![]() ![]() In fact, SBRT allows prescribing in a limited number of fractions, high dose irradiation to small target volumes, and minimizing the dose exposure to organ at risks (OARs). The combination of both strategies has the purpose to prescribe earlier ablative treatments, prevent local symptoms and postpone the prescription of new systemic treatments. Moreover, in the oligometastatic and oligoprogressive patients, it is progressively becoming current clinical practice to prescribe local ablative radiation treatments (SBRT). Accurate radiological staging, as magnetic resonance imaging (MRI) and metabolic images (PET-CT), allows to detect any metastatic disease presentation earlier. In fact, in the last decades, significant non-invasive technological improvements have been observed in modern radiotherapy. Nonetheless, radiation therapy is still considered one of the important therapeutic options in the management of spinal metastases. Nevertheless, both oncological approaches were associated with a limited local control probability and pain relief. Traditionally, surgical decompression and palliative radiotherapy have been recognized as the main treatment options for these patients. Local back pain and neurological symptoms are the most common clinical disease presentations in spinal metastases. Thus, the evaluated system could be useful in the setting of spinal SBRT to reduce uncertainties of contouring increasing the level of precision on target delivered doses. The dedicated contouring tool allows greater precision and reduction of inter-observer differences in the delineation of the target in SBRT spines. The agreement of GTV contours outlined by independent operators was superior with the use of the automatic contour tool compared to manually outlined contours (mean DICE coefficient 0.75 vs 0.57, pā=ā0.048). To evaluate the advantage of the automatic target contouring tool (Elements SmartBrush Spine), which uses the identification of different densities within the target vertebra, we evaluated the agreement of the contours of 20 spinal target (2 cervical, 9 dorsal and 9 lumbar column), outlined by three independent observers using the automatic tool compared to the contours obtained manually, and measured by DICE similarity coefficient. Simulation CT scans and MRI data of 20 patients with spinal metastases were evaluated. In this study, an automatic contouring tool was evaluated. An automatic target contouring system for spine SBRT is useful to reduce inter-observer differences in target definition. Due to the high delivered doses and the proximity of critical organs at risk (OAR) such as the spinal cord, the correct definition of the treatment volume becomes even more important in SBRT treatment, thus making it necessary to standardize the method of target definition and contouring, through the adoption of specific guidelines and specific automatic contouring tools. Stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT) have been offered in clinical practice mainly for the management of oligometastatic and oligoprogressive patients, allowing the prescription of high total dose delivered in one or few sessions to small target volumes, minimizing the dose exposure of normal tissues. Approximately one third of cancer patients will develop spinal metastases, that can be associated with back pain, neurological symptoms and deterioration in performance status.
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