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Original Article

Korean Journal of Medical Physics 2013; 24(3): 145-153

Published online September 30, 2013

Copyright © Korean Society of Medical Physics.

Comparison of IMRT and VMAT Techniques in Spine Stereotactic Radiosurgery with International Spine Radiosurgery Consortium Consensus Guidelines

International Spine Radiosurgery Consortium Consensus Guidelines에 따른 Spine Stereotactic Radiosurgery에서 IMRT와 VMAT의 비교연구

Se An Oh*†, Min Kyu Kang, Sung Kyu Kim, Ji Woon Yea

오세안*†ㆍ강민규ㆍ김성규ㆍ예지원

*Department of Radiation Oncology, Yeungnam University Medical Center, Daegu, Department of Physics, Yeungnam University, Gyeongsan, Department of Radiation Oncology, Yeungnam University College of Medicine, Daegu, Korea

*영남대학교병원 방사선종양학과, 영남대학교 물리학과, 영남대학교 의과대학 방사선종양학교실

Abstract

Stereotactic body radiation therapy (SBRT) is increasingly used to treat spinal metastases. To achieve the highest steep dose gradients and conformal dose distributions of target tumors, intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) techniques are essential to spine radiosurgery. The purpose of the study was to qualitatively compare IMRT and VMAT techniques with International Spine Radiosurgery Consortium (ISRC) contoured consensus guidelines for target volume definition. Planning target volume (PTV) was categorized as TB, TBPT and TST depending on sectors involved; TB (vertebral body only), TBPT (vertebral body+ pedicle+transverse process), and TST (spinous process+transverse process). Three patients treated for spinal tumor in the cervical, thoracic, and lumbar region were selected. Each tumor was contoured by the definition from the ISRC guideline. Maximum spinal cord dose were 12.46 Gy, 12.17 Gy and 11.36 Gy for TB, TBPT and TST sites, and 11.81 Gy, 12.19 Gy and 11.99 Gy for the IMRT, RA1 and RA2 techniques, respectively. Average fall-off dose distance from 90% to 50% isodose line for TB, TBPT, and TST sites were 3.5 mm, 3.3 mm and 3.9 mm and 3.7 mm, 3.7 mm and 3.3 mm for the IMRT, RA1 and RA2 techniques, respectively. For the most complicated target TBPT sites in the cervical, thoracic and lumbar regions, the conformity index of the IMRT, RA1 and RA2 is 0.621, 0.761 and 0.817 and 0.755, 0.796 and 0.824 for rDHI. Both IMRT and VMAT techniques delivered high conformal dose distributions in spine stereotactic radiosurgery. However, if the target volume includes the vertebral body, pedicle, and transverse process, IMRT planning resulted in insufficient conformity index, compared to VMAT planning. Nevertheless, IMRT technique was more effective in reducing the maximum spinal cord dose compared to RA1 and RA2 techniques at most sites.

KeywordsStereotactic body radiation therapy (SBRT), International Spine Radiosurgery Consortium (ISRC), Intensity-modulated radiation therapy (IMRT), Volumetric-modulated arc therapy (VMAT)

Korean Society of Medical Physics

Vol.35 No.2
June 2024

pISSN 2508-4445
eISSN 2508-4453
Formerly ISSN 1226-5829

Frequency: Quarterly

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