Journal of Experimental & Clinical Cancer Research Research A dosimetric comparison of different treatment plans of palliative spinal bone irradiation: analysis of dose coverage with respect to ICRU 50 report Fundagul Andic*, Sule Baz Cifci, Yasemin Ors, Umar Niang, Ahmet Dirier and Mustafa Adli BioMed Central Open Access Address: Department of Radiation Oncology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey Email: Fundagul Andic* - fgandic@gmail.com; Sule Baz Cifci - sbaz1979@mynet.com; Yasemin Ors - yasemin25_25@hotmail.com; Umar Niang - niango71@yahoo.fr; Ahmet Dirier - ahmetdirier@yahoo.com; Mustafa Adli - adli@gantep.edu.tr * Corresponding author Published: 7 January 2009 Journal of Experimental & Clinical Cancer Research 2009, 28:2 doi:10.1186/1756-9966-28-2 This article is available from: http://www.jeccr.com/content/28/1/2 Received: 17 November 2008 Accepted: 7 January 2009 © 2009 Andic et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: This study aimed to analyze three-dimensional (3D) dosimetric data of conventional two- dimensional (2D) palliative spinal bone irradiation using different reference points and treatment plans with respect to the International Commission on Radiation Units and Measurements (ICRU) Report 50. Methods: Forty-five simulation CT scans of 39 patients previously treated for thoraco-lumbar spinal bone metastases were used. Three different treatment plans were created: (1) single posterior field plans using the ICRU reference points (ICRUrps); (2) single posterior field plans using the International Bone Metastasis Consensus Working Party reference points (IBMCrps); (3) two opposed anterior-posterior (AP-PA) field plans using the ICRUrps. The intended dose range for planning target volume (PTV) was 90% to 110% of the prescribed dose for AP-PA field plans. Cumulative dose-volume histograms were generated for each plan, and minimum, maximum and mean doses to the PTV, medulla spinalis, esophagus and intestines were analyzed. Results: The mean percentages of minimum, maximum and mean PTV doses ± standard deviation were, respectively, 91 ± 1.3%, 108.8 ± 1.3% and 99.7 ± 1.3% in AP-PA field plans; 77.3 ± 2.6%, 122.2 ± 4.3% and 99.8 ± 2.6% in ICRUrp single field plans; and 83.7 ± 3.3%, 133.9 ± 7.1% and 108.8 ± 3.3% in IBMCrp single field plans. Minimum doses of both single field plans were significantly lower (p < 0.001) while maximum doses were significantly higher (p < 0.001) than AP-PA field plans. Minimum, maximum and mean doses were higher in IBMCrp single field plans than in ICRUrp single field plans (p < 0.001). The mean medulla spinalis doses were lower in AP-PA field plans than single posterior field plans (p < 0.001). Maximum doses for medulla spinalis were higher than 120% of the prescribed dose in 22 of 45 (49%) IBMCrp single field plans. Mean esophagus and intestinal doses were higher (p < 0.001) in AP-PA field plans than single field plans, however, less than 95% of the prescribed dose. Conclusion: In palliative spinal bone irradiation, 2D conventional single posterior field radiotherapy did not accomplish the ICRU Report 50 recommendations for PTV dose distribution, while the AP-PA field plans did achieve the intended dose ranges with a homogenous distribution and reasonable doses to the medulla spinalis, esophagus and intestines. Page 1 of 7 (page number not for citation purposes)