One vertebra above and below the involved vertebra(e) were

included in the clinical target volume (CTV). However, the upper end-plate of the upper vertebra and the lower end-plate of the lower vertebra were not included in the CTV, to limit the distal and proximal borders of the treatment fields in the inter-vertebral space. To determine the planning target volume (PTV), 10 mm was added to CTV in lateral directions and 5 mm in anterior-posterior and superior-inferior directions. Treatment fields were determined by adding 7–10 mm to the PTV using multi-leaf Decitabine order collimators. Figure 1 Target volumes and reference points. Clinical target volume (CTV), (pink line); planning target volume (PTV), (dark-blue line); ICRUrp, the International Commission on Radiation Units and Measurements reference point; IBMCrp, the International Bone Metastasis Consensus Working Party reference point. Portions of the esophagus located in thoracic radiotherapy fields, the intestines located in lumbar radiotherapy fields and the medulla spinalis in all fields were delineated as critical organs. Treatment

planning Precise PLAN®2.11 (Elekta, Crawley, UK) treatment planning system (TPS), which enables 3D conformal radiotherapy planning, AZD6244 cost was used for treatment plans. To calculate the dose distribution of the photon beam, the TPS uses an irregular field algorithm, for different depths and field sizes, based on data measures in a phantom. The algorithm takes into account the inhomogeneity of the patient’s tissue and uses an integration scheme to

evaluate the scatter component of the dose. The dose calculation grid is set to 2.5 mm. Three different treatment plans were created (1) single posterior field treatment plans using ICRUrps; (2) single posterior field treatment plans using IBMCrps; and (3) two opposed anterior-posterior (AP-PA) field plans using ICRUrps. The ICRUrp was defined as the center of the PTV, the IBMCrp was defined as the mid-vertebral body point in the central plane, and the prescription dose was normalized to these points (Figure 1). Dose distributions of treatment plans in one case are shown in Figure 2. Figure 2 Dose distributions in one case for STK38 ICRUrp single field plan (A), IBMCrp single field plan (B) and two opposed anterior-posterior field plan (C). ICRUrp, the International Commission on Radiation Units and Measurements reference point; IBMCrp, the International Bone Metastasis Consensus Working Party reference point. The isodose lines are shown as follows: 75% (blue), 80% (yellow), 90% (dark blue), 95% (red), 100 (pink), 110% (green), 115% (orange). The nominal prescribed dose was 2000 cGy in 5 fractions using 6-MV photons for posterior fields and 18-MV for anterior fields. In AP-PA field plans, beam weights were used as 1 and 1.5–2 in AP and PA fields, while assuring the intended dose range of 90% to 110% of the prescribed dose for the PTV. No dose constraint was used in single posterior field plans.