radioresistant tumor. 24 , 25 It has long been believed that delivery of higher doses of radiation will yield better control of RCC metastases to the spine. However, the radiation tolerance of the spinal cord limits the dose that can be safely delivered to treat these metastases. Stereotactic body radiotherapy enables the delivery of highly conformal large doses of radiation with

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Ahmed Hashmi, Matthias Guckenberger, Ron Kersh, Peter C. Gerszten, Frederick Mantel, Inga S. Grills, John C. Flickinger, John H. Shin, Daniel K. Fahim, Brian Winey, Kevin Oh, B. C. John Cho, Daniel Létourneau, Jason Sheehan and Arjun Sahgal

. These data highlight the need for more effective treatments in the retreatment indication. It is also important to recognize that the decision to re-irradiate with additional cEBRT limits further treatment options significantly due to toxicity concerns, and this is of particular relevance to spinal metastases because the spinal cord and cauda equina (critical neural tissue [CNT]) can tolerate only so much cumulative exposure. Stereotactic body radiotherapy (SBRT) has been defined by several national and international bodies and associations as the precise delivery

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Eric L. Chang, Almon S. Shiu, Ehud Mendel, Leni A. Mathews, Anita Mahajan, Pamela K. Allen, Jeffrey S. Weinberg, Barry W. Brown, Xin Shelly Wang, Shiao Y. Woo, Charles Cleeland, Moshe H. Maor and Laurence D. Rhines

which his head was stabilized. The beam arrangement, radiation treatment plan, and dose–volume histogram are shown in Fig. 5 . F ig . 5. Stereotactic body radiotherapy for spinal metastasis centered on C-2 with: a nine-coplanar beam arrangement (A), treatment plans shown in axial, sagittal, and coronal views (B), and a dose–volume histogram for spinal metastasis centered on C-2 (C). Cord = spinal cord; GTV = gross tumor volume. The patient underwent an elective tracheostomy to protect his airway passage prior to the simulation. Grade 3 dysphagia and

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Jonathan E. Leeman, Mark Bilsky, Ilya Laufer, Michael R. Folkert, Neil K. Taunk, Joseph R. Osborne, Julio Arevalo-Perez, Joan Zatcky, Kaled M. Alektiar, Yoshiya Yamada and Daniel E. Spratt

therapy options for many types of sarcomas. Therefore, treatment of spinal lesions from metastatic sarcoma typically involves surgery and radiotherapy. Stereotactic body radiotherapy (SBRT) is a modern technique that uses high-dose-per-fraction radiation delivered precisely to the target lesion. SBRT results in local control rates > 85%, with minimal impact of histology. 1 , 6 , 10 , 11 , 15 , 19 Across a mixture of cancer types, investigators have shown that 83% of patients with metastatic disease to the spine have multilevel involvement at the time of presentation

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Michael W. Chan, Isabelle Thibault, Eshetu G. Atenafu, Eugene Yu, B. C. John Cho, Daniel Letourneau, Young Lee, Albert Yee, Michael G. Fehlings and Arjun Sahgal

-Cote L , Campbell M , Atenafu EG , Parent A , : Surgical resection of epidural disease improves local control following postoperative spine stereotactic body radiotherapy . Neuro Oncol 15 : 1413 – 1419 , 2013 2 Algra PR , Heimans JJ , Valk J , Nauta JJ , Lachniet M , Van Kooten B : Do metastases in vertebrae begin in the body or the pedicles? Imaging study in 45 patients . AJR Am J Roentgenol 158 : 1275 – 1279 , 1992 3 Bilsky MH , Laufer I , Fourney DR , Groff M , Schmidt MH , Varga PP , : Reliability analysis

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Isabelle Thibault, Ameen Al-Omair, Giuseppina Laura Masucci, Laurence Masson-Côté, Fiona Lochray, Renée Korol, Lu Cheng, Wei Xu, Albert Yee, Michael G. Fehlings, Georg A. Bjarnason and Arjun Sahgal

R enal cell cancer (RCC) metastases have been traditionally considered to be radioresistant, with poor response rates to conventional palliative radiotherapy. However, high dose per fraction radiation delivered using stereotactic body radiotherapy (SBRT) has the potential to maximize local control (LC) safely and to treat patients with locally “curative” intent rather than locally “palliative” intent. 20 The SBRT technique has been recently defined by the Canadian Association of Radiation Oncologists as “The precise delivery of highly conformal and image

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Nicholas S. Boehling, David R. Grosshans, Pamela K. Allen, Mary F. McAleer, Allen W. Burton, Syed Azeem, Laurence D. Rhines and Eric L. Chang

stabilizing metastatic spine lesions. 2–4 , 12 , 14 , 16 , 20 , 22 , 29 Stereotactic body radiotherapy itself sometimes requires lengthy setup times and intervention before treatment to both stabilize at-risk fractures and allow patients to be comfortably immobilized. In addition, post-SBRT prophylactic interventions for those deemed at risk for VCF can reduce the time spent in bed rest, sequelae such as deep venous thrombosis, and possibly mortality. 24 We retrospectively evaluated data to review the risk of VCF and associated factors in patients treated with SBRT for

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Kei Ito, Keiji Nihei, Takuya Shimizuguchi, Hiroaki Ogawa, Tomohisa Furuya, Shurei Sugita, Takahiro Hozumi, Keisuke Sasai and Katsuyuki Karasawa

extending life expectancy for patients with metastatic disease, the need for safe re-irradiation and long-term local control of spinal metastases is growing. Stereotactic body radiotherapy (SBRT) with intensity-modulated radiation therapy (IMRT) and an image guidance technique has emerged as a new treatment option for spinal metastases 13 and has been applied to patients following surgery. 27 SBRT can spare the adjacent organs at risk (OARs), while delivering high-dose radiation to the target volume. Spine SBRT, therefore, could provide safe re-irradiation and a high

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Arjun Sahgal, Mark Bilsky, Eric L. Chang, Lijun Ma, Yoshiya Yamada, Laurence D. Rhines, Daniel Létourneau, Matthew Foote, Eugene Yu, David A. Larson and Michael G. Fehlings

S tereotactic body radiotherapy is increasingly being applied to treat primary and metastatic spinal tumors. 10 , 13 , 46 , 48 The term SBRT implies high-doseper-fraction radiation (typically > 5 Gy per fraction) delivered to an image-guided target in 1 to 5 fractions by using conformal radiation techniques. 48 Stereotactic body radiotherapy for the spine is technically demanding because it often requires near-rigid body immobilization, sophisticated treatment planning allowing for sharp dose gradients (in particular at the spinal cord–vertebral segment

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Stereotactic body radiotherapy for de novo spinal metastases: systematic review

International Stereotactic Radiosurgery Society practice guidelines

Zain A. Husain, Arjun Sahgal, Antonio De Salles, Melissa Funaro, Janis Glover, Motohiro Hayashi, Masahiro Hiraoka, Marc Levivier, Lijun Ma, Roberto Martínez-Alvarez, J. Ian Paddick, Jean Régis, Ben J. Slotman and Samuel Ryu

/spinal neoplasms, spinal cord neoplasm, radiosurgery SBRT, stereotactic body radiotherapy, stereotactic radiosurgery, stereotactic body radiation, SABR, stereotactic ablative body radiation, stereotactic ablative body radiotherapy, radiotherapy dosage, fractures, compression, and radiation injuries. Eligibility Criteria Published studies that reported clinical outcomes for patients treated with SBRT for spinal metastases were included if the report included, at a minimum, clinical outcomes regarding local control or pain control. Studies that included a mixed group of previously