A Phase II Study of Spinal Radiosurgery

Optimal radiation plan is generated that treats the tumor (CTV) and spares normal tissue,
especially the spinal cord. Motion and QA study will determine intrafraction motion for phase
II portion of the study.

Dose prescription to tumor is based upon maximal dose received by 0.5 cc of spinal cord and
whether patient has had prior radiation therapy to that area:

Phase I - Motion and QA Study: 20-25 Gy in 5 fractions/10-20 patients/previous RT = <50% CTV
dose/No previous RT = <80% CTV dose.

Phase II - 9-24 Gy in 1 fraction/30 total in order to have 20 evaluable patients (15 patients
with prior RT and 15 without prior RT/previous RT = 8 Gy/No previous RT = 10 Gy.

# Motion and QA study will treat CTV to 20-25 Gy in 5 fractions to study intrafraction motion
for QA of single fraction administration. This will define treatment margins for single
fraction radiosurgery.

*Previous RT:

- greater than six months since completion of RT

- at least 20 Gy, but no more than 50 Gy

Inclusion Criteria:

1. All subjects must have history of histologically confirmed neoplasm or
radiographically-diagnosed AVM. Patients without a prior tissue diagnosis but who have
a radiographically characteristic lesion are eligible if there is consensus agreement
of the diagnosis in the UAB Neuro-oncology Tumor Board.

2. ECOG performance status of less than or equal to 2

3. Age greater than 18

4. Life expectancy greater than 12 weeks

5. Subjects given written informed consent

Exclusion Criteria:

1. Cytotoxic chemotherapy within 7 days of treatment

2. Insufficient recovery from all active toxicities of prior therapies

3. Epidural spinal cord compression requiring immediate neurosurgical decompression. If a
patient requires immediate surgery for neurologic compromise, they may still be
eligible post operatively if tumor was incompletely resected.

4. Patient is non-ambulatory. Optimization of pretreatment neurologic function with
steroids is allowed. Ambulation with assistance of walker or cane is allowed.

5. Patient is pregnant and it is judged by the treating Radiation Oncologist that spinal
radiosurgery would place the fetus in unacceptable danger.