Contemporary treatment with radiosurgery for spine metastasis and spinal cord compression in 2015

Ryu, Samuel; Yoon, Hyun-Ki; Stessin, A.; Gutman, Fred; Rosiello, Arthur; Davis, Raphael P.

doi:10.3857/roj.2015.33.1.1

Cited by 45 publications

(28 citation statements)

References 37 publications

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“…23 Recent advances in radiobiology and image guidance led to the development of spinal SRS, which allows the delivery of a high dose of radiation in a single or hypofractionated fashion, with the hallmark of a rapid fall off outside a selected target. 19,26 Several reports have demonstrated good local control in cases of unfavorable histologies to cEBRT and cemented the role of SRS in the management of spinal metastasis. [6][7][8]20,27 Nevertheless, in the setting of epidural disease leading to spinal cord displacement, the radiation dose prescribed to the tumor needs to be adjusted to respect the constraints of the spinal cord, 19,21 which can be associated with treatment failure.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous surgery for treatment of epidural spinal cord compression and spinal instability: technical note

Tatsui¹,

Belsuzarri

Oro³

et al. 2016

FOC

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OBJECTIVE An emerging paradigm for treating patients with epidural spinal cord compression (ESCC) caused by metastatic tumors is surgical decompression and stabilization, followed by stereotactic radiosurgery. In the setting of rapid progressive disease, interruption or delay in return to systemic treatment can lead to a negative impact in overall survival. To overcome this limitation, the authors introduce the use of spinal laser interstitial thermotherapy (sLITT) in association with percutaneous spinal stabilization to facilitate a rapid return to oncological treatment. METHODS The authors retrospectively reviewed a consecutive series of patients with ESCC and spinal instability who were considered to be poor surgical candidates and instead were treated with sLITT and percutaneous spinal stabilization. Demographic data, Spine Instability Neoplastic Scale score, degree of epidural compression before and after the procedure, length of hospital stay, and time to return to oncological treatment were analyzed. RESULTS Eight patients were treated with thermal ablation and percutaneous spinal stabilization. The primary tumors included melanoma (n = 3), lung (n = 3), thyroid (n = 1), and renal cell carcinoma (n = 1). The median Karnofsky Performance Scale score before and after the procedure was 60, and the median hospital stay was 5 days (range 3–18 days). The median Spine Instability Neoplastic Scale score was 13 (range 12–16). The mean modified postoperative ESCC score (2.75 ± 0.37) was significantly lower than the preoperative score (4.5 ± 0.27) (Mann-Whitney test, p = 0.0044). The median time to return to oncological treatment was 5 days (range 3–10 days). CONCLUSIONS The authors present the first cohort of sLITT associated with a percutaneous spinal stabilization for the treatment of ESCC and spinal instability. This minimally invasive technique can allow a faster recovery without prejudice of adjuvant systemic treatment, with adequate local control and spinal stabilization.

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Section: Discussionmentioning

confidence: 99%

Percutaneous surgery for treatment of epidural spinal cord compression and spinal instability: technical note

Tatsui¹,

Belsuzarri

Oro³

et al. 2016

FOC

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“…[1][2][3] The most challenging part of spine SABR is ensuring that the dose delivered to the spinal cord is lower than its tolerance dose while still delivering a prescription dose to the target volume, as the target volume of spine SABR is close to the spinal cord. 4,5 In certain cases, the target volume of spine SABR wraps around the spinal cord; therefore, a steep dose gradient between the target volume and the spinal cord, i.e.…”

Section: Introductionmentioning

confidence: 99%

Quality of tri-Co-60 MR-IGRT treatment plans in comparison with VMAT treatment plans for spine SABR

Choi

Park

Kim

et al. 2016

The British Journal of Radiology

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FULL PAPERQuality of tri-Co-60 MR-IGRT treatment plans in comparison with VMAT treatment plans for spine SABR Objective: To investigate the plan quality of tri-Co-60 intensity-modulated radiation therapy (IMRT) plans for spine stereotactic ablative radiotherapy (SABR). Methods: A total of 20 patients with spine metastasis were retrospectively selected. For each patient, a tri-Co-60 IMRT plan and a volumetric-modulated arc therapy (VMAT) plan were generated. The spinal cords were defined based on MR images for the tri-Co-60 IMRT, while isotropic 1-mm margins were added to the spinal cords for the VMAT plans. The VMAT plans were generated with 10-MV flattening filter-free photon beams of TrueBeam STx™ (Varian Medical Systems, Palo Alto, CA), while the tri-Co-60 IMRT plans were generated with the ViewRay™ system (ViewRay inc., Cleveland, OH). The initial prescription dose was 18 Gy(1 fraction). If the tolerance dose of the spinal cord was not met, the prescription dose was reduced until the spinal cord tolerance dose was satisfied.Results: The mean dose to the target volumes, conformity index and homogeneity index of the VMAT and tri-Co-60 IMRT were 17.8 6 0.8 vs 13.7 6 3.9 Gy, 0.85 6 0.20 vs 1.58 6 1.29 and 0.09 6 0.04 vs 0.24 6 0.19, respectively. The integral doses and beam-on times were 16,570 6 1768 vs 22,087 6 2.986 Gy cm 3 and 3.95 6 1.13 vs 48.82 6 10.44 min, respectively. Conclusion: The tri-Co-60 IMRT seems inappropriate for spine SABR compared with VMAT. Advances in knowledge: For spine SABR, the tri-Co-60 IMRT is inappropriate owing to the large penumbra, large leaf width and low dose rate of the ViewRay system.

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“…Since then, spinal SRS has gradually increased both in popularity and availability, and has been used for spinal pathology ranging from metastases to arteriovenous malformations [2][3]. Performed predominantly as an outpatient procedure, spinal SRS has emerged as an attractive alternative to microsurgical resection in appropriately selected patients [3][4]. However, to date there has been no population-based examination of spinal SRS utilization nor on the role of patient demographics on the receipt of spinal SRS.…”

Section: Introductionmentioning

confidence: 99%

Limitations of Using Population-Based Databases to Assess Trends in Spinal Stereotactic Radiosurgery

et al. 2016

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Contemporary treatment with radiosurgery for spine metastasis and spinal cord compression in 2015

Cited by 45 publications

References 37 publications

Percutaneous surgery for treatment of epidural spinal cord compression and spinal instability: technical note

Percutaneous surgery for treatment of epidural spinal cord compression and spinal instability: technical note

Quality of tri-Co-60 MR-IGRT treatment plans in comparison with VMAT treatment plans for spine SABR

Limitations of Using Population-Based Databases to Assess Trends in Spinal Stereotactic Radiosurgery

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