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Table 5 Doses and fractionation

From: Clinical practice of image-guided spine radiosurgery - results from an international research consortium

  UHW UPMC UofT UVAMC RSMC
Use of single fraction radiosurgery No, all patients are treated with either five or ten fractions Single fraction radiosurgery for 95% of the patients unless very near to spinal cord. Majority is treated with two or three fractions and specific cases for single fraction Majority is treated with a single fraction of radiosurgery, occasionally up to 3 fractions No, majority are treated with three fractions with treatments given one week apart.
Criteria for selection of hypo-fractionated regimes Selection of fractionation scheme based on life expectancy using the Mizumoto Score   Fractionated protocols in:
1. Epidural disease or large volume and no prior irradiation
2. Prior radiation
Fractionated protocols after prior radiation If it represents the only site of disease, we use 30 Gy in 3
Schema 1: # fractions and single fraction dose Good life expectancy:
30 Gy in 10: PTV-elective
48.5 Gy in 10: PTV -macroscopic *
16-24 Gy in 1;
Most frequently 17 Gy in 1
20-24 Gy in 1;
Most frequently 20 Gy in 1
18 to 24 Gy in 1;
Most frequently 20 Gy in 1
24 Gy in 3
Schema 2: # fractions and single fraction dose Intermediate life expectancy:
20 Gy in 5: PTV-elective
35 Gy in 5: PTV -macroscopic *
  24 - 27 Gy in 2-3 24 Gy in 3 30 Gy in 3
Schema 3: # fractions and single fraction dose    30 Gy in 3
(for sarcomas)
18 Gy in 3  
Dose prescription D90 D90 ICRU point D90 D90
  1. * a simultaneous integrated boost (SIB) was used at the UHW with two dose levels to PTV -macroscopic and PTV -elective