The ESCC scale provides a valid and reliable instrument that may be used to describe the degree of ESCC based on T2-weighted MR images. This scale accounts for recent advances in the treatment of spinal metastases and may be used to provide an ESCC classification scheme for multicenter clinical trial and outcome studies.

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Seizures are the second most common presenting symptom of arteriovenous malformations (AVMs) in children. Although radiosurgery has been found to be a safe and effective alternateve treatment, the outcome of seizure control in children after radiosurgery for AVMs is unknown. Between 1987 and 1994, 72 children under the age of 18 years were treated with gamma knife radiosurgery for AVMs at our institution. Fifteen patients (21 %) had seizures as part of their clinical course. There were 11 boys and 4 girls with ages varying from 2 to 17 years (median 16 years). Seizures included: generalized tonic-clonic (n = 8); focal motor or sensory (n = 4); partial complex (n = 2), and a combination of generalized and partial complex (n = 1). Nine lesions were in cortical locations; six were subcortical. Spetzler-Martin grades included: II (n = 7); III (n = 4); IV (n = 2), and VI (n = 2). During follow-up after radiosurgical treatment, 11 of 13 patients (85%) were seizure free and off anticonvulsant therapy (mean follow-up 47 months). Two patients had a significant improvement in their seizures but continue on medication. Two of the 72 patients (3%) developed seizures after treatment and remain on medication. Seizure outcome was not associated with the location or complete obliteration of the lesion. We conclude that stereotactic radiosurgery, as a non-invasive alternative, is associated with a good outcome for the AVM as well as AVM-related seizures in children.

SINS demonstrated near-perfect inter- and intraobserver reliability in determining three clinically relevant categories of stability. The sensitivity and specificity of SINS for potentially unstable or unstable lesions were 95.7% and 79.5%, respectively.

The Spine Instability Neoplastic Score is a comprehensive classification system with content validity that can guide clinicians in identifying when patients with neoplastic disease of the spine may benefit from surgical consultation. It can also aid surgeons in assessing the key components of spinal instability due to neoplasia and may become a prognostic tool for surgical decision-making when put in context with other key elements such as neurologic symptoms, extent of disease, prognosis, patient health factors, oncologic subtype, and radiosensitivity of the tumor.

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Purpose The phase II component of RTOG 0631 assessed the feasibility and safety of spine radiosurgery (SRS) for localized spine metastases in a cooperative group setting. Materials and Methods Patients with 1-3 spine metastasis with a Numerical Rating Pain Scale (NRPS) score ≥ 5 received 16 Gy single fraction SRS. The primary endpoint was SRS feasibility: image-guidance RT (IGRT) targeting accuracy ≤ 2mm, target volume coverage > 90% of prescription dose, maintaining spinal cord dose constraints (10 Gy to ≤ 10% of the cord volume from 5-6mm above to 5-6mm below the target or absolute spinal cord volume < 0.35cc) and other normal tissue dose constraints. A feasibility success rate < 70% was considered unacceptable for continuation of the phase III component. Based on the one-sample exact binomial test with α=0.10 (1-sided), 41 patients were required. Acute toxicity was assessed using the National Cancer Institute Common Toxicity Criteria for Adverse Events, version 3.0. Results Sixty-five institutions were credentialed with spine phantom dosimetry and IGRT compliance. Forty-six patients were accrued, and 44 were eligible. There were 4 cervical, 21 thoracic and 19 lumbar sites. Median NRPS was 7 at presentation. Final pre-treatment rapid review was approved in 100%. Accuracy of image-guided SRS targeting was in compliance with the protocol in 95%. The target coverage and spinal cord dose constraint were in accordance with the protocol requirements in 100% and 97%. Overall compliance for other normal tissue constraints was per protocol in 74%. There were no cases of grade 4-5 acute treatment-related toxicity. Conclusion The phase II results demonstrate the feasibility and accurate use of SRS to treat spinal metastases, with rigorous quality control, in a cooperative group setting. The planned RTOG 0631 phase III component will proceed to compare pain relief and quality of life between SRS and external beam radiotherapy.

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