Phase I of the study (motion and quality assurance [QA] study) is being used to determine
intrafraction target motion and define quality assurance procedures for single fraction
spinal radiosurgery. The Phase II portion of the study is being used to estimate the
palliative response (pain or relief of neurologic symptoms) and local control for single
fraction radiosurgery delivered with TomoTherapy and to assess the acute and late toxicity
of spinal radiosurgery.
Optimal radiation plan is generated that treats the tumor (CTV) and spares normal tissue,
especially the spinal cord. Motion and QA study will determine intrafraction motion for
phase II portion of the study.
Dose prescription to tumor is based upon maximal dose received by 0.5 cc of spinal cord and
whether patient has had prior radiation therapy to that area:
Phase I - Motion and QA Study: 20-25 Gy in 5 fractions/10-20 patients/previous RT = <50% CTV
dose/No previous RT = <80% CTV dose.
Phase II - 9-24 Gy in 1 fraction/30 total in order to have 20 evaluable patients (15
patients with prior RT and 15 without prior RT/previous RT = 8 Gy/No previous RT = 10 Gy.
# Motion and QA study will treat CTV to 20-25 Gy in 5 fractions to study intrafraction
motion for QA of single fraction administration. This will define treatment margins for
single fraction radiosurgery.
- greater than six months since completion of RT
- at least 20 Gy, but no more than 50 Gy
1. All subjects must have history of histologically confirmed neoplasm or
radiographically-diagnosed AVM. Patients without a prior tissue diagnosis but who
have a radiographically characteristic lesion are eligible if there is consensus
agreement of the diagnosis in the UAB Neuro-oncology Tumor Board.
2. ECOG performance status of less than or equal to 2
3. Age greater than 18
4. Life expectancy greater than 12 weeks
5. Subjects given written informed consent
1. Cytotoxic chemotherapy within 7 days of treatment
2. Insufficient recovery from all active toxicities of prior therapies
3. Epidural spinal cord compression requiring immediate neurosurgical decompression. If
a patient requires immediate surgery for neurologic compromise, they may still be
eligible post operatively if tumor was incompletely resected.
4. Patient is non-ambulatory. Optimization of pretreatment neurologic function with
steroids is allowed. Ambulation with assistance of walker or cane is allowed.
5. Patient is pregnant and it is judged by the treating Radiation Oncologist that spinal
radiosurgery would place the fetus in unacceptable danger.