Multimodality therapy improves survival in intramedullary spinal cord metastasis of lung primary

Saeed, Hayder; Patel, Reema; Thakkar, Jigisha P.; Hamoodi, Lames; Chen, Li; Villanó, John L.

doi:10.1016/j.hemonc.2017.07.003

Cited by 12 publications

(9 citation statements)

References 51 publications

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“…[5,8,12] Although chemotherapy is uniformly utilized, surgery is performed in 31% of cases along with adjuvant radiotherapy. [3,9,11,12,13,15] In our patient, as the systemic evaluation revealed a primary RCC, it was most likely that the intramedullary C1-C2 lesion was a metastasis.…”

Section: Discussionmentioning

confidence: 71%

Intramedullary craniovertebral junction metastasis leading to the diagnosis of underlying renal cell carcinoma

Ponzo

Umana

Giuffrida

et al. 2020

Surgical Neurology International

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Background: Intramedullary spinal cord metastases represent 4–8.5% of the central nervous system metastases and affect only 0.1–0.4% of all patients. Those originating from renal cell carcinoma (RCC) are extremely rare. Of the eight patients described in the literature with metastatic RCC and intramedullary cord lesion, only five were found in the cervical spine. Here, the authors add a 6th case involving an RCC intramedullary metastasis at the C1–C2 level. Case Description: A 78-year-old male patient presented with intermittent cervicalgia of 5 months duration accompanied by few weeks of a progressive severe right hemiparesis, up to hemiplegia. The magnetic resonance imaging (MRI) examination revealed an intramedullary expansive lesion measuring 10 mm×15 mm at the C1–C2 level; it readily enhanced with contrast. A total body computed tomography (CT) scan documented an 85 mm mass involving the right kidney, extending to the ipsilateral adrenal gland, and posteriorly infiltrating the ipsilateral psoas muscle. The subsequent CT-guided fine-needle biopsy confirmed the diagnosis of an RCC (Stage IV). The patient next underwent total surgical total removal of the C1–C2 intramedullary mass, following which he exhibited a slight motor improvement, with the right hemiparesis (2/5). He died after 14 months due to global RCC tumor progression. Conclusion: The present case highlights that a patient without a prior known diagnosis of RCC may present with an intramedullary C1–C2 metastasis. In such cases, global staging is critical to determine whether primary lesion resection versus excision of metastases (e.g., in this case, the C1–C2 intramedullary tumor) are warranted.

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Section: Discussionmentioning

confidence: 71%

Intramedullary craniovertebral junction metastasis leading to the diagnosis of underlying renal cell carcinoma

Ponzo

Umana

Giuffrida

et al. 2020

Surgical Neurology International

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“…Moreover, immunotherapy may play a role in the treatment in the future [31]. While all these modalities on their own may play an essential role in the management of these lesions, a recent review showed favorable survival in patients receiving a multimodal treatment [17]. However, these results were only shown in patients with metastatic lung cancer, which limits the significance for intramedullary metastases of other tumors.…”

Section: Discussionmentioning

confidence: 99%

“…Given the scarcity of intramedullary metastases, highlevel evidence and guidelines on their management are lacking. Current treatment options include microsurgical resection, chemotherapy, fractionated radiotherapy and stereotactic radiosurgery (SRS) as well as a combination of them [2,[15][16][17]. In recent years, several studies have been published on the efficacy of surgery and radiotherapy for local control and their effect on neurological deficits [5,[18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Image-Guided Robotic Radiosurgery for the Management of Intramedullary Spinal Cord Metastases—A Multicenter Experience

Ehret

Senger

Kufeld³

et al. 2021

Cancers

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Background: Intramedullary metastases are rare and bear a dismal prognosis. Limited data are available on the treatment of such lesions. As surgery may be the mainstay of treatment for patients with resectable and localized metastatic spread, previous case reports and case series suggest radiosurgery to be another viable treatment modality. This multicenter study analyzes the efficacy and safety of robotic radiosurgery (RRS) for intramedullary metastases. Methods: Patients who received RRS for the treatment of at least one intramedullary metastasis were included. Results: Thirty-three patients with 46 intramedullary metastases were treated with a median dose of 16 Gy prescribed to a median isodose of 70%. The local control was 79% after a median follow-up of 8.5 months. The median overall survival (OS) was 11.7 months, with a 12- and 24-month OS of 47 and 31%. The 12-month progression-free survival was 42% and at 24 months 25%. In addition, 57% of patients showed either an improved or stable neurological function after treatment delivery. Systemic disease progression was the main cause of death. No significant treatment-related toxicities were observed. Conclusions: RRS appears to be a safe, time-saving and effective treatment modality for intramedullary metastases, especially for patients with unresectable lesions and high burden of disease.

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“…Typically, oligometastatic patients in whom the primary pathology is controlled [ 19 , 20 ], and with significant or complete neurological deficits are managed surgically [ 1 , 21 ]. In our review, the tumor volume of treated IMMs averaged 0.9 cc [ 13 , 15 – 17 ].…”

Section: Discussionmentioning

confidence: 99%

Stereotactic body radiotherapy for intramedullary metastases: a retrospective series at the Oscar Lambret center and a systematic review

et al. 2021

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Background Intramedullary metastasis (IMM) is a rare disease with poor prognosis. The incidence of IMMs has increased, which has been linked to improved systemic treatment in many cancers. Surgery and/or radiotherapy are the most commonly used treatments; only small-sample retrospective studies and case reports on stereotactic body radiotherapy (SBRT) have reported acceptable results in terms of local control and clinical improvement, with no reported toxicity. Thus, we performed this monocentric retrospective study on five cases treated with SBRT for IMMs, which we supplemented with a systematic review of the literature. Methods We included all patients treated for IMM with SBRT. The target tumor volume, progression-free survival, prescription patterns in SBRT, survival without neurological deficit, neurological functional improvement after treatment, and overall survival were determined. Results: Five patients treated with a median dose of 30 Gy in a median number of fractions of 5 (prescribed at a median isodose of 86%) included. The median follow-up duration was 23 months. Two patients showed clinical improvement. Three patients remained stable. Radiologically, 25% of patients had complete response and 50% had stable disease. No significant treatment-related toxicity was observed. Conclusion: SBRT appears to be a safe, effective, and rapid treatment option for palliative patients.

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Multimodality therapy improves survival in intramedullary spinal cord metastasis of lung primary

Abstract: Lung cancer is the predominant cause of intramedullary involvement of the spinal cord. Overall prognosis is poor, although a multimodality approach was associated with improved survival.

Cited by 12 publications

References 51 publications

Intramedullary craniovertebral junction metastasis leading to the diagnosis of underlying renal cell carcinoma

Intramedullary craniovertebral junction metastasis leading to the diagnosis of underlying renal cell carcinoma

Image-Guided Robotic Radiosurgery for the Management of Intramedullary Spinal Cord Metastases—A Multicenter Experience

Stereotactic body radiotherapy for intramedullary metastases: a retrospective series at the Oscar Lambret center and a systematic review

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