Image-Guided Robotic Radiosurgery for the Management of Spinal Ependymomas

Abstract

BackgroundEpendymomas are rare neoplasms of the central nervous system (CNS), usually localized intracranially and most commonly diagnosed in children. Spinal ependymomas are more frequent in young adults. They are either primary lesions or manifest as disseminated seeding of cranial tumors. Data on the management of spinal ependymoma lesions remain scarce, especially concerning stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT). The purpose of this study is to report the treatment outcomes of two institutions using robotic radiosurgery (RRS) for the treatment of spinal ependymomas.Materials and MethodsAll patients with a histopathologically confirmed diagnosis of an ependymoma WHO grade II or III who were treated with RRS for one or more spinal lesions were included in this analysis.ResultsTwelve patients underwent RRS for the treatment of 32 spinal ependymoma lesions between 2005 and 2020. Two patients were below the age of 18 when treated, whereas nine patients (75%) suffered from a primary spinal ependymoma. The median dose was 15 Gy prescribed to a median isodose of 70%, with 27 lesions (84%) receiving a single-session treatment. The local control (LC) after a median follow-up of 56.7 months was 84%. LC rates at 1, 3, and 5 years were 92, 85, and 77%, respectively. The Kaplan-Meier estimated overall survival after 1, 3, and 5 years were 75, 75, and 64%, respectively. Five patients died, all of them suffering from an anaplastic ependymoma, with widespread CNS tumor progression being the reason for death in four patients. The majority of patients (58%) showed a stable neurological status at the last available follow-up. Overall, the treatment was well tolerated.ConclusionRRS appears to be a safe and efficient treatment modality for managing primary and secondary spinal ependymal tumors in patients with multiple lesions and local recurrences.

Applications of Frameless Image-Guided Robotic Stereotactic Radiotherapy and Radiosurgery in Pediatric Neuro-Oncology: A Systematic Review

“…The first report, a case report of a recurrent vestibular schwannoma treated with RRS in a 13-year-old boy, was published in 2000 [ 13 ]. The latest study addressed the treatment of spinal ependymomas, included two pediatric cases, and was published in 2021 [ 14 ]. The studies reviewed herein reported on a broad variety of CNS entities, including arteriovenous malformations (AVM), neuroblastoma, ependymoma, vestibular schwannoma, chordoma, craniopharyngioma (CP), fibrosarcoma, hamartoma, pineal germinoma, pituitary adenoma, optic pathway or pilocytic glioma, Ewing sarcoma, atypical teratoid rhabdoid tumor (ATRT), and medulloblastoma.…”

Comparison between supine and prone patient setup for lumbosacral spinal stereotactic body radiosurgery with CyberKnife

“…Stereotactic radiation therapy (SRT) can increase tumor dose and reduce exposure to normal tissue, resulting in higher tumor control rates and lower normal tissue complications ( 1 – 3 ). As a special device for SRT, CyberKnife is increasingly applied in the treatment of spinal tumors in modern radiotherapy ( 4 – 6 ). To ensure the stability of the patient’s position during treatment, CyberKnife is used to treat tumors in the supine position.…”