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Dear SDN rad oncs,
I'm helping to develop a clinical trial in the setting of palliative SBRT for spine metastases and I wanted to ask: Would you please share your preferred way of attacking spine mets? I just want to make sure that in protocol development we don't end up recommending a style of treatment that goes against what people are actually doing in their practices.
Here's my personal SBRT spine history (in the palliative setting):
When I was in residency, I usually followed the RTOG 0631 protocol and had a single 16-18Gy volume that usually encompassed the whole vertebral body and the immediately adjacent vertebral segments. (Because the trial reported as negative, I have generally stopped doing single fraction SBRT.)
When the CCTG SC.24 (Sahgal) reported as positive, I switched to 24Gy in 2 daily fractions and my volumes were still similar to RTOG 0631.
Then Guckenberger et al reported as positive and I switched again, now doing 20Gy in 5 daily fractions to the majority of the vertebral body (usually only skimping at the spinous process or the tips of the transverse processes) with a simultaneous integrated boost to 40Gy to the gross tumor. I often don't have much if any CTV margin on the gross disease for the 40Gy volume and I let things run extremely hot inside the gross tumor. I usually have a 2mm PTV on everything but it really doesn't matter because I'm always running cold along cord/cauda and esophagus anyways.
Sincerely,
Music Man Stan
I'm helping to develop a clinical trial in the setting of palliative SBRT for spine metastases and I wanted to ask: Would you please share your preferred way of attacking spine mets? I just want to make sure that in protocol development we don't end up recommending a style of treatment that goes against what people are actually doing in their practices.
Here's my personal SBRT spine history (in the palliative setting):
When I was in residency, I usually followed the RTOG 0631 protocol and had a single 16-18Gy volume that usually encompassed the whole vertebral body and the immediately adjacent vertebral segments. (Because the trial reported as negative, I have generally stopped doing single fraction SBRT.)
When the CCTG SC.24 (Sahgal) reported as positive, I switched to 24Gy in 2 daily fractions and my volumes were still similar to RTOG 0631.
Then Guckenberger et al reported as positive and I switched again, now doing 20Gy in 5 daily fractions to the majority of the vertebral body (usually only skimping at the spinous process or the tips of the transverse processes) with a simultaneous integrated boost to 40Gy to the gross tumor. I often don't have much if any CTV margin on the gross disease for the 40Gy volume and I let things run extremely hot inside the gross tumor. I usually have a 2mm PTV on everything but it really doesn't matter because I'm always running cold along cord/cauda and esophagus anyways.
Sincerely,
Music Man Stan
