A Prospective Study Using Implanted Fiducial Markers to Assess Treatment Accuracy and Esophageal Toxicity in Spinal Stereotactic Body Radiation Therapy

Study Groups:

If you are found to be eligible to take part in this study, you will be assigned to a study
group based on when you join this study. Up to 3 groups of 10 participants will be enrolled
in the first part of the study, and up to 2 groups of 10 participants will be enrolled in the
second part of the study. Only participants who will receive a single spinal SBRT treatment
are eligible for the second part of the study.

The participants in the first part of the study will receive standard doses of radiation
therapy to normal organs while treating the tumor. In the second part of the study, each new
group will receive a higher dose of radiation to the esophagus than the group before it, if
no intolerable side effects were seen.

Radiation Planning and Treatment:

Before starting radiation treatment, you will be asked to complete a questionnaire about any
symptoms you might be having and any drugs that you are taking. It should take about 10
minutes to complete. After treatment, you will be given copies of the questionnaire to take
with you, and asked to fill it out 1 time a week for the next 4 weeks. You should return the
questionnaires by mail. Self-addressed stamped envelopes will be given to you.

During all radiation treatments, the images that are taken during your treatment will be
closely analyzed after treatment is over. You will have 1 to 3 radiation treatment sessions
depending on your doctor's decision.

If you are in the second part of the study, you will receive slightly more radiation than
usual to the normal esophagus.

The rest of your radiation treatment planning and treatment delivery appointments will be
unchanged. The dose given to the tumor and number of treatments you receive will be
determined by your doctor, and is not affected by taking part in this study.

Follow-Up Visits:

After your radiation treatment schedule ends, you will return for follow-up visits at the
following time points:

- At 3 months

- Then, every 3 months for 1 year

- Every 6 months during year 2, and then

- 1 time a year after that, for as long as possible

Additional follow up visits may be scheduled, if your doctor thinks they are needed.

At these visits, the following tests and procedures will be performed:

- Any updates to your medical history will be recorded and you will be asked about any
side effects you may be having.

- Your performance status will be recorded.

- Your completed symptom questionnaires will be reviewed.

- You will have a physical, including measurement of your vital signs

- You will have a neurological exam.

- You will have follow-up imaging (such as an MRI) to check the status of the disease.

This is an investigational study. Radiation therapy is delivered using FDA-approved and
commercially available methods. It is considered investigational to give increased radiation
to the esophagus.

Up to 57 patients will take part in this study. All will be enrolled at MD Anderson.

Inclusion Criteria:

1. STAGE 1: >/= 18 years old

2. STAGE 1: Pathologically confirmed diagnosis of cancer, including, but not limited to
non-small cell lung cancer, breast, prostate, renal cell, melanoma, gastrointestinal,
sarcoma, thyroid, head and neck primary, and carcinoma of unknown primary

3. STAGE 1: Signed informed consent

4. STAGE 2: 1-3 above, and Patients undergoing single fraction spinal SBRT

Exclusion Criteria:

1. STAGE 1: Patient with radiosensitive histologies (lymphoma, multiple myeloma, small
cell carcinomas, germ cell tumors)

2. STAGE 1: Extensive (> 50%) height loss of the involved vertebral body

3. STAGE 1: Inability to tolerate lying flat on treatment table for greater than 30
minutes

4. STAGE 1: Pregnancy

5. STAGE 2: Prior irradiation of the spine site and level to be treated

6. STAGE 2: Patients with primary disease arising in the posterior elements of the VB in
question

7. STAGE 2: History of Barrett's esophagus, esophageal webbing, stricture, or fistula

8. STAGE 2: Prior radiation to the esophagus