Stereotactic LINAC Radiosurgery

Mendel²,

Yamada³

2009

Spine

293

A systematic review of the available evidence suggests that conventional radiotherapy is safe and effective with good symptomatic response and local control, particularly for radiosensitive histologies. A strong recommendation can be made with moderate quality evidence that conventional fractionated radiotherapy is an appropriate initial therapy option for patients with spine metastases in cases in which no relative contraindication exists. A systematic review of the available evidence suggests that radiosurgery is safe and provides an incremental benefit over conventional radiotherapy with more durable symptomatic response and local control independent of histology, even in the setting of prior fractionated radiotherapy. A strong recommendation can be made with low-quality evidence that radiosurgery should be considered over conventional fractionated radiotherapy for the treatment of solid tumor spine metastases in the setting of oligometastatic disease and/or radioresistant histology.

mentioning

confidence: 99%

Radiotherapy and Radiosurgery for Metastatic Spine Disease

Mendel²,

Yamada³

2009

Spine

293

Section: Discussionmentioning

confidence: 99%

“…Authors of recent studies involving hypofractionated or single-dose treatments for spinal metastases have reported results that were comparable with those achieved using conventional fractionation. 10,19 Furthermore, hypofractionation or single-dose radiation decreases the treatment duration, is more convenient for patients, and is less costly.The use of multiple radiation beams requires extremely precise control of patient position and movement of the LINAC. Current stereotactic radiotherapy surgery is limited to cases of intracranial disease because precise localization can be achieved only by neurosurgical frames fixed to the patient's skull.…”

mentioning

confidence: 99%

Feasibility of frameless single-fraction stereotactic radiosurgery for spinal lesions

Ozhasoglu

Burton

et al. 2002

FOC

Object The role of stereotactic radiosurgery for the treatment of intracranial lesions is well established. Its use for the treatment of spinal lesions has been limited by the availability of effective target-immobilizing devices. In this study the authors evaluated the CyberKnife Real-Time Image-Guided Radiosurgery System for spinal lesion treatment involving a single-fraction radiosurgical technique. Methods This frameless image-guided radiosurgery system uses the coupling of an orthogonal pair of x-ray cameras to a dynamically manipulated robot-mounted linear accelerator possessing six degrees of freedom, which guides the therapy beam to the target without the use of frame-based fixation. Cervical lesions were located and tracked relative to osseous skull landmarks; lower spinal lesions were tracked relative to percutaneously placed gold fiducial bone markers. Fifty-six spinal lesions in 46 consecutive patients were treated using single-fraction radiosurgery (26 cervical, 15 thoracic, and 11 lumbar, and four sacral). There were 11 benign and 45 metastatic lesions. Tumor volume ranged from 0.3 to 168 ml (mean 26.7 ml). Thirty-one lesions had previously received external-beam radiotherapy with maximum spinal cord doses. Dose plans were calculated based on computerized tomography scans acquired using 1.25-mm slices. Tumor dose was maintained at 12 to 18 Gy to the 80% isodose line; spinal cord lesions receiving greater than 8 Gy ranged from 0 to 1.3 ml (mean 0.3 ml). All patients tolerated the procedure in an outpatient setting. No acute radiation-induced toxicity or new neurological deficits occurred during the follow-up period. Axial and radicular pain improved in all patients who were symptomatic prior to treatment. Conclusions Spinal stereotactic radiosurgery involving a frameless image-guided system was found to be feasible and safe. The major potential benefits of radiosurgical ablation of spinal lesions are short treatment time in an outpatient setting with rapid recovery and symptomatic response. This procedure offers a successful alternative therapeutic modality for the treatment of a variety of spinal lesions not amenable to open surgical techniques; the intervention can be performed in medically untreatable patients, lesions located in previously irradiated sites, or as an adjunct to surgery.

“…[38][39][40][41][42][43] Multiple centers have also demonstrated the clinical efficacy of large-fraction conformal radiation delivery to spinal lesions using a variety of technologies. 29,[31][32][33][34][35][36][37][44][45][46][47][48][49][50][51][52][53][54][55] The current study evaluated the clinical outcomes of radiosurgery for the treatment of metastases to the spine from lung cancer to determine whether such a radiosurgery technique parallels the efficacy that has been demonstrated for the treatment of intracranial lung metastases.…”

mentioning

confidence: 99%

Radiosurgery for the treatment of spinal lung metastases

Burton

Belani

et al. 2006

Cancer

BACKGROUND. Spinal metastases are a common source of pain as well as neurologic deficit in patients with lung cancer. Metastases from lung cancer traditionally have been believed to be relatively responsive to radiation therapy. However, conventional external beam radiotherapy lacks the precision to allow delivery of large single‐fraction doses of radiation and simultaneously limit the dose to radiosensitive structures such as the spinal cord. The current study evaluated the efficacy of single‐fraction radiosurgery for the treatment of spinal lung cancer metastases. METHODS. In the current prospective cohort evaluation, 87 lung cancer metastases to the spine in 77 patients were treated with a single‐fraction radiosurgery technique with a follow‐up period of 6 to 40 months (median, 12 months). The indication for radiosurgery treatment was pain in 73 cases, as a primary treatment modality in 7 cases, for radiographic tumor progression in 4 cases, and for progressive neurologic deficit in 3 cases. RESULTS. Tumor volume ranged from 0.2 to 264 cm3 (mean, 25.7 cm3). The maximum tumor dose was maintained at 15 to 25 grays (Gy) (mean, 20 Gy; median, 20 Gy). No radiation‐induced toxicity occurred during the follow‐up period. Long‐term axial and radicular pain improvement occurred in 65 of 73 patients (89%) who were treated primarily for pain. Long‐term radiographic tumor control was observed in all patients who underwent radiosurgery as their primary treatment modality or for radiographic tumor progression. CONCLUSIONS. Spinal radiosurgery was found to be feasible, safe, and clinically effective for the treatment of spinal metastases from lung cancer. The results of the current study indicate the potential of radiosurgery in the treatment of patients with spinal lung metastases, especially those with solitary sites of spine involvement, to improve long‐term palliation. Cancer 2006. © 2006 American Cancer Society.