Short-course radiotherapy (8 Gy × 2) in metastatic spinal cord compression: An effective and feasible treatment

Maranzano, Ernesto; Latini, P; Perrucci, Elisabetta; Beneventi, S.; Lupattelli, Marco; Corgna, E.

doi:10.1016/s0360-3016(97)00128-4

Cited by 92 publications

(44 citation statements)

References 36 publications

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“…Radiosensitive solid tumor histologies include breast, prostate, ovarian, and neuroendocrine carcinomas. Renal, thyroid, hepatocellular, colon, and non-small cell lung carcinomas, sarcoma, and melanoma represent radioresistant tumors [7][8][9][10][11][12][13][14][15]. Solid tumors with radioresistant histologies generally require SRS to achieve durable local control, whereas radiosensitive solid tumors may be treated with cEBRT or SRS.…”

Section: Oncologic Assessmentmentioning

confidence: 99%

The NOMS Framework: Approach to the Treatment of Spinal Metastatic Tumors

et al. 2013

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Background. Spinal metastases frequently arise in patients with cancer. Modern oncology provides numerous treatment options that include effective systemic, radiation, and surgical options. We delineate and provide the evidence for the neurologic, oncologic, mechanical, and systemic (NOMS) decision framework, which is used at Memorial Sloan-Kettering Cancer Center to determine the optimal therapy for patients with spine metastases. Methods. We provide a literature review of the integral publications that serve as the basis for the NOMS framework and report the results of systematic implementation of the NOMSguided treatment. Results. The NOMS decision framework consists of the neurologic, oncologic, mechanical, and systemic considerations and incorporates the use of conventional external beam radiation, spinal stereotactic radiosurgery, and minimally invasive and open surgical interventions. Review of radiation oncology and surgical literature that examine the outcomes of treatment of spinal metastatic tumors provides support for the NOMS decision framework. Application of the NOMS paradigm integrates multimodality therapy to optimize local tumor control, pain relief, and restoration or preservation of neurologic function and minimizes morbidity in this often systemically ill patient population. Conclusion. NOMS paradigm provides a decision framework that incorporates sentinel decision points in the treatment of spinal metastases. Consideration of the tumor sensitivity to radiation in conjunction with the extent of epidural extension allows determination of the optimal radiation treatment and the need for surgical decompression. Mechanical stability of the spine and the systemic disease considerations further help determine the need and the feasibility of surgical intervention. The Oncologist 2013;18:744 -751 Implications for Practice: Treatment of spinal metastatic tumors requires a multidisciplinary approach which integrates radiation and medical oncology, surgery, and interventional radiology. The NOMS framework described in this manuscript incorporates the neurologic, oncologic, mechanical, and systemic considerations to facilitate decision making in the care of patients with spinal metastases. Furthermore, this framework allows dynamic integration of novel systemic and radiation options which is crucial in these rapidly evolving disciplines. The article summarizes the supporting literature for this framework and provides the results of implementation of the NOMS paradigm in the care of cancer patients. INTRODUCTIONSpinal metastases occur in 20% of all patients with cancer [1, 2], with 5%-10% of patients with cancer developing spinal cord compression [3,4]. The treatment of spinal metastases is palliative, with the goals of providing pain relief, maintenance or recovery of neurologic function, local durable tumor control, spinal stability, and improved quality of life. Over the past decade, treatment has evolved from simple decisions regarding the need for either surgery or conventional external beam...

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Section: Oncologic Assessmentmentioning

confidence: 99%

The NOMS Framework: Approach to the Treatment of Spinal Metastatic Tumors

et al. 2013

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“…In general, radiation is well toler- ated by patients, and the conventional regimen of 30 Gy in 10 fractions is commonly used even in cases of terminal disease. 25,33,34 The notion that conventional radiotherapy confers a palliative benefit comes from studies that compared this modality with lumbar and thoracic laminectomy and used the maintenance and recovery of ambulation as an outcome measure. 4,19,20,23,24,42 It is well known that some histologies are more sensitive to conventional radiation (breast, prostate, hematological) than others (lung, renal cell carcinoma).…”

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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“…In this regard, Maranzano et al 24 showed a pretreatment ambulation rate of 47% in mscc patients with poor prognosis (low radioresponsive primary tumour, paraplegic or paraparetic, poor performance status, poor life expectancy) and a post-radiotherapy (16 Gy in 2 fractions) total motor function response rate of 63%. In mscc patients with good prognosis (without neurologic deficit at diagnosis), a 30-Gy regimen resulted in an adequate motor function response for all patients 23 .…”

Section: Radiotherapymentioning

confidence: 98%

Treatment of Metastatic Spinal Cord Compression: cepo Review and Clinical Recommendations

L’Espérance¹,

Vincent²,

Gaudreault

et al. 2012

Current Oncology

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the Comité de l'évolution des pratiques en oncologie• long-course radiotherapy be administered to patients with inoperable spinal cord compression and good life expectancy.• decompressive surgery followed by long-course radiotherapy be offered to appropriate symptomatic mscc patients (including spinal instability, displacement of vertebral fragment); and • patients considered for surgery have a life expectancy of at least 3-6 months.

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Short-course radiotherapy (8 Gy × 2) in metastatic spinal cord compression: An effective and feasible treatment

Cited by 92 publications

References 36 publications

The NOMS Framework: Approach to the Treatment of Spinal Metastatic Tumors

The NOMS Framework: Approach to the Treatment of Spinal Metastatic Tumors

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

Treatment of Metastatic Spinal Cord Compression: cepo Review and Clinical Recommendations

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