Generalizable class solutions for treatment planning of spinal stereotactic body radiation therapy

David C. Weksberg; Matthew B. Palmer; Khoi N. Vu; Neal C. Rebueno; Hadley J. Sharp; Dershan Luo; James N. Yang; Almon S. Shiu; Laurence D. Rhines; Mary Frances McAleer; Paul D. Brown; Eric L. Chang

doi:10.1016/j.ijrobp.2011.12.060

Generalizable class solutions for treatment planning of spinal stereotactic body radiation therapy

David C. Weksberg, Matthew B. Palmer, Khoi N. Vu, Neal C. Rebueno, Hadley J. Sharp, Dershan Luo, James N. Yang, Almon S. Shiu, Laurence D. Rhines, Mary Frances McAleer, Paul D. Brown, Eric L. Chang

Research output: Contribution to journal › Article › peer-review

22 Scopus citations

Abstract

Purpose: Spinal stereotactic body radiation therapy (SBRT) continues to emerge as an effective therapeutic approach to spinal metastases; however, treatment planning and delivery remain resource intensive at many centers, which may hamper efficient implementation in clinical practice. We sought to develop a generalizable class solution approach for spinal SBRT treatment planning that would allow confidence that a given plan provides optimal target coverage, reduce integral dose, and maximize planning efficiency. Methods and Materials: We examined 91 patients treated with spinal SBRT at our institution. Treatment plans were categorized by lesion location, clinical target volume (CTV) configuration, and dose fractionation scheme, and then analyzed to determine the technically achievable dose gradient. A radial cord expansion was subtracted from the CTV to yield a planning CTV (pCTV) construct for plan evaluation. We reviewed the treatment plans with respect to target coverage, dose gradient, integral dose, conformality, and maximum cord dose to select the best plans and develop a set of class solutions. Results: The class solution technique generated plans that maintained target coverage and improved conformality (1.2-fold increase in the 95% van't Riet Conformation Number describing the conformality of a reference dose to the target) while reducing normal tissue integral dose (1.3-fold decrease in the volume receiving 4 Gy (V_4Gy) and machine output (19% monitor unit (MU) reduction). In trials of planning efficiency, the class solution technique reduced treatment planning time by 30% to 60% and MUs required by ∼20%: an effect independent of prior planning experience. Conclusions: We have developed a set of class solutions for spinal SBRT that incorporate a pCTV metric for plan evaluation while yielding dosimetrically superior treatment plans with increased planning efficiency. Our technique thus allows for efficient, reproducible, and high-quality spinal SBRT treatment planning.

Original language	English (US)
Pages (from-to)	847-853
Number of pages	7
Journal	International Journal of Radiation Oncology Biology Physics
Volume	84
Issue number	3
DOIs	https://doi.org/10.1016/j.ijrobp.2011.12.060
State	Published - Nov 1 2012

Keywords

Class solution
Spinal metastases
Spinal sterotactic body radiation therapy
Stereotactic body radiation therapy

ASJC Scopus subject areas

Radiation
Oncology
Radiology Nuclear Medicine and imaging
Cancer Research

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10.1016/j.ijrobp.2011.12.060

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Weksberg, D. C., Palmer, M. B., Vu, K. N., Rebueno, N. C., Sharp, H. J., Luo, D., Yang, J. N., Shiu, A. S., Rhines, L. D., McAleer, M. F., Brown, P. D., & Chang, E. L. (2012). Generalizable class solutions for treatment planning of spinal stereotactic body radiation therapy. International Journal of Radiation Oncology Biology Physics, 84(3), 847-853. https://doi.org/10.1016/j.ijrobp.2011.12.060

Weksberg, DC, Palmer, MB, Vu, KN, Rebueno, NC, Sharp, HJ, Luo, D, Yang, JN, Shiu, AS, Rhines, LD , McAleer, MF, Brown, PD & Chang, EL 2012, 'Generalizable class solutions for treatment planning of spinal stereotactic body radiation therapy', International Journal of Radiation Oncology Biology Physics, vol. 84, no. 3, pp. 847-853. https://doi.org/10.1016/j.ijrobp.2011.12.060

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abstract = "Purpose: Spinal stereotactic body radiation therapy (SBRT) continues to emerge as an effective therapeutic approach to spinal metastases; however, treatment planning and delivery remain resource intensive at many centers, which may hamper efficient implementation in clinical practice. We sought to develop a generalizable class solution approach for spinal SBRT treatment planning that would allow confidence that a given plan provides optimal target coverage, reduce integral dose, and maximize planning efficiency. Methods and Materials: We examined 91 patients treated with spinal SBRT at our institution. Treatment plans were categorized by lesion location, clinical target volume (CTV) configuration, and dose fractionation scheme, and then analyzed to determine the technically achievable dose gradient. A radial cord expansion was subtracted from the CTV to yield a planning CTV (pCTV) construct for plan evaluation. We reviewed the treatment plans with respect to target coverage, dose gradient, integral dose, conformality, and maximum cord dose to select the best plans and develop a set of class solutions. Results: The class solution technique generated plans that maintained target coverage and improved conformality (1.2-fold increase in the 95% van't Riet Conformation Number describing the conformality of a reference dose to the target) while reducing normal tissue integral dose (1.3-fold decrease in the volume receiving 4 Gy (V4Gy) and machine output (19% monitor unit (MU) reduction). In trials of planning efficiency, the class solution technique reduced treatment planning time by 30% to 60% and MUs required by ∼20%: an effect independent of prior planning experience. Conclusions: We have developed a set of class solutions for spinal SBRT that incorporate a pCTV metric for plan evaluation while yielding dosimetrically superior treatment plans with increased planning efficiency. Our technique thus allows for efficient, reproducible, and high-quality spinal SBRT treatment planning.",

keywords = "Class solution, Spinal metastases, Spinal sterotactic body radiation therapy, Stereotactic body radiation therapy",

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AU - Weksberg, David C.

AU - Palmer, Matthew B.

AU - Vu, Khoi N.

AU - Rebueno, Neal C.

AU - Sharp, Hadley J.

AU - Luo, Dershan

AU - Yang, James N.

AU - Shiu, Almon S.

AU - Rhines, Laurence D.

AU - McAleer, Mary Frances

AU - Brown, Paul D.

AU - Chang, Eric L.

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AB - Purpose: Spinal stereotactic body radiation therapy (SBRT) continues to emerge as an effective therapeutic approach to spinal metastases; however, treatment planning and delivery remain resource intensive at many centers, which may hamper efficient implementation in clinical practice. We sought to develop a generalizable class solution approach for spinal SBRT treatment planning that would allow confidence that a given plan provides optimal target coverage, reduce integral dose, and maximize planning efficiency. Methods and Materials: We examined 91 patients treated with spinal SBRT at our institution. Treatment plans were categorized by lesion location, clinical target volume (CTV) configuration, and dose fractionation scheme, and then analyzed to determine the technically achievable dose gradient. A radial cord expansion was subtracted from the CTV to yield a planning CTV (pCTV) construct for plan evaluation. We reviewed the treatment plans with respect to target coverage, dose gradient, integral dose, conformality, and maximum cord dose to select the best plans and develop a set of class solutions. Results: The class solution technique generated plans that maintained target coverage and improved conformality (1.2-fold increase in the 95% van't Riet Conformation Number describing the conformality of a reference dose to the target) while reducing normal tissue integral dose (1.3-fold decrease in the volume receiving 4 Gy (V4Gy) and machine output (19% monitor unit (MU) reduction). In trials of planning efficiency, the class solution technique reduced treatment planning time by 30% to 60% and MUs required by ∼20%: an effect independent of prior planning experience. Conclusions: We have developed a set of class solutions for spinal SBRT that incorporate a pCTV metric for plan evaluation while yielding dosimetrically superior treatment plans with increased planning efficiency. Our technique thus allows for efficient, reproducible, and high-quality spinal SBRT treatment planning.

KW - Class solution

KW - Spinal metastases

KW - Spinal sterotactic body radiation therapy

KW - Stereotactic body radiation therapy

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Generalizable class solutions for treatment planning of spinal stereotactic body radiation therapy

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