The purpose of our study is to evaluate the outcomes of patients with high-grade epidural spinal cord compression (ESCC) spinal metastases treated with spine stereotactic radiosurgery (SSRS) in the postoperative setting. Materials/Methods: We reviewed the medical records of 20 patients with high-grade (ESCC) spinal metastases who underwent separation surgery followed by postoperative spine stereotactic radiosurgery (SSRS). CT simulation and postoperative myelography were fused to delineate planning target volume (PTV), spinal cord and dural margins. Six patients (30%) received a single fraction of 16 Gy, and 14 patients (70%) received 24-27 Gy in 3 fractions. Preoperative epidural spinal cord compression (Bilsky) scores of 1c, 2, and 3 were found in 30%, 50% and 20% of patients, respectively. Patients were followed with spinal MRI and CTmylography at regular intervals to determine local control (LC). Pain control data were collected to determine clinical treatment response. Radiographic local control was calculated using the Kaplan-Meier method. Results: Fifty-three segments were treated. The median PTV was 88.0 cm 3 (range: 24.6e354.6 cm 3), with a median V90 of 94% and D90 of 93%. Solid tumor histology represented 80% of the patient population. Four patients (20%) had been treated with radiation to the spine utilizing conventional fractionation prior to surgical intervention. The median followup for this cohort was 9.5 months (range: 2-31mo). The 1-year radiographic LC was 75.3%. Durable pain control, defined as a numeric pain score of <4 out of 10, was achieved in 73% of patients. Four patients failed locally. Two of these patients were salvaged with additional SBRT and now have stable disease. No grade-2 or higher treatment-related toxicity has been observed. Conclusion: The combination of separation surgery with stereotactic spine radiosurgery can offer patients with high-grade epidural spinal cord compression spinal metastases the chance of effective palliation, along with durable tumor control. Separation surgery may optimize the conditions for the safe and effective delivery of spine radiosurgery.

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Purpose/Objective(s): Patients with cervical lymphadenopathies of unknown primary carcinoma (CUP) usually undergo neck dissection and irradiation. There is an ongoing controversy regarding the extent of nodal and mucosal volumes to be irradiated. We assessed outcomes after bilateral or unilateral nodal irradiation. Materials/Methods: This retrospective multicentric study included CUPpatients undergoing radiotherapy between 2000 and 2015. Results: Of 350 patients, 74.5% had unilateral disease. Sixty-one (20.5%) patients had unilateral disease and unilateral irradiation, 155 (52.2%) unilateral disease and bilateral irradiation and 81 (27.3%) bilateral disease and bilateral irradiation. Thirty-four (9.7%) and 217 (62.0%) patients had neoadjuvant and/or concomitant chemotherapy, respectively. Median follow-up was 37 months. Three-year local, regional, locoregional failure rates and CUP-specific survival were 5.6%, 11.7%, 15.0%, and 84.7%, respectively. In patients with unilateral disease, the 3-year cumulative incidence of regional / local relapse was 7.7%/4.3% after bilateral irradiation versus 16.9%/11.1% after unilateral irradiation (pZ0.17/0.32). The cumulative incidence of cause-specific deaths was 9.2% after bilateral irradiation and 15.5% after unilateral irradiation (pZ0.92). In multivariate analysis, mucosal irradiation was associated with better local control; while neck dissection, N2b and interruption of radiotherapy for more than 4 days were associated with poorer regional control. Toxicity was higher after bilateral irradiation (p <0.05). PET-CT, largest node diameter, N2b, interruption of radiotherapy and neoadjuvant chemotherapy were associated with poorer cause specific survival. Conclusion: Bilateral nodal irradiation yielded non-significant better nodal and mucosal control rates but was associated with higher rates of severe toxicity.

compared with preradiation therapy, and 26 patients who did not need hormone replacement after radiation therapy. Conclusion: Radiation therapy for intracranial germinoma resulted in excellent treatment outcome. Omitting spinal irradiation was feasible for germinoma with localized disease, but CSI was still recommended for multifocal disease. Serum and/or CSF b-HCG levels had no significant influence on treatment outcome.