MRI-guided stereotactic ablative radiation therapy of spinal bone metastases: A preliminary experience

Ricardo Llorente, Benjamin O. Spieler, James Victoria, Cristiane Takita, Raphael Yechieli, John C. Ford, Karen Brown, Michael A. Samuels, Eric A. Mellon

Research output: Contribution to journalArticle

Abstract

Objective: MRI provides clear visualization of spinal cord, tumor, and bone for patient positioning and verification during MRI-guided radiotherapy (MRI-RT). Therefore, we wished to evaluate spine stereotactic ablative radiotherapy (SABR) feasibility with MRI-RT. Given dosimetric limitations of first generation Co-60 MRI-RT, we then evaluated improvements by newer linear accelerator (linac) MRI-RT. Methods: Nine spinal metastases were treated with Co-60 MRI-RT. Seven received a single 16 Gy fraction, and two received three fractions totaling 24 or 30 Gy. After replanning with linac MRI-RT software, comparisons of organ at risk and dose spillage objectives between Co-60 and linac plans were performed. results: Spinal cord and cauda equina dose constraints were met in all Co-60 cases. Treatments were delivered successfully with real-time imaging during treatment and no treatment-related toxicities. While limits for dose spillage into surrounding soft tissues were not achieved due to the limitations of the Co-60 system, this could be corrected with linac MRI-RT delivery. Conclusions: MRI-RT SABR of spinal metastases is feasible with Co-60 MRI-RT. Dose delivery is improved by linac MRI-RT. advances in knowledge: This is the first report of MRI-RT for SABR of spinal metastases. The enhanced visualization of anatomy by MRI may facilitate RT dose escalation for spine SABR.

Original languageEnglish (US)
Article number20190655
JournalBritish Journal of Radiology
Volume93
Issue number1105
DOIs
StatePublished - Jan 1 2020

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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