gms | German Medical Science

27th German Cancer Congress Berlin 2006

German Cancer Society (Frankfurt/M.)

22. - 26.03.2006, Berlin

Accuracy, feasibility and preliminary clinical results using a real-time image-guided robotic stereotactic radiosurgery system for treatment of spinal tumors

Meeting Abstract

  • corresponding author presenting/speaker Alexander Muacevic - Cyberknife Zentrum München Großhadern, Deutschland
  • Berndt Wowra - Cyberknife Zentrum München Großhadern
  • Christian Drexler - Cyberknife Zentrum München Großhadern
  • Jörg-Christian Tonn - Neurochirurgische Universitätsklinik, LMU, München

27. Deutscher Krebskongress. Berlin, 22.-26.03.2006. Düsseldorf, Köln: German Medical Science; 2006. DocPO386

The electronic version of this article is the complete one and can be found online at:

Published: March 20, 2006

© 2006 Muacevic et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Introduction: We here present for the first time the concept, phantom accuracy and first clinical results using a fiducial free tracking system for spinal single session high precision radiotherapy (radiosurgery).

Methods: The spine tracking system integrates with a robotic radiosurgery system (CyberKnife, Accuray, Sunnyvale, CA, USA)to eliminate the need for surgical implantation of radiographic markers, or fiducials, in the delivery of radiosurgery treatments for spinal tumors. Ten phantom accuracy End-to-End tests have been performed.25 patients (8 intraspinal,17 paraspinal) with spine tumors (80% metastases) have been treated by31 spinal single fraction radiosurgical procedures usingthe newfiducialless tracking system. 70% of the patients were treated by conventional fractionated radiotherapy before radiosurgery. In 2 cases transpedicular screw placement was done before radiosurgery. Follow-up ranged from 2 - 15 weeks. Pain relief and tumor response was evaluated after treatment.

Results: Phantom end-to-end test showed an over all mean targeting error of 0.56 mm (±0.23). All patients could be treated by the fiducial free radiosurgical procedures. Treatment was tolerated well by all patients. Setup time for patient alignment was from 2 – 45 minutes. Treatment doses varied between 13.5 – 18 Gy. The median prescription isodose was 70% (60-80%). Tumor volume ranged between 1.6 to 17 ccm. Patient tracking was also possible after transpedicular screw placement. No short term adverse events were noted. Spinal radiosurgery lead to pain relieve in all patients between 7 and 14 days after treatment. No patient showed tumor progression during the short term follow up period.

Conclusions:The new possibility of spinal radiosurgeryis a feasible, safe, accurate and reliable tool for the treatment ofspinal tumors.It offers an alternative or addition to standard treatmentconcepts.It can be performed in a single session procedureandextendsthe treatment possibilities for combined oncological treatment concepts in cases of spinal tumors.