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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