Evidence map›Paper›PMID 40144347›Full record

ArticleInternational journal of particle therapy2025

Comparison of Proton Versus Photon SBRT for Treatment of Spinal Metastases Using Variable RBE Models.

Sherif G Shaaban, Michael LeCompte, Hao Chen, Daniel Lubelski, Ali Bydon, Nicholas Theodore, Majid Khan, Sang Lee, Khaled Kebaish, Lawrence Kleinberg and 3 more

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PubMed Full text at PMC Publisher
In one paragraph

Article in International journal of particle therapy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Sherif G ShaabanRadiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA.
Michael LeCompteRadiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA.
Hao ChenRadiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA.
Daniel LubelskiNeurosurgery, Johns Hopkins University, Baltimore, MD, USA.
Ali BydonNeurosurgery, Johns Hopkins University, Baltimore, MD, USA.
Nicholas TheodoreNeurosurgery, Johns Hopkins University, Baltimore, MD, USA.
Majid KhanRadiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA.
Sang LeeOrthopedic Surgery, Johns Hopkins University, Baltimore, MD, USA.
Khaled KebaishOrthopedic Surgery, Johns Hopkins University, Baltimore, MD, USA.
Lawrence KleinbergRadiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA.
Ted HookerRadiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA.
Heng LiRadiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA.
Kristin J RedmondRadiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Purpose: Study of proton stereotactic body radiation therapy (SBRT) for spinal metastasis has been limited, largely due to concerns of increased risk of spinal cord injury given the challenges of end of range relative biological effectiveness (RBE). Although the 1.1 RBE constant for proton beam has been adopted for clinical use, data indicate that proton RBE is variable and dependent on technical-, tissue-, and patient factors. To better understand the safety of proton SBRT for spinal metastasis, this dosimetric analysis compares plans using photon robotic techniques and proton therapy accounting for RBE-weighted dose (D_{RBE}). Materials and Methods: Nine patients with spinal metastasis were selected to be representative of a broad range of complex clinical practice (3 cervical, 3 thoracic, 3 lumbar) that are uniquely challenging to treat with SBRT were identified. Each vertebral level contained a case with paraspinal extension, a reirradiation case, and a case with high-grade epidural disease (Bilsky grade ≥1c) given that such complex cases in current practice often require target volume under-coverage with photon SBRT (PH-SBRT) in order to meet organ at risk (OAR) dose constraints. All selected patients were treated with PH-SBRT using a robotic system to a prescription dose of 30 Gy in 5 fractions despite our institutional preference for further dose escalation, because further dose escalation was not feasible in the original planning process while keeping normal tissues below acceptable dose constraints. To see if superior target coverage could be achieved with proton treatment, comparative intensity modulated proton therapy (IMPT) plans were generated with the same prescription dose as what was clinically delivered using the 1.1 RBE constant. Dose escalated IMPT plans were then generated to 45 Gy(RBE) in 5 fractions. Variable RBE models (Carabe, McNamara, and Wedenberg) were then utilized to generate RBE-weighted dose D_{RBE} distribution for 30 Gy(RBE) and 45 Gy(RBE) plans using the α/β value (which was 3.76 in this study), physical dose, linear energy transfer (LET) value, and dose per fraction parameters. Proton plans used the robust optimization parameters of ±3.5% range and 2-mm setup uncertainties. Planning target volume (PTV) coverage and OARs sparing were compared using the Wilcoxon signed-rank test. Results: Planning target volume coverage was significantly improved when comparing PH-SBRT at 30 Gy in 5 fractions (median: 25 Gy) to IMPT at 30 Gy[RBE] in 5 fractions (median: 30.3 Gy[RBE], Conclusion: We report the first dosimetric analysis of proton SBRT for spine metastasis using variable RBE dose models. Compared to photon SBRT, IMPT may provide improved target coverage and better spare adjacent OARs, though fixed RBE models can underestimate the maximum dose to adjacent OARs. Future prospective studies are needed to validate these results.

Indexed as

Photon spine SBRTProton spine SBRTRBE-weighted doseSpine metastasis

Identifiers

PMID40144347
PMCPMC11932874

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.