Diagnosis and Management of Metastatic Cervical Spine Tumors

Molina, Camilo A.; Gokaslan, Ziya L.; Sciubba, Daniel M.

doi:10.1016/j.ocl.2011.08.004

Cited by 45 publications

(50 citation statements)

References 71 publications

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“…In cases with a high degree of spinal cord compression, the most common surgical approach for the thoracic and lumbar spine involves a laminectomy with pedicle screw stabilization; 3,13,42 for the cervical spine, an anterior approach with vertebral column reconstruction. 27,31 In either case, surgical intervention delays systemic treatment (usually for 3-4 weeks) while patients recover functional status, wounds heal, and postoperative radiation is delivered.…”

Section: Discussionmentioning

confidence: 99%

“…Overall, the fractionation regimen is prescribed based on prior irradiation history, tumor radiosensitivity, tumor volume, and number of vertebral bodies involved. All patients received either a single fraction (24 Gy) or hypofractionation (24)(25)(26)(27) Gy in 3 doses), and most patients were treated within 3 days of the ablation. The treatment plan was calculated to limit the spinal cord dose to 12 Gy and to maximally cover the gross target volume, as if no ablation had been performed.…”

Section: Delivery Of Spinal Stereotactic Radiationmentioning

confidence: 99%

“…Once the patient recovers from surgery, SSRS is contoured to cover the surgical field, and all residual tumor receives adequate tumoricidal doses of radiation since the epidural disease likely to be underdosed has been surgically removed. 4,5,22,28 Laufer et al documented a 1-year cumulative incidence of local recurrence of only 4.1% when separation surgery was used in combination with hypofractionated SSRS (24)(25)(26)(27)(28)(29)(30) Gy divided into 3 fractions) and 9% when surgery was followed by highdose single-fraction SSRS (24 Gy). 21 Percutaneous procedures for tumor ablation are widely used with the intent of local tumor control, as in the treatment of visceral 2,41 and bone metastasis.…”

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confidence: 99%

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Utilization of laser interstitial thermotherapy guided by real-time thermal MRI as an alternative to separation surgery in the management of spinal metastasis

Tatsui¹,

Stafford

et al. 2015

SPI

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OBJECT High-grade malignant spinal cord compression is commonly managed with a combination of surgery aimed at removing the epidural tumor, followed by spinal stereotactic radiosurgery (SSRS) aimed at local tumor control. The authors here introduce the use of spinal laser interstitial thermotherapy (SLITT) as an alternative to surgery prior to SSRS. METHODS Patients with a high degree of epidural malignant compression due to radioresistant tumors were selected for study. Visual analog scale (VAS) scores for pain and quality of life were obtained before and within 30 and 60 days after treatment. A laser probe was percutaneously placed in the epidural space. Real-time thermal MRI was used to monitor tissue damage in the region of interest. All patients received postoperative SSRS. The maximum thickness of the epidural tumor was measured, and the degree of epidural spinal cord compression (ESCC) was scored in pre- and postprocedure MRI. RESULTS In the 11 patients eligible for study, the mean VAS score for pain decreased from 6.18 in the preoperative period to 4.27 within 30 days and 2.8 within 60 days after the procedure. A similar VAS interrogating the percentage of quality of life demonstrated improvement from 60% preoperatively to 70% within both 30 and 60 days after treatment. Imaging follow-up 2 months after the procedure demonstrated a significant reduction in the mean thickness of the epidural tumor from 8.82 mm (95% CI 7.38–10.25) before treatment to 6.36 mm (95% CI 4.65–8.07) after SLITT and SSRS (p = 0.0001). The median preoperative ESCC Grade 2 was scored as 4, which was significantly higher than the score of 2 for Grade 1b (p = 0.04) on imaging follow-up 2 months after the procedure. CONCLUTIONS The authors present the first report on an innovative minimally invasive alternative to surgery in the management of spinal metastasis. In their early experience, SLITT has provided local control with low morbidity and improvement in both pain and the quality of life of patients.

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Section: Discussionmentioning

confidence: 99%

Section: Delivery Of Spinal Stereotactic Radiationmentioning

confidence: 99%

mentioning

confidence: 99%

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Utilization of laser interstitial thermotherapy guided by real-time thermal MRI as an alternative to separation surgery in the management of spinal metastasis

Tatsui¹,

Stafford

et al. 2015

SPI

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“…Common degenerative disorders less commonly affect the thoracic spine than the cervical or lumbar spine, hence pain in the thoracic spine warrants a high clinical suspicion for metastatic disease [11] . Likewise, patients with persistent nonmechanical pain should have a low threshold for evaluation of a neoplastic etiology [21] . Eliciting the type of spinal pain is important as one may receive clues to the etiology, location, and severity of the tumor infiltration.…”

Section: Clinical Manifestationsmentioning

confidence: 99%

“…The approach can be anterior, posterior, lateral or a combination of the above depending on the tumor location. Lesions may also involve multiple levels and require multiple-level decompression and excisions if the osteolytic lesions are extensive [21] . Because the vertebral body is most commonly involved in metastatic disease, an anterior approach often represents the most direct route to the tumor [22] .…”

Section: Surgical Techniquesmentioning

confidence: 99%

Diagnosis and surgical management of breast cancer metastatic to the spine

Yurter

Gokaslan

et al. 2014

WJCO

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Breast cancer is the most common malignancy and the second leading cause of death in Western women. Breast cancer most commonly metastasizes to the bone and has a particular affinity with the spine, accounting for 2/3 of osseous metastases discovered. With significant improvements in cancer therapies, the number of patients at risk for symptomatic spinal metastases is likely to increase. Patients may suffer from intractable pain and neurological dysfunction, negatively influencing their quality of life. Timely diagnosis of patients is crucial and has been aided by several breakthrough advances in imaging techniques which aid in detection, staging, and follow-up of bone metastases. Breast metastases are usually responsive to hormonal therapy and pharmacologic interventions, but skeletal metastases often require surgical intervention. The treatments are palliative but goals include the preserving or restoring neurologic function, ensuring spinal stability, and relieving pain. Advances in surgical techniques and instrumentation have allowed more effective decompression and stabilization of the spine, and with the support of recent evidence the trend has shifted towards using more advanced surgical options in appropriately selected patients. In this review, the clinical presentation, diagnosis, patient selection, and surgical management of breast cancer metastatic to the spine are discussed. Key words: Breast cancer; Spine; Metastasis; Surgery; Outcomes; Decompression Core tip: Breast cancer most commonly metastasizes to the bone and has a particular affinity for the spine. The treatment for symptomatic spinal metastases remains palliative and is not intended to prolong survival. Surgical advances in the last few decades have allowed improved spinal cord decompression and tumor resection. With the support of recent literature, the trend has shifted towards using more advanced surgical options in appropriately selected patients. Goals of treatment include restoration of and preservation of neurological function, maintaining spinal stability, and pain relief in an effort to achieve a better quality of life.Ju DG, Yurter A, Gokaslan ZL, Sciubba DM. Diagnosis and surgical management of breast cancer metastatic to the spine. World

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