Stereotactic Body Radiation Therapy in Nonsurgical Patients with Metastatic Spinal Disease and Epidural Compression: A Retrospective Review.
Epidural disease
Malignant spinal cord compression (MSCC)
Spinal metastases
Stereotactic ablative body radiotherapy (SABR)
Stereotactic body radiation therapy (SBRT)
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
Feb 2019
Feb 2019
Historique:
received:
27
08
2018
accepted:
26
09
2018
pubmed:
12
10
2018
medline:
6
3
2019
entrez:
12
10
2018
Statut:
ppublish
Résumé
In the setting of spinal metastases with epidural cord compression, radiosurgery is often only considered when there is sufficient separation between the epidural disease and the spinal cord. However, in patients who are nonsurgical candidates or those who prefer nonoperative management, there may be a benefit from stereotactic body radiation therapy, even when the epidural target is closer than the traditionally referenced 3 mm distance from the spinal cord. The purpose of this retrospective study is to evaluate our institution's experience in treating 20 such patients. We reviewed records of all patients treated with stereotactic body radiation therapy for spinal metastases at our institution from January 2010 to January 2016, with follow-up through December 2016. The primary end point was local progression of disease. Local progression was defined as clear radiographic disease growth on follow-up imaging or worsening clinical symptoms in the absence of evidence for radiation myelopathy. Local control was obtained in 55% of patients meeting these criteria without a single case of radiation myelitis. Most patients with disease progression were able to undergo additional local treatment. Although local control was less than expected when compared with spine radiosurgery with adequate separation between the target and spinal cord, this treatment appears to be a viable option in the nonsurgical candidate.
Sections du résumé
BACKGROUND
BACKGROUND
In the setting of spinal metastases with epidural cord compression, radiosurgery is often only considered when there is sufficient separation between the epidural disease and the spinal cord. However, in patients who are nonsurgical candidates or those who prefer nonoperative management, there may be a benefit from stereotactic body radiation therapy, even when the epidural target is closer than the traditionally referenced 3 mm distance from the spinal cord. The purpose of this retrospective study is to evaluate our institution's experience in treating 20 such patients.
METHODS
METHODS
We reviewed records of all patients treated with stereotactic body radiation therapy for spinal metastases at our institution from January 2010 to January 2016, with follow-up through December 2016. The primary end point was local progression of disease. Local progression was defined as clear radiographic disease growth on follow-up imaging or worsening clinical symptoms in the absence of evidence for radiation myelopathy.
RESULTS
RESULTS
Local control was obtained in 55% of patients meeting these criteria without a single case of radiation myelitis. Most patients with disease progression were able to undergo additional local treatment.
CONCLUSIONS
CONCLUSIONS
Although local control was less than expected when compared with spine radiosurgery with adequate separation between the target and spinal cord, this treatment appears to be a viable option in the nonsurgical candidate.
Identifiants
pubmed: 30308345
pii: S1878-8750(18)32265-4
doi: 10.1016/j.wneu.2018.09.210
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e198-e205Informations de copyright
Copyright © 2018 Elsevier Inc. All rights reserved.