Transcription of SBRT Treatment Planning: Practical Considerations
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SBRT Treatment Planning: Practical Considerations
SBRT Treatment Planning: Practical ConsiderationsLinda Hong, Medical CenterAlbert Einstein College of MedicineBronx, New YorkI have no conflicts of interest to The Basic Principles of SBRT Treatment Planning Conventional fractionated plan vs. SBRT plan Cranial SRS plan vs. SBRT plan Practical Considerations on SBRT Treatment Planning Spine Lung Liver Lessons learned from our experiencesStereotactic Body Radiation Therapy (SBRT) Fractional dose >5 Gyrange: 5 Gyto 34 Gyper fraction Number of fractions <5range: 1 to 5 Safe delivery is of utmost importance due to high fractional dose and small number of fractions. Montefiore-Einstein SBRT Experiences Started 1stSBRT Spine 1/2008 Started 1stSBRT Lung 4/2008 Started 1stSBRT Liver 8/2008 About 2 new SBRT cases weekly ever since Machines Varian Trilogy or Truebeam Eclipse TPSS pine1- 3 lesions Single Fraction: 16 Gy Three Fraction: 24 Gy (8 Gy per fraction)LungPeripheral Lesions Three fractions: 60 Gy (20 Gy per fraction)Central Lesions Five fractions: 50 Gy (10 Gy per fraction)LiverMetastasis If lesions > 2cm from Porta Hepatis/Bile Duct: Three Fractions 20Gy x 3 If lesions 2cmfrom Porta Hepatis/Bile Duct: Five Fractions 10Gy x 5 Hepatocellular Carcinoma Five fractions: 30-50 Gy (depends on Veff)Montefiore-Einstein Cancer Center (MECC) SBRT RegistryRTOG SBRT Protocols 0631 Spine 0813 and 0915 Lung 0438 LiverThese protocols specify detailed requ
For Spine Cases: IMRT or VMAT is required to create concave dose distributions. We use two full RapidArcs, or two partial RapidArcs to avoid shoulders or arms, one arc with collimator at 0, the other with collimator at 90. Multiple fixed IMRT fields can be used. No need to do any non-coplanar beams (no clearance anyway).
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