Program Information
Surgical Resection with Radiation Treatment Planning of Spinal Tumors
R Jakubovic1*, (1) ,
Presentations
SU-I-GPD-J-106 (Sunday, July 30, 2017) 3:00 PM - 6:00 PM Room: Exhibit Hall
Purpose: The clinical paradigm for spinal tumors is a challenge considering the rigid dose tolerances of the spinal cord. Therefore, an open surgery approach whereby the tumor is resected and treated with adjuvant stereotactic radiosurgery is used, improving local to over 90%. Dose prescription is determined by several factors such as tumor histology, spinal cord tolerance, and prior radiation. However, dose prescription only takes into consideration the tumor volume following surgery, and thus it is not performed concurrently during actual tumor resection. Thus, it is the neurosurgeon’s clinical expertise that determines resection, and affects the post-operative radiation therapy planning. We will retrospectively study the effect of tumor resection on dose planning to the target and surrounding structures.
Methods: Ten patients having undergone spinal separation surgery with radiotherapy treatment were retrospectively reviewed. Treatment planning was performed using a standard clinical software. The goal of dose prescription is to maximize the dose to the gross tumor volume, clinical target volume and planning treatment volume while minimizing the dose to organs at risk (i.e. spinal cord). Contours representing incremental tumour resection were be generated to simulate the effect of tumor resection. Dose volume histograms were generated for the target regions and incremental disease contours and compared to the actual PTV.
Results: Spine separation surgery provides a sufficient division between the spinal cord and the epidural disease, thus facilitating better disease coverage with subsequent radiotherapy. Further, this suggests that by quantifying the dosimetric advantage of spine separation surgery prior to surgery, a more robust and targeted surgical plan can be implemented. This manifestation is demonstrated as a median 1.8 Gy increase in dose coverage of the epidural disease based on a simulated resection of 5 mm and a prescribed dose of 24 Gy in 2 fractions.
Conclusion: Spine separation surgery improves dosimetric coverage.
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