Journal ArticleDOI
Prospective evaluation of spinal reirradiation by using stereotactic body radiation therapy: The University of Texas MD Anderson Cancer Center experience.
Amit Kumar Garg,Xin Shelley Wang,Almon S. Shiu,Pamela K. Allen,James Chih-Hsin Yang,Mary Frances McAleer,Syed Azeem,Laurence D. Rhines,Eric L. Chang +8 more
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TLDR
Stereotactic body radiotherapy for previously irradiated, progressive spinal metastases may be a viable option in selected patients, and a prospective series of spinal metastasis patients reirradiated with stereotacticBody radiotherapy is reviewed.Abstract:
Background Stereotactic body radiotherapy for previously irradiated, progressive spinal metastases may be a viable option in selected patients. The authors review a prospective series of spinal metastasis patients reirradiated with stereotactic body radiotherapy. Methods A total of 59 patients with 63 tumors of the spine were reirradiated with stereotactic body radiotherapy between 2003 and 2009. Spinal magnetic resonance imaging was performed both before treatment initiation and at regular follow-up intervals. Stereotactic body radiotherapy was delivered to a peripheral dose of 30 grays (Gy) in 5 fractions (6 Gy per fraction), or 27 Gy in 3 fractions (9 Gy per fraction). The National Cancer Institute Common Toxicity Criteria 2.0 and McCormick neurological function system were used to evaluate toxicity and neurologic status, respectively. Results Mean follow-up was 17.6 months. Actuarial 1-year radiographic local control and overall survival for all patients were both 76%. Of the tumors that progressed after stereotactic body radiotherapy, 13 (81%) of 16 patients had tumors that were within 5 mm of the spinal cord, and 6 of them eventually developed spinal cord compression. Toxicity was most commonly grade 1 or 2 fatigue. Two patients experienced mild to moderate radiation injury (lumbar plexopathy) while remaining independently ambulatory and pain free. Freedom from neurologic deterioration from any cause was 92% at 1 year. Conclusions Reirradiation for progressive spinal metastases with stereotactic body radiotherapy results in good local control and limited toxicity. Initial surgery should be considered for tumors within 5 mm of the spinal cord. Radiation dose should be tailored for tumors near or invading the psoas muscle secondary to observed risk of lumbar plexopathy.read more
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Local disease control for spinal metastases following "separation surgery" and adjuvant hypofractionated or high-dose single-fraction stereotactic radiosurgery: outcome analysis in 186 patients.
Ilya Laufer,J. Bryan Iorgulescu,Talia Chapman,Eric Lis,Weiji Shi,Zhigang Zhang,Brett Cox,Yoshiya Yamada,Mark H. Bilsky,Mark H. Bilsky +9 more
TL;DR: Postoperative adjuvant SRS following epidural spinal cord decompression and instrumentation is a safe and effective strategy for establishing durable local tumor control regardless of tumor histology-specific radiosensitivity.
Journal ArticleDOI
Stereotactic body radiation therapy for management of spinal metastases in patients without spinal cord compression: a phase 1–2 trial
Xin Shelley Wang,Laurence D. Rhines,Almon S. Shiu,James N Yang,Ugur Selek,Ibrahima Gning,Ping Liu,Pamela K. Allen,Syed Azeem,Paul D. Brown,Hadley J. Sharp,David C. Weksberg,Charles S. Cleeland,Eric L. Chang +13 more
TL;DR: Significant reductions in patient-reported pain and other symptoms were evident 6 months after SBRT, along with satisfactory progression-free survival and no late spinal cord toxicities.
Journal ArticleDOI
Phase 1/2 Trial of Single-Session Stereotactic Body Radiotherapy for Previously Unirradiated Spinal Metastases
Amit Kumar Garg,Almon S. Shiu,James Chih-Hsin Yang,Xin Shelley Wang,Pamela K. Allen,Barry W. Brown,Patricia Grossman,Erik K. Frija,Mary Frances McAleer,Syed Azeem,Paul D. Brown,Laurence D. Rhines,Eric L. Chang +12 more
TL;DR: In this paper, the authors tested the hypothesis that single-fraction stereotactic body radiotherapy (SBRT) for previously unirradiated spinal metastases is a safe, feasible, and efficacious treatment approach.
Journal ArticleDOI
Vertebral compression fracture after stereotactic body radiotherapy for spinal metastases
TL;DR: The evidence and predictive factors for VCF induced by spinal SBRT are summarized, the pathophysiology of VCF in the metastatic spine is reviewed, and strategies used to prevent and manage this potentially disabling complication are discussed.
Journal ArticleDOI
Separation surgery for spinal metastases: effect of spinal radiosurgery on surgical treatment goals.
Nelson Moussazadeh,Nelson Moussazadeh,Ilya Laufer,Ilya Laufer,Yoshiya Yamada,Mark H. Bilsky,Mark H. Bilsky +6 more
TL;DR: The combination of separation surgery and high-dose hypofractionated or single-fraction SRS results in high local tumor control at 1 year and is an effective palliative paradigm for this patient population.
References
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Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution.
TL;DR: The results indicate the potential of radiosurgery in the treatment of patients with spinal metastases, especially those with solitary sites of spine involvement, to improve long-term palliation.
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Intramedullary ependymoma of the spinal cord
TL;DR: The data support the belief that long-term disease-free control of intramedullary spinal ependymomas with acceptable morbidity may be achieved utilizing microsurgical removal alone.
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Phase I/II study of stereotactic body radiotherapy for spinal metastasis and its pattern of failure
Eric L. Chang,Almon S. Shiu,Ehud Mendel,Leni A. Mathews,Anita Mahajan,Pamela K. Allen,Jeffrey S. Weinberg,Barry W. Brown,Xin Shelly Wang,Shiao Y. Woo,Charles S. Cleeland,Moshe H. Maor,Laurence D. Rhines +12 more
TL;DR: Analysis of the data obtained in the present study supports the safety and effectiveness of SBRT in cases of spinal metastatic cancer and considers it prudent to routinely treat the pedicles and posterior elements using a wide bone margin posterior to the diseased vertebrae because of the possible direct extension into these structures.
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Stereotactic Body Radiosurgery for Spinal Metastases: A Critical Review
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Radiotherapy and radiosurgery for metastatic spine disease: what are the options, indications, and outcomes?
TL;DR: 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.