Transcript
I am much honored to have the opportunity to give a [inaudible 00:00:05] presentation in Novalis Circle conference here. Two cases of intramedullary cervical spinal cord metastases are presented. Both were successfully treated by VMAT-IMRT using Novalis TrueBeam STx. Case 1, 76-year-old female, C6-7 tumor. The tumor was totally covered by spinal medullary parenchyma. The symptoms were dysesthesia in both legs, and left-sided hemiparesis, and left shoulder pain. The patient had thyroid carcinoma, so it may be relatively radioresistant we think so. Case 2, 48-year-old male. The tumor is at the C2 level and it was asymptomatic, but the patient had whole brain radiation therapy, and this tumor was adjacent to the prior whole brain radiation therapy field. Diagnosis was done clinically regarding synchronous manifestation of multiple brain metastases. Those were treated by SRS in case one and by whole brain radiation therapy and SRS and resection in case 2.
Case one. CT and MRI. The tumor was located at C6-7. Dose distribution. Cervical spinal intramedullary metastasis treated by VMAT-SRT of 39 Gy/13 fx. PTV was 0.3 ml without PTV margin. D95% was covered by 95% dose, almost 37 Gy. DVH, PTV here. This is a 36 Gy line and this is 39 Gy line. Those are equivalent with 45 Gy in 2 Gy fx. And 50 Gy in 2 Gy fx, in alpha/beta ratio of 2. This additional central dose elevation was obtained by TrueBeam VMAT. Maybe it was the advantage for tumor ablation. The tumor was remarkably shrunk from four months after the treatment. This is the MRI 32 months after the treatment. Now, the patient is 32 months follow-up. The patient's condition is stable and the symptoms are totally relieved. No motor weakness and no shoulder pain now.
Case two. DVH was the same protocol, 39 Gy/13 fx. No PTV margin. In this patient, PTV was 0.5 ml. The same protocol of D95% was covered by 95% dose, and central dose elevation is here. Follow up, the tumor was remarkably shrunk and now the patient is under 8 months follow-up. The symptoms are stable. No side effect.
So in conclusion, in case one, spinal metastasis had been thought to be relatively radioresistant thyroid carcinoma metastasis, and in case two spinal metastasis was near the field of prior whole brain radiation therapy. Both tumors were successfully treated without adverse effects by VMAT IMRT with Novalis system with accurate ExacTrac system, with bone structure patients [inaudible 00:05:53]. I think our protocol is a very safe protocol. Before we give treatment, we were afraid long-time tumor control would be obtained, but as a result, the outcome was very good. Thank you.
Case one. CT and MRI. The tumor was located at C6-7. Dose distribution. Cervical spinal intramedullary metastasis treated by VMAT-SRT of 39 Gy/13 fx. PTV was 0.3 ml without PTV margin. D95% was covered by 95% dose, almost 37 Gy. DVH, PTV here. This is a 36 Gy line and this is 39 Gy line. Those are equivalent with 45 Gy in 2 Gy fx. And 50 Gy in 2 Gy fx, in alpha/beta ratio of 2. This additional central dose elevation was obtained by TrueBeam VMAT. Maybe it was the advantage for tumor ablation. The tumor was remarkably shrunk from four months after the treatment. This is the MRI 32 months after the treatment. Now, the patient is 32 months follow-up. The patient's condition is stable and the symptoms are totally relieved. No motor weakness and no shoulder pain now.
Case two. DVH was the same protocol, 39 Gy/13 fx. No PTV margin. In this patient, PTV was 0.5 ml. The same protocol of D95% was covered by 95% dose, and central dose elevation is here. Follow up, the tumor was remarkably shrunk and now the patient is under 8 months follow-up. The symptoms are stable. No side effect.
So in conclusion, in case one, spinal metastasis had been thought to be relatively radioresistant thyroid carcinoma metastasis, and in case two spinal metastasis was near the field of prior whole brain radiation therapy. Both tumors were successfully treated without adverse effects by VMAT IMRT with Novalis system with accurate ExacTrac system, with bone structure patients [inaudible 00:05:53]. I think our protocol is a very safe protocol. Before we give treatment, we were afraid long-time tumor control would be obtained, but as a result, the outcome was very good. Thank you.