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Para-spinal Tumors Encircling the Spinal Cord IMRT. Comparison of Several Target Definitions. SLICE 116 CTV Superior Brain stem and L & R eyes. Slice 104 CTV , Spinal cord L & R Parotid glands. Slice 83 Mid Volume CTV 3 – 5 mm separation between spinal cord and CTV.

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Para-spinal Tumors Encircling the Spinal Cord IMRT

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Para spinal tumors encircling the spinal cord imrt
Para-spinal Tumors Encircling the Spinal Cord IMRT

Comparison of Several Target Definitions


Para spinal tumors encircling the spinal cord imrt

SLICE 116

CTVSuperior

Brain stem and L & R eyes


Para spinal tumors encircling the spinal cord imrt

Slice 104

CTV , Spinal cord

L & R Parotid glands


Para spinal tumors encircling the spinal cord imrt

Slice 83 Mid Volume CTV

3 – 5 mm separation between spinal cord and CTV


Para spinal tumors encircling the spinal cord imrt

Slice 63

Inferior CTV

13 mm Separation of spinal cord and CTV


Planning volumes
Planning Volumes

CTV3mm Expansion63 Gy

Spinal Cord3mm Expansion43 Gy

Rt & Lt Eyes3mm Expansion3 Gy

Brain Stem3mm Expansion43Gy

Parotid Glands3mm Expansion30 Gy



Para spinal tumors encircling the spinal cord imrt

Beam Arrangement

Gantry0

Gantry 40

Gantry80

Gantry160

Gantry200

Gantry315



Para spinal tumors encircling the spinal cord imrt

Dose Statistics

63 Gy

Target Type Basic


Para spinal tumors encircling the spinal cord imrt

DVH 63 Gy

Target Type Basic

63 Gy @ ~76% Volume




Para spinal tumors encircling the spinal cord imrt

Dose Statistics

63 Gy

Target Type Homogenous


Para spinal tumors encircling the spinal cord imrt

DVH 63 Gy

Target Type Homogenous

63Gy @ ~46 % Volume




Para spinal tumors encircling the spinal cord imrt

Dose Statistics

63 Gy

Target Type IMRS

Emphasizes Conformality


Para spinal tumors encircling the spinal cord imrt

DVH 63 Gy

Target Type IMRS

63Gy @ ~90% Volume






Para spinal tumors encircling the spinal cord imrt

Intensity Levels 10

Step Increment 1cm

MLC leaf 1cm


Step increment
Step Increment

1cm step with 0.5cm MLC

0.5cm step with 0.5cm MLC

9991-959-08C






Para spinal tumors encircling the spinal cord imrt

Large Complex Treatment Volume

Long (~ 60 cm) volume needed 27 junctioned IMRT fields and

an 16 MeV electron field











Para spinal tumors encircling the spinal cord imrt

12 Mev Beam at 0 Foils0

12 Mev beam at 400






Para spinal tumors encircling the spinal cord imrt

Interoperative Radiation Therapy Foils

The benefit of IORT normal tissues are removed from

the treatment fields and the dose is delivered locally.

The enengy of the electron beams used is usually between

9-16 Mev.

The use in the country has been developed used at large

medical centers.



Para spinal tumors encircling the spinal cord imrt

ORIGINAL HARD DOCKING COX LL Foils

STANDARD LINEAR ACCELERATOR


Para spinal tumors encircling the spinal cord imrt

MGH Foils

SOFT DOCKING

LASER SYSTEM IN

HEAD OF MACHINE



Para spinal tumors encircling the spinal cord imrt

MOBETRON HARD DOCKING Foils

Energies Available

4, 6, 9 & 12 Mev


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