Patient motion and targeting accuracy in robotic spinal radiosurgery: 260 single-fraction fiducial-free cases.

PURPOSE: To evaluate clinical targeting precision and assess patient movement data during fiducial-free, single-fraction spinal radiosurgery with the Cyberknife (CK). METHODS AND MATERIALS: Image-guided spine tracking accuracy was tested using two phantoms. Movement patterns (three translations, roll, pitch and yaw) were obtained from log files of 260 patient treatments (47 cervical, 89 thoracic, 90 lumbar, and 34 pelvic/sacral). For two treatments (average and maximum motion scenario), we added offsets to all beams according to recorded patient movements and recalculated the delivered dose distribution to simulate the dosimetric impact of intrafraction motion.
RESULTS: Phantom spine position was registered with an accuracy of <0.2 mm for translational and <0.3° for rotational directions. Residual patient motion yielded mean targeting errors per beam of 0.28 ± 0.13 mm (X), 0.25 ± 0.15 mm (Y), 0.19 ± 0.11 mm (Z) and 0.40 ± 0.20° (roll), 0.20 ± 0.08° (pitch), and 0.19 ± 0.08° (yaw). Spine region had little influence on overall targeting error, which was <1 mm for more than 95% of treatments (median, 0.48 mm). In the maximum motion case, target coverage decreased by 1.7% (from 92.1% to 90.4%) for the 20-Gy prescription isodose. Spinal cord volume receiving more than 8 Gy increased slightly, from 2.41 to 2.46 cm(3).
CONCLUSIONS: Submillimeter targeting precision was obtained for fiducial-free spinal radiosurgery despite patient motion. Patient motion has little effect on the delivered dose distribution when image-guided correction of beam aiming is employed.