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Table 5 Doses and fractionation

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

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