Review ArticleNovalis radiosurgery for metastatic spine tumors
Section snippets
Materials and methods
The image-guided shaped-beam radiosurgery program at Henry Ford Hospital (HFH) uses the Novalis system (BrainLAB, Ammerthalstrabe, Germany). It was installed at HFH in April 2001. Since the inception of the extracranial radiosurgery program, 140 treatments in 110 patients with primary and metastatic spine and spinal cord tumors have been performed as of August 2003. Most of these patients were previously untreated patients with spinal metastases and previously treated patients with recurrent
Results
Preclinical studies for extracranial radiosurgery included dosimetric and technical descriptions and validation of the techniques in the phantom [6]. The initial technical validation was described from the experience of the first 25 patients with various spinal tumors, mostly recurrent tumors in the spine [6]. The first protocol of the clinical feasibility study was developed as a phase I study to determine the accuracy and precision of spinal radiosurgery for the treatment of single spinal
Discussion
All radiosurgical applications require accurate delivery of radiation based on precise target localization and immobilization. Whereas target localization for cranial radiosurgery has traditionally been achieved with head frames, and recently with form-fitted masks, target localization for extracranial radiosurgery has only recently been ensured. Advances in digital imaging and high-speed computer computations have been critical to the development of this technology. The image-guided frameless
Summary
It is logical to anticipate that the field of spinal radiosurgery will evolve in a fashion similar to that seen for intracranial radiosurgery. Given the frequency of various pathologic entities that affect the spine, including those that have proven to be largely intractable to surgery, radiation, and chemotherapy (eg, sarcomas), and the serious clinical, economic and quality-of-life consequences of paraplegia, radiosurgery offers new hope as an adjuvant or primary therapy. The meticulous
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