CyberKnife Radiosurgery for Malignant Spinal Tumors

Wowra, Berndt; Zausinger, Stefan; Drexler, Christian; Kufeld, Markus; Muacevic, Alexander; Staehler, Michael; Tonn, Joerg‐Christian

doi:10.1097/brs.0b013e31818c680a

Cited by 47 publications

(26 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Local tumour control of 240 treated metastases 15 months after SRS was 98% (95% CI 89-99%). As previously reported, the statistical model failed to identify factors predictive of local tumour control [23]. Median overall survival was 15.2 months after SRS.…”

Section: Resultsmentioning

confidence: 78%

“…Little is known about the control of spinal and cerebral lesions by systemic treatment alone, as the evaluation criteria used in phase III study protocols either exclude patients with cerebral lesions or disregard osseous lesions when evaluating remission. We have previously shown that single-session spinal and cerebral SRS is feasible, safe and effective, with the major benefits being short treatment times in an outpatient setting and rapid recovery from symptoms [8,9,21,23]. In our experience SRS not only stabilizes lesions, but also prevents further local problems in patients undergoing systemic therapy.…”

Section: Discussionmentioning

confidence: 82%

“…The CyberKnife and the skeletal structure tracking software (X SIGHT , Accuray Inc.), were used for spinal radiosurgery in all patients. Previous studies have shown the feasibility and submillimetre accuracy of this fiducial-free, frameless method [15,20,21,23,24]. Planning and delivery of treatment were performed as outpatient procedures.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Simultaneous anti‐angiogenic therapy and single‐fraction radiosurgery in clinically relevant metastases from renal cell carcinoma

Staehler¹,

Haseke²,

Nuhn³

et al. 2010

BJU International

Self Cite

104

View full text Add to dashboard Cite

not alter the adverse effects of antiangiogenic therapy.• Local tumour control 15 months after SRS was 98% (95% confidence interval 89-99%). The median pain score before SRS was 5 (range 1-8) and was lowered to 0 (range 0-2, P < 0.01) after SRS. There were no treatment-related deaths or late complications after SRS.• Overall survival was 17.4 months in patients with spinal lesions and 11.1 month in patients with cerebral lesions ( P = 0.038). CONCLUSIONS• Simultaneous systemic anti-angiogenic therapy and SRS for selected patients with renal cell carcinoma who have spinal and cerebral metastases is safe and effective.• Single-fraction delivery allows for efficacious integration of focal radiation treatment into oncological treatment concepts without additional toxicity.• Further studies are needed to determine the limits of SRS for renal cell carcinoma metastases outside the brain and spine. KEYWORDSrenal cell cancer, cyberknife, sunitinib, sorafenib, stereotactic, robotic surgery, spinal tumours, cerebral metastasis What's known on the subject? and What does the study add? To date radiation therapy has had no oncological implication in renal cell carcinoma. Its use was limited to palliation in painful bone lesions. Radiation therapy was considered ineffective as renal cell cancer is resistant to the commonly used doses of radiotherapy. Side effects in combination with systemic therapy were not known, but heavy skin toxicities were expected. Only a few cases of combined radiation with systemic therapy were published. This is the only series where consecutive patients have been treated simultaneously with sunitnib and hypo-fractionated high-dose radiotherapy. Side effects were similar to those expected with systemic therapy or radiation therapy alone. Oncological results are extremely encouraging.Study Type -Therapy (case series) Level of Evidence 4 OBJECTIVE• To analyse the safety and efficacy of simultaneous standard anti-angiogenic therapy and stereotactic radiosurgery (SRS) in patients with spinal and cerebral metastases from renal cell carcinoma. PATIENTS AND METHODS• In all, 106 patients with spinal ( n = 55) or cerebral ( n = 51) metastatic lesions and an Eastern Cooperative Oncology Group status of 0 or 1 were treated with sorafenib or sunitinib and simultaneous SRS.• The primary endpoint was local control.• Secondary endpoints were toxicity and overall survival.

show abstract

Section: Resultsmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 82%

See 1 more Smart Citation

Simultaneous anti‐angiogenic therapy and single‐fraction radiosurgery in clinically relevant metastases from renal cell carcinoma

Staehler¹,

Haseke²,

Nuhn³

et al. 2010

BJU International

Self Cite

104

View full text Add to dashboard Cite

show abstract

“…Since the publication of that report, several other centers have evaluated the CyberKnife and other technologies for the treatment of spinal metastases with promising results. 5,[8][9][10][11][12]26,27 At the GUMC, Degen et al 5 have reported on the treatment of 51 patients with 72 spinal tumors. Lesions received a mean dose of 21.2 Gy over a mean of 3.6 fractions.…”

mentioning

confidence: 99%

Single-session and multisession CyberKnife radiosurgery for spine metastases—University of Pittsburgh and Georgetown University experience

Heron

Rajagopalan

Stone

et al. 2012

SPI

View full text Add to dashboard Cite

ObjectThe authors compared the effectiveness of single-session (SS) and multisession (MS) stereotactic radiosurgery (SRS) for the treatment of spinal metastases.MethodsThe authors conducted a retrospective review of the clinical outcomes of 348 lesions in 228 patients treated with the CyberKnife radiosurgery at the University of Pittsburgh Cancer Institute and Georgetown University Medical Center. One hundred ninety-five lesions were treated using an SS treatment regimen (mean 16.3 Gy), whereas 153 lesions were treated using an MS approach (mean 20.6 Gy in 3 fractions, 23.8 Gy in 4 fractions, and 24.5 Gy in 5 fractions). The primary end point was pain control. Secondary end points included neurological deficit improvement, toxicity, local tumor control, need for retreatment, and overall survival.ResultsPain control was significantly improved in the SS group (SSG) for all measured time points up to 1 year posttreatment (100% vs 88%, p = 0.003). Rates of toxicity and neurological deficit improvement were not statistically different. Local tumor control was significantly better in the MS group (MSG) up to 2 years posttreatment (96% vs 70%, p = 0.001). Similarly, the need for retreatment was significantly lower in the MSG (1% vs 13%, p < 0.001). One-year overall survival was significantly greater in the MSG than the SSG (63% vs 46%, p = 0.002).ConclusionsSingle-session and MS SRS regimens are both effective in the treatment of spinal metastases. While an SS approach provides greater early pain control and equivalent toxicity, an MS approach achieves greater tumor control and less need for retreatment in long-term survivors.

show abstract

“…No effort was made to specifically adjust dose homogeneity within the target because very different isodose levels (50% to 85%) are being used clinically 15 , 16 …”

Section: Methodsmentioning

confidence: 99%

CyberKnife robotic spinal radiosurgery in prone position: dosimetric advantage due to posterior radiation access?

Fürweger¹,

Drexler²,

Muacevic³

et al. 2014

J Applied Clin Med Phys

Self Cite

View full text Add to dashboard Cite

CyberKnife spinal radiosurgery suffers from a lack of posterior beams due to workspace limitations. This is remedied by a newly available tracking modality for fiducial‐free, respiration‐compensated spine tracking in prone patient position. We analyzed the potential dosimetric benefit in a planning study. Fourteen exemplary cases were compared in three scenarios: supine (PTV=CTV), prone (PTV=CTV), and prone position with an additional margin (PTV=CTV+2 mm), to incorporate reduced accuracy of respiration‐compensated tracking. Target and spinal cord constraints were chosen according to RTOG 0631 protocol for spinal metastases. Plan quality was scored based on four predefined parameters: dose to cord (D0.1cc and D1cc), high dose (V10Gy), and low dose (V4Gy) volume of healthy tissue. Prescription dose was 16 Gy to the highest isodose line encompassing 90% of the target. Results were related to target size and position. All plans fulfilled RTOG 0631 constraints for coverage and dose to cord. When no additional margin was applied, a majority of eight cases benefitted from prone position, mainly due to a reduction of V4Gy by 23% ± 26%. In the 2 mm prone scenario, the benefit was nullified by an average increase of V10Gy by 43% ± 24%, and an increase of D1cc to cord (four cases). Spinal cord D0.1cc was unchanged (<.15em±.15em1.15emGy) in all but two cases for both prone scenarios. Conformity (nCI) and number of beams were equivalent in all scenarios, but supine plans used a significantly higher number of monitor units (+16%) than prone. Posterior beam access can reduce dose to healthy tissue in CyberKnife spinal radiosurgery when no additional margin is applied. When a target margin of 2 mm is added, this potential gain is lost. Relative anterior‐posterior position and size of the target are selection criteria for prone treatment.PACS numbers: 87,53.Ly, 87.55.D‐

show abstract

CyberKnife Radiosurgery for Malignant Spinal Tumors

Cited by 47 publications

References 23 publications

Simultaneous anti‐angiogenic therapy and single‐fraction radiosurgery in clinically relevant metastases from renal cell carcinoma

Simultaneous anti‐angiogenic therapy and single‐fraction radiosurgery in clinically relevant metastases from renal cell carcinoma

Single-session and multisession CyberKnife radiosurgery for spine metastases—University of Pittsburgh and Georgetown University experience

CyberKnife robotic spinal radiosurgery in prone position: dosimetric advantage due to posterior radiation access?

Contact Info

Product

Resources

About