Metastatic adrenal pheochromocytoma to the thoracic spine

Scalfani, Michael T.; Arnold, Paul M.; Anderson, Karen K.

doi:10.1590/s1808-18512010000300017

Cited by 4 publications

(4 citation statements)

References 30 publications

(64 reference statements)

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“…There have been case reports on malignant PCC/PGL in which EBRT was delivered to unknown total doses. In these cases, irradiation was delivered to the primary tumor or metastatic sites with varying symptomatic control and most often with progression of local and distant disease ( 2 – 6 ). However, these reports may be of limited utility especially in PCC/PGL, given results from a 1978 literature review, which concluded that radiation therapy is beneficial for symptomatic relief of bone and lymph node metastases only at high doses ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

External Beam Radiation Therapy in Treatment of Malignant Pheochromocytoma and Paraganglioma

et al. 2014

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Purpose: Pheochromocytomas (PCCs) are neuroendocrine tumors arising from the adrenal medulla or as paraganglioma (PGL) from extra-adrenal sites. While usually benign, a small fraction is malignant. Multi-modality therapy is used in treating malignant disease; however, little data exist on the role of external beam radiation therapy (EBRT). In this retrospective review, we assessed response to EBRT in malignant PCCs or PGLs.Methods and Materials: Records of patients treated at the National Institutes of Health who received EBRT between 1990 and 2012 were studied. Patients were assessed for symptomatic control, biochemical response, local and distant control by response evaluation criteria in solid tumors v1.1 or stable disease on imaging reports, toxicity by radiation therapy oncology group (RTOG) criteria, and survival.Results: There were 24 patients treated who received EBRT to lesions of the abdomen (n = 3), central nervous system (n = 4), and bone (n = 40). Lesions were treated with 3D conformal EBRT to a mean dose of 31.8 Gy in 3.3 Gy fractions, or fractionated stereotactic radiosurgery to 21.9 Gy in 13.6 Gy fractions. Patients experienced acute (n = 15) and late (n = 2) RTOG toxicities; no patient experienced acute toxicity ≥4 or late toxicity ≥2. Symptomatic control was achieved in 81.1% of lesions. Stable radiographic response was achieved in 86.7% of lesions with progression in 13%. Distant progression was observed overall in 75% of patients and average survival was 52.4 months.Conclusion: Malignant PCC and PGL often do not respond well to current systemic therapies. In these cases, EBRT can be considered in patients with symptomatic, localized disease progression.

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Section: Introductionmentioning

confidence: 99%

External Beam Radiation Therapy in Treatment of Malignant Pheochromocytoma and Paraganglioma

et al. 2014

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“… 20 Scalfani et al reported excision of the extradural component of a thoracic metastatic pheochromocytoma in a patient with disseminated disease who died 26 months after surgery. 21 …”

Section: Resultsmentioning

confidence: 99%

“…Several case reports have demonstrated that intralesional surgical resection for functional tumor spinal metastasis has some benefit; however, the prognosis often remains dismal. 20 21 …”

Section: Discussionmentioning

confidence: 99%

En Bloc Resection of Solitary Functional Secreting Spinal Metastasis

Goodwin

Clarke

Gokaslan

et al. 2015

Global Spine Journal

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Study Design Literature review. Objective Functional secretory tumors metastatic to the spine can secrete hormones, growth factors, peptides, and/or molecules into the systemic circulation that cause distinct syndromes, clinically symptomatic effects, and/or additional morbidity and mortality. En bloc resection has a limited role in metastatic spine disease due to the current paradigm that systemic burden usually determines morbidity and mortality. Our objective is to review the literature for studies focused on en bloc resection of functionally active spinal metastasis as the primary indication. Methods A review of the PubMed literature was performed to identify studies focused on functional secreting metastatic tumors to the spinal column. We identified five cases of patients undergoing en bloc resection of spinal metastases from functional secreting tumors. Results The primary histologies of these spinal metastases were pheochromocytoma, carcinoid tumor, choriocarcinoma, and a fibroblast growth factor 23–secreting phosphaturic mesenchymal tumor. Although studies of en bloc resection for these rare tumor subtypes are confined to case reports, this surgical treatment option resulted in metabolic cures and decreased clinical symptoms postoperatively for patients diagnosed with solitary functional secretory spinal metastasis. Conclusion Although the ability to formulate comprehensive conclusions is limited, case reports demonstrate that en bloc resection may be considered as a potential surgical option for the treatment of patients diagnosed with solitary functional secretory spinal metastatic tumors. Future prospective investigations into clinical outcomes should be conducted comparing intralesional resection and en bloc resection for patients diagnosed with solitary functional secretory spinal metastasis.

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“…No hemodynamic instability was noted in the patient. Similarly, Scalfani et al 16 reported an excision of the extradural component of a metastatic pheochromocytoma in the thoracic spine of a patient with widespread systemic disease. Although the authors did not report any postoperative complications, this patient died of disease 26 months after surgery.…”

Section: Discussionmentioning

confidence: 96%

En bloc resection of a pheochromocytoma metastatic to the spine for local tumor control and for treatment of chronic catecholamine release and related hypertension

Kaloostian¹,

Zadnik²,

Awad³

et al. 2013

SPI

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Resection of metastatic pheochromocytomas may be complicated by transient postoperative neurological deficits due to hypotension. The authors report the first case of en bloc excision of a spinal pheochromocytoma with associated long-term hypertensive management off all medication. Interestingly, this is the first case of transient hypotension following en bloc resection of pheochromocytoma associated with temporary hypotension-associated neurological decline that resolved completely after correction of hypotension postoperatively. A 23-year-old man with a prior adrenalectomy for pheochromocytoma presented with focal thoracic pain. He had a known T-10 vertebral body lesion for which he received chemotherapy and radiation therapy. Imaging demonstrated increased destruction of the T-10 vertebral body, which was concerning for tumor growth. The patient underwent angiographic embolization followed by single-stage posterior en bloc vertebrectomy with placement of a cage and posterior instrumentation and fusion without event. However, approximately 24 hours after surgery, the patient's systolic blood pressure was consistently no higher than 70 mm Hg. During this time, he began suffering from severe bilateral lower-extremity weakness. His systolic blood pressure increased with dopamine, and his strength immediately improved. The patient's oral regimen of adrenergic blockade was stopped, and he recovered without event. Since that time, the patient has been symptom free and requires no antihypertensive medication. The role of en bloc resection for metastatic lesions of the spine is controversial but may be warranted in cases of metastatic pheochromocytoma. En bloc resection avoids intralesional tumor resection and thus may help prevent complications of hypertensive crisis associated with hormonal secretion and extensive blood loss, which are not uncommon with pheochromocytoma resection surgeries. Additionally, the role of en bloc spondylectomy in this setting may allow for metabolic treatment as patients with actively secreting tumors may no longer require antiadrenergic medications.

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Metastatic adrenal pheochromocytoma to the thoracic spine

Cited by 4 publications

References 30 publications

External Beam Radiation Therapy in Treatment of Malignant Pheochromocytoma and Paraganglioma

External Beam Radiation Therapy in Treatment of Malignant Pheochromocytoma and Paraganglioma

En Bloc Resection of Solitary Functional Secreting Spinal Metastasis

En bloc resection of a pheochromocytoma metastatic to the spine for local tumor control and for treatment of chronic catecholamine release and related hypertension

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