CyberKnife stereotactic radiosurgical treatment of spinal tumors for pain control and quality of life

Degen, Jeffrey W.; Gagnon, Gregory; Voyadzis, Jean Marc; McRae, D.; Lunsden, Michael; Dieterich, Sonja; Molzahn, Inge; Henderson, Fraser

doi:10.3171/spi.2005.2.5.0540

Cited by 189 publications

(101 citation statements)

References 46 publications

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“…For patients with localized bone pain that has not responded to systemic therapy and analgesics, external beam irradiation (30 Gy in ten fractions) is the treatment of choice and usually provides good pain relief [29,31,32,40]. Spinal [9,17]. In addition, percutaneous vertebroplasty and kyphoplasty have been shown to be safe and effective techniques for treating intractable pain secondary to pathological vertebral fractures of metastatic spine disease [14].…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment strategies and outcome in patients with breast cancer metastatic to the spine: a review of 87 patients

et al. 2007

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Aggressive surgical management of spinal metastatic disease can provide improvement of neurological function and significant pain relief. However, there is limited literature analyzing such management as is pertains to individual histopathology of the primary tumor, which may be linked to overall prognosis for the patient. In this study, clinical outcomes were reviewed for patients undergoing spinal surgery for metastatic breast cancer. Respective review was done to identify all patients with breast cancer over an eight-year period at a major cancer center and then to select those with symptomatic spinal metastatic disease who underwent spinal surgery. Pre-and postoperative pain levels (visual analog scale [VAS]), analgesic medication usage, and modifed Frankel grade scores were compared on all patients who underwent surgery. Univariate and multivariate analyses were used to assess risks for complications. A total of 16,977 patients were diagnosed with breast cancer, and 479 patients (2.8%) were diagnosed with spinal metastases from breast cancer. Of these patients, 87 patients (18%) underwent 125 spinal surgeries. Of the 76 patients (87%) who were ambulatory preoperatively, the majority (98%) were still ambulatory.Of the 11 patients (13%) who were nonambulatory preoperatively, four patients were alive at 3 months postoperatively, three of which (75%) regained ambulation. The preoperative median VAS of six was significantly reduced to a median score of two at the time of discharge and at 3, 6, and 12 months postoperatively (P < 0.001 for all time points). A total of 39% of patients experienced complications; 87% were early (within 30 days of surgery), and 13% were late. Early major surgical complications were significantly greater when five or more levels were instrumented. In patients with spinal metastases specifically from breast cancer, aggressive surgical management provides significant pain relief and preservation or improvement of neurological function with an acceptably low rate of complications.

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Section: Discussionmentioning

confidence: 99%

Surgical treatment strategies and outcome in patients with breast cancer metastatic to the spine: a review of 87 patients

et al. 2007

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“…Spinal stereotactic radiosurgery (SRS) is a relatively new radiation treatment option for spinal metastases that not undergone rigorous, long-term investigation, but may have advantages over conventional XRT for the treatment of metastatic spine disease. Interestingly, a number of studies involving SRS for metastatic spine disease have provided encouraging results in relation to pain control and improvement in neurological function [11,17]. In addition, percutaneous vertebroplasty and kyphoplasty have been shown to be safe and effective techniques for treating intractable pain secondary to pathological vertebral fractures of metastatic spine disease [15].…”

Section: Discussionmentioning

confidence: 99%

Positive and negative prognostic variables for patients undergoing spine surgery for metastatic breast disease

et al. 2007

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The histology of the primary tumor in metastatic spine disease plays an important role in its treatment and prognosis. However, there is paucity in the literature of histology-specific analysis of spinal metastases. In this study, prognostic variables were reviewed for patients who underwent surgery for breast metastases to the spinal column. Respective chart review was done to first identify all patients with breast cancer over an 8-year period at a major cancer center and then to select all those with symptomatic metastatic disease to the spine who underwent spinal surgery. Univariate and multivariate analyses were used to assess several prognostic variables. Presence of visceral metastases, multiplicity of bony lesions, presence of estrogen receptors (ER), and segment of spine (cervical, thoracic, lumbar, sacral) in which metastases arose were compared with patient survival. Eighty-seven patients underwent 125 spinal surgeries. Those with estrogen receptor (ER) positivity had a longer median survival after surgery compared to those with estrogen receptor negativity. Patients with cervical location of metastasis had a shorter median survival compared with those having metastases in other areas of the spine. The presence of visceral metastases or a multiplicity of bony lesions did not have prognostic value. In patients with spinal metastases from breast cancer, aggressive surgical management may be an option for providing significant pain relief and preservation/improvement of neurological function. Interestingly, in patients undergoing such surgery, cervical location of metastasis is a negative prognostic variable, and ER-positivity is associated with better survival, while presence of visceral or multiple bony lesions does not significantly alter survival.

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“…Clinical experience with single high dose SRS for spinal metastases demonstrated both safety and efficacy (6)(7)(8)(9)(10). Median time to pain relief was within 2 weeks, and there was durable pain contorl in 80-90%.…”

Section: Introductionmentioning

confidence: 97%

RTOG 0631 Phase II/III Study of Image-guided Stereotactic Radiosurgery for Localized Spine Metastases: Phase II Results

Sungpil

James

Gerszten

et al. 2011

International Journal of Radiation Oncology*Biology*Physics

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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 Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. (1-sided), 41 patients were required. Acute toxicity was assessed using the National Cancer Institute Common Toxicity Criteria for Adverse Events, version 3.0. NIH Public AccessResults-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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CyberKnife stereotactic radiosurgical treatment of spinal tumors for pain control and quality of life

Cited by 189 publications

References 46 publications

Surgical treatment strategies and outcome in patients with breast cancer metastatic to the spine: a review of 87 patients

Surgical treatment strategies and outcome in patients with breast cancer metastatic to the spine: a review of 87 patients

Positive and negative prognostic variables for patients undergoing spine surgery for metastatic breast disease

RTOG 0631 Phase II/III Study of Image-guided Stereotactic Radiosurgery for Localized Spine Metastases: Phase II Results

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