Stereotactic Body Radiotherapy Reirradiation for Recurrent Epidural Spinal Metastases

Mahadevan, Anand; Floyd, Scott R.; Wong, Eric T.; Jeyapalan, Suriya; Groff, Michael W.; Kasper, Ekkehard M.

doi:10.1016/j.ijrobp.2010.08.012

Cited by 88 publications

(58 citation statements)

References 30 publications

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“…1,31,37,46,47,52,62,70,72,79,86,95 Risk stratification of patients preoperatively is important to optimize outcomes, 48,52,65,74,86,93,98 and prior studies have identified anatomical location, tumor size, tumor histology, extent of resection, surgical approaches, age, functional status, comorbidities, preoperative medication (steroid use, morphine), longer operative time, insurance status, early postoperative complications, and adjuvant chemotherapy and radiotherapy as factors associated with postoperative morbidity and mortality. 1,[18][19][20][21][22][23][24]39,41,42,44,48,51,52,56,58,66,69,78,92,99 Nevertheless, many of these previous publications were retrospective, institutional studies, 10,11,55,60,65,87,…”

mentioning

confidence: 99%

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

Karhade

Vasudeva

Dasenbrock

et al. 2016

FOC

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OBJECTIVE The goal of this study was to use a large national registry to evaluate the 30-day cumulative incidence and predictors of adverse events, readmissions, and reoperations after surgery for primary and secondary spinal tumors. METHODS Data from adult patients who underwent surgery for spinal tumors (2011–2014) were extracted from the prospective National Surgical Quality Improvement Program (NSQIP) registry. Multivariable logistic regression was used to evaluate predictors of reoperation, readmission, and major complications (death, neurological, cardiopulmonary, venous thromboembolism [VTE], surgical site infection [SSI], and sepsis). Variables screened included patient age, sex, tumor location, American Society of Anesthesiologists (ASA) physical classification, preoperative functional status, comorbidities, preoperative laboratory values, case urgency, and operative time. Additional variables that were evaluated when analyzing readmission included complications during the surgical hospitalization, hospital length of stay (LOS), and discharge disposition. RESULTS Among the 2207 patients evaluated, 51.4% had extradural tumors, 36.4% had intradural extramedullary tumors, and 12.3% had intramedullary tumors. By spinal level, 20.7% were cervical lesions, 47.4% were thoracic lesions, 29.1% were lumbar lesions, and 2.8% were sacral lesions. Readmission occurred in 10.2% of patients at a median of 18 days (interquartile range [IQR] 12–23 days); the most common reasons for readmission were SSIs (23.7%), systemic infections (17.8%), VTE (12.7%), and CNS complications (11.9%). Predictors of readmission were comorbidities (dyspnea, hypertension, and anemia), disseminated cancer, preoperative steroid use, and an extended hospitalization. Reoperation occurred in 5.3% of patients at a median of 13 days (IQR 8–20 days) postoperatively and was associated with preoperative steroid use and ASA Class 4–5 designation. Major complications occurred in 14.4% of patients: the most common complications and their median time to occurrence were VTE (4.5%) at 9 days (IQR 4–19 days) postoperatively, SSIs (3.6%) at 18 days (IQR 14–25 days), and sepsis (2.9%) at 13 days (IQR 7–21 days). Predictors of major complications included dependent functional status, emergency case status, male sex, comorbidities (dyspnea, bleeding disorders, preoperative systemic inflammatory response syndrome, preoperative leukocytosis), and ASA Class 3–5 designation (p < 0.05). The median hospital LOS was 5 days (IQR 3–9 days), the 30-day mortality rate was 3.3%, and the median time to death was 20 days (IQR 12.5–26 days). CONCLUSIONS In this NSQIP analysis, 10.2% of patients undergoing surgery for spinal tumors were readmitted within 30 days, 5.3% underwent a reoperation, and 14.4% experienced a major complication. The most common complications were SSIs, systemic infections, and VTE, which often occurred late (after discharge from the surgical hospitalization). Patients were primarily readmitted for new complications that developed following discharge rather than exacerbation of complications from the surgical hospital stay. The strongest predictors of adverse events were comorbidities, preoperative steroid use, and higher ASA classification. These models can be used by surgeons to risk-stratify patients preoperatively and identify those who may benefit from increased surveillance following hospital discharge.

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confidence: 99%

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

Karhade

Vasudeva

Dasenbrock

et al. 2016

FOC

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“…[25] Daha önce EBRT alsın ya da almasın bu hastalar için SBRT bir seçenek olarak gö-rülmektedir. [20] Dört SBRT tedavisi uygulanan vaka serimizde iki hastada kıs-mi cevap bir hasta da tam cevap elde edildi. Lokal nüks saptanan bir hastada tedavi sonrası birinci yılda tam cevap elde edildi ve nüks ancak dördüncü yılda gözlendi.…”

Section: Discussionunclassified

“…[18][19][20] Abusaris ve ark. yakın bir zamanda abdominal ve pelvik nüksleri ikinci seri RT ile tedavi ettiği olgu çalışmasını yayınla-mıştır.…”

Section: Discussionunclassified

“…[48,49] Stereotaktik beden radyoterapisi 3-5 fraksiyon kullanılmaktadır. [20] Olgularımızda doz sınırlayıcı yapılar nedeniyle 3-5 fraksiyon kullandığımız SBRT etkili ve takrarlanabilir bir yaklaşımdır. Sonuçlarımız diğer SBRT çalışmalarının sonuçlarıyla benzerdir.…”

Section: Discussionunclassified

“…[17] Stereotaktik beden radyoterapisi (SBRT) konformalitesi ve normal yapıların ışınlanmasından kaçınabilmesi nedeniyle primer tedavi ve tekrar radyoterapisi şeklinde başarılı bir şekilde kullanılmaktadır. [18][19][20] Bu nedenle pelvik nükslerde SBRT'nin uygulanması düşünülmüştür. Bu ça-lışmada kolorektal kanserli hastalarımızda pelvik nükslerin tedavisinde SBRT tecrübemizi aktardık.…”

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Is stereotactic body radiotherapy a treatment option for pelvic recurrences?

Dağoğlu¹

2015

TJ Oncol

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KliNiK ÇalIŞma ORIGINAL ARTICLE oBJeCtIVeSWhen surgery is not adequate, stereotactic body radiotherapy (SBRT) has been used for recurrent cancers. We report the outcomes of case series with pelvic recurrences from colorectal cancer irradiated with SBRT. metHoDSRobotic Stereotactic Radiotherapy system was used. The dose fractionation scheme was individualized based on tumor volume and location and prior radiation dose. reSultSBetween February 2010 and December 2014, four patients were treated. Treatment regions were pelvic side wall for two patients and presacral for two patients. SBRT doses were 24 Gy in 3 fractions for three patients and 36.25 Gy in 5 fractions for one patient.One patient treated for pelvic side wall recurrence developed symptomatic noropathy at fist year. CoNCluSIoNLocal recurrence in pelvis after modern combined modality treatment for colorectal cancer is rare. However it presents a therapeutic dilemma when it occurs; often symptomatic and eventually life threatening. SBRT can be a useful modality in this setting.

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Use of Technologically Advanced Radiation Oncology Techniques for Palliative Patients

Teh

Chao

et al. 2013

Radiation Oncology in Palliative Cancer Care

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Stereotactic Body Radiotherapy Reirradiation for Recurrent Epidural Spinal Metastases

Cited by 88 publications

References 30 publications

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

Is stereotactic body radiotherapy a treatment option for pelvic recurrences?

Use of Technologically Advanced Radiation Oncology Techniques for Palliative Patients

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