MRI-guided stereotactic ablative radiation therapy of spinal bone metastases: a preliminary experience

• Published in: British journal of radiology Vol. 93; no. 1105; p. 20190655
• Main Authors: Llorente, Ricardo, Spieler, Benjamin O, Victoria, James, Takita, Cristiane, Yechieli, Raphael, Ford, John C, Brown, Karen, Samuels, Michael A, Mellon, Eric A
• Format: Journal Article
• Language: English
• Published: England The British Institute of Radiology 01.01.2020
• Subjects: Algorithms; Cobalt Radioisotopes; Dose Fractionation, Radiation; Humans; Magnetic Resonance Imaging; Organs at Risk; Patient Positioning; Radiosurgery - methods; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted - methods; Radiotherapy, Image-Guided - methods; Short Communication; Spinal Neoplasms - diagnostic imaging; Spinal Neoplasms - radiotherapy; Spinal Neoplasms - secondary
• ISSN: 0007-1285; 1748-880X
• DOI: 10.1259/bjr.20190655

MRI provides clear visualization of spinal cord, tumor, and bone for patient positioning and verification during MRI-guided radiotherapy (MRI-RT). Therefore, we wished to evaluate spine stereotactic ablative radiotherapy (SABR) feasibility with MRI-RT. Given dosimetric limitations of first generation Co-60 MRI-RT, we then evaluated improvements by newer linear accelerator (linac) MRI-RT. Nine spinal metastases were treated with Co-60 MRI-RT. Seven received a single 16 Gy fraction, and two received three fractions totaling 24 or 30 Gy. After replanning with linac MRI-RT software, comparisons of organ at risk and dose spillage objectives between Co-60 and linac plans were performed. Spinal cord and cauda equina dose constraints were met in all Co-60 cases. Treatments were delivered successfully with real-time imaging during treatment and no treatment-related toxicities. While limits for dose spillage into surrounding soft tissues were not achieved due to the limitations of the Co-60 system, this could be corrected with linac MRI-RT delivery. MRI-RT SABR of spinal metastases is feasible with Co-60 MRI-RT. Dose delivery is improved by linac MRI-RT. This is the first report of MRI-RT for SABR of spinal metastases. The enhanced visualization of anatomy by MRI may facilitate RT dose escalation for spine SABR.