Prognostic Factors for Local Control and Survival After Radiotherapy of Metastatic Spinal Cord Compression

Rades, Dirk; Fehlauer, Fabian; Schulte, Rainer; Veninga, Theo; Stalpers, Lukas J.A.; Basić, Hiba; Bajrovic, Amira; Hoskin, Peter; Tribius, Silke; Wildfang, I.; Rudat, Volker; Engenhart-Cabilic, Rita; Karstens, Johann H.; Alberti, Winfried; Dunst, Juergen; Schild, Steven E.

doi:10.1200/jco.2005.05.0542

Cited by 283 publications

(210 citation statements)

References 15 publications

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“…These findings are in accord with the prognostic factors identified for survival after first course of RT of MSCC in a multivariate analysis of 1852 patients. 1 In that multivariate analysis, ECOG performance status showed at least a strong trend. The other 3 factors that were significant in the present study also achieved significance in a previous multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

“…[12][13][14][27][28][29] Therefore, in accord with data for the first course of RT, one may consider single-fraction RT or multifraction short-course RT for patients with a poor estimated survival, who will probably not benefit from longer-course RT in terms of better recalcification and local control. 1,30 Survival after Re-RT may be predicted with the help of the prognostic factors identified in this series.…”

Section: Discussionmentioning

confidence: 99%

“…In-field recurrence of MSCC can occur in the previously irradiated segment of the spine. 1 Many patients with locally recurrent MSCC are not surgical candidates because of poor expected survival, poor performance status, or significant comorbidity. 2 Re-irradiation (Re-RT) remains their primary treatment option.…”

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confidence: 99%

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Prognostic factors for functional outcome and survival after reirradiation for in‐field recurrences of metastatic spinal cord compression

Rades

Rudat

Veninga

et al. 2008

Cancer

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Objective: We examined whether glucose transporter 1 (GLUT1) deficiency causes common idiopathic generalized epilepsies (IGEs). Methods: The IGEs are common, heritable epilepsies that usually follow complex inheritance; currently little is known about their genetic architecture. Previously considered rare, GLUT1 deficiency, due to mutations in SLC2A1, leads to failure of glucose transport across the blood–brain barrier and inadequate glucose for brain metabolism. GLUT1 deficiency was first associated with an encephalopathy and more recently found in rare dominant families with epilepsy and paroxysmal exertional dyskinesia (PED). Five hundred four probands with IGEs and 470 controls underwent SLC2A1 sequencing. Glucose transport was assayed following expression of SLC2A1 variants in Xenopus oocytes. All available relatives were phenotyped, and SLC2A1 was sequenced. Results: Functionally validated mutations in SLC2A1 were present in 7 of 504 (1.4%) probands and 0 of 470 controls. PED, undiagnosed prior to study, occurred in 1 proband and 3 of 13 relatives with mutations. The IGEs in probands and relatives were indistinguishable from typical IGE. Three cases (0.6%) had mutations of large functional effect and showed autosomal dominant inheritance or were de novo. Four (0.8%) cases had a subtle functional effect; 2 showed possible dominant inheritance, and 2 did not. These alleles leading to subtle functional impairment may contribute to complex, polygenic inheritance of IGE. Interpretation: SLC2A1 mutations contribute to approximately 1% of IGE both as a dominant gene and as a susceptibility allele in complex inheritance. Diagnosis of GLUT1 deficiency has important treatment (ketogenic diet) and genetic counseling implications. The mechanism of restricted glucose delivery differs from the current focus on IGEs as ion channel disorders. ANN NEUROL 2012;72:807–815

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Prognostic factors for functional outcome and survival after reirradiation for in‐field recurrences of metastatic spinal cord compression

Rades

Rudat

Veninga

et al. 2008

Cancer

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“…However, only 6%-67% percent of nonambulatory patients recovered ambulation, with reports in the 60% range thought to be attributable to the large number of favorable histologies in those series [7]. Literature analysis reveals that all authors classify lymphoma, seminoma, and myeloma as radiosensitive histologies (Table 1) and supports the use of cEBRT to treat these tumors, regardless of the degree of ESCC or neurologic deficit [7][8][9][10][11][12][13][14]. On the other hand, solid tumors exhibit a wide range of radiosensitivity.…”

Section: Oncologic Assessmentmentioning

confidence: 99%

“…Radiosensitive solid tumor histologies include breast, prostate, ovarian, and neuroendocrine carcinomas. Renal, thyroid, hepatocellular, colon, and non-small cell lung carcinomas, sarcoma, and melanoma represent radioresistant tumors [7][8][9][10][11][12][13][14][15]. Solid tumors with radioresistant histologies generally require SRS to achieve durable local control, whereas radiosensitive solid tumors may be treated with cEBRT or SRS.…”

Section: Oncologic Assessmentmentioning

confidence: 99%

The NOMS Framework: Approach to the Treatment of Spinal Metastatic Tumors

et al. 2013

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Background. Spinal metastases frequently arise in patients with cancer. Modern oncology provides numerous treatment options that include effective systemic, radiation, and surgical options. We delineate and provide the evidence for the neurologic, oncologic, mechanical, and systemic (NOMS) decision framework, which is used at Memorial Sloan-Kettering Cancer Center to determine the optimal therapy for patients with spine metastases. Methods. We provide a literature review of the integral publications that serve as the basis for the NOMS framework and report the results of systematic implementation of the NOMSguided treatment. Results. The NOMS decision framework consists of the neurologic, oncologic, mechanical, and systemic considerations and incorporates the use of conventional external beam radiation, spinal stereotactic radiosurgery, and minimally invasive and open surgical interventions. Review of radiation oncology and surgical literature that examine the outcomes of treatment of spinal metastatic tumors provides support for the NOMS decision framework. Application of the NOMS paradigm integrates multimodality therapy to optimize local tumor control, pain relief, and restoration or preservation of neurologic function and minimizes morbidity in this often systemically ill patient population. Conclusion. NOMS paradigm provides a decision framework that incorporates sentinel decision points in the treatment of spinal metastases. Consideration of the tumor sensitivity to radiation in conjunction with the extent of epidural extension allows determination of the optimal radiation treatment and the need for surgical decompression. Mechanical stability of the spine and the systemic disease considerations further help determine the need and the feasibility of surgical intervention. The Oncologist 2013;18:744 -751 Implications for Practice: Treatment of spinal metastatic tumors requires a multidisciplinary approach which integrates radiation and medical oncology, surgery, and interventional radiology. The NOMS framework described in this manuscript incorporates the neurologic, oncologic, mechanical, and systemic considerations to facilitate decision making in the care of patients with spinal metastases. Furthermore, this framework allows dynamic integration of novel systemic and radiation options which is crucial in these rapidly evolving disciplines. The article summarizes the supporting literature for this framework and provides the results of implementation of the NOMS paradigm in the care of cancer patients. INTRODUCTIONSpinal metastases occur in 20% of all patients with cancer [1, 2], with 5%-10% of patients with cancer developing spinal cord compression [3,4]. The treatment of spinal metastases is palliative, with the goals of providing pain relief, maintenance or recovery of neurologic function, local durable tumor control, spinal stability, and improved quality of life. Over the past decade, treatment has evolved from simple decisions regarding the need for either surgery or conventional external beam...

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Myelopathies in Patients With Cancer

Graber¹,

Nolan²

2010

Arch Neurol

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yelopathy is a devastating neurologic complication of cancer. The resulting pain, paralysis, and incontinence can turn a patient with cancer from a functioning individual to one who is confined to a chair or bed. Early diagnosis and appropriate therapy can prevent or ameliorate these symptoms and improve both duration of survival and quality of life. Accurate neurologic assessment of patients is crucial for early diagnosis and correct therapy. Myelopathy in patients with cancer is not rare. Epidural spinal cord compression (SCC) affects an estimated 5% of patients with cancer; other disorders such as intramedullary spinal cord metastases, adverse effects of therapy, and paraneoplastic spinal cord syndromes, although less common, are equally devastating. Because of space limitations, this review addresses the pathophysiology, clinical findings, diagnosis, and treatment of only some of the myelopathies that affect patients with cancer (Table 1). Because of new data, epidural SCC and paraneoplastic syndromes are emphasized.

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Prognostic Factors for Local Control and Survival After Radiotherapy of Metastatic Spinal Cord Compression

Cited by 283 publications

References 15 publications

Prognostic factors for functional outcome and survival after reirradiation for in‐field recurrences of metastatic spinal cord compression

Prognostic factors for functional outcome and survival after reirradiation for in‐field recurrences of metastatic spinal cord compression

The NOMS Framework: Approach to the Treatment of Spinal Metastatic Tumors

Myelopathies in Patients With Cancer

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