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首页> 外文期刊>Neurosurgical focus >Stereotactic radiosurgery for intradural spine tumors using cone-beam CT image guidance
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Stereotactic radiosurgery for intradural spine tumors using cone-beam CT image guidance

机译：锥束CT图像引导下的立体定向放射外科治疗硬脊膜内肿瘤

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OBJECTIVE Cone-beam CT (CBCT) image guidance technology has been widely adopted for spine radiosurgery delivery. There is relatively little experience with spine radiosurgery for intradural tumors using CBCT image guidance. This study prospectively evaluated a series of intradural spine tumors treated with radiosurgery. Patient setup accuracy for spine radiosurgery delivery using CBCT image guidance for intradural spine tumors was determined. METHODS Eighty-two patients with intradural tumors were treated and prospectively evaluated. The positioning deviations of the spine radiosurgery treatments in patients were recorded. Radiosurgery was delivered using a linear accelerator with a beam modulator and CBCT image guidance combined with a robotic couch that allows positioning correction in 3 translational and 3 rotational directions. To measure patient movement, 3 quality assurance CBCTs were performed and recorded in 30 patients: before, halfway, and after the radiosurgery treatment. The positioning data and fused images of planning CT and CBCT from the treatments were analyzed to determine intrafraction patient movements. From each of 3 CBCTs, 3 translational and 3 rotational coordinates were obtained. RESULTS The radiosurgery procedure was successfully completed for all patients. Lesion locations included cervical (22), thoracic (17), lumbar (38), and sacral (5). Tumor histologies included schwannoma (27), neurofibromas (18), meningioma (16), hemangioblastoma (8), and ependymoma (5). The mean prescription dose was 17 Gy (range 12–27 Gy) delivered in 1–3 fractions. At the halfway point of the radiation, the translational variations and standard deviations were 0.4 ± 0.5, 0.5 ± 0.8, and 0.4 ± 0.5 mm in the lateral (x), longitudinal (y), and anteroposterior (z) directions, respectively. Similarly, the variations immediately after treatment were 0.5 ± 0.4, 0.5 ± 0.6, and 0.6 ± 0.5 mm along x, y, and z directions, respectively. The mean rotational angles were 0.3° ± 0.4°, 0.3° ± 0.4°, and 0.3° ± 0.4° along yaw, roll, and pitch, respectively, at the halfway point and 0.5° ± 0.5°, 0.4° ± 0.5°, and 0.2° ± 0.3° immediately after treatment. CONCLUSIONS Radiosurgery offers an alternative treatment option for intradural spine tumors in patients who may not be optimal candidates for open surgery. CBCT image guidance for patient setup for spine radiosurgery is accurate and successful in patients with intradural tumors.
机译：目的锥形束CT（CBCT）图像引导技术已广泛应用于脊柱放射外科手术。使用CBCT图像引导进行脊柱内硬膜内肿瘤的放射外科手术的经验相对较少。这项研究前瞻性评估了放射外科治疗的一系列硬膜内脊柱肿瘤。使用硬膜内脊柱肿瘤的CBCT图像指导确定了用于脊柱放射外科手术的患者设置准确性。方法对82例硬膜内肿瘤患者进行治疗并进行前瞻性评估。记录患者脊柱放射手术治疗的位置偏差。放射外科手术是使用带有光束调制器的线性加速器和CBCT图像引导结合机器人卧榻进行的，该卧榻可以在3个平移和3个旋转方向上进行位置校正。为了测量患者的活动情况，对30例患者进行了3项质量保证CBCT，并进行了记录：放射外科治疗之前，中途和之后。分析了来自治疗方案的计划CT和CBCT的定位数据和融合图像，以确定患者在小范围内的运动。从3个CBCT中的每一个中，获得3个平移坐标和3个旋转坐标。结果所有患者均成功完成了放射外科手术。病变部位包括颈椎（22），胸椎（17），腰椎（38）和骨（5）。肿瘤组织学包括神经鞘瘤（27），神经纤维瘤（18），脑膜瘤（16），血管母细胞瘤（8）和室管膜瘤（5）。平均处方剂量为17 Gy（12至27 Gy），分1-3次给药。在辐射的中点，在横向（x），纵向（y）和前后（z）方向的平移变化和标准偏差分别为0.4±0.5、0.5±0.8和0.4±0.5 mm。类似地，处理后立即沿x，y和z方向的变化分别为0.5±0.4、0.5±0.6和0.6±0.5 mm。在中途点的平均偏航角为0.3°±0.4°，0.3°±0.4°和0.3°±0.4°，在中点分别为0.5°±0.5°，0.4°±0.5°，处理后立即为0.2°±0.3°。结论放射外科手术为可能不是开放手术的最佳候选人的患者的硬脑膜内脊柱肿瘤提供了另一种治疗选择。对于硬膜内肿瘤患者，脊柱放射外科患者设置的CBCT图像指导是准确而成功的。

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