Surgical treatment of spinal cord compression in kidney cancer.

Sundaresan, Narayan; Scher, Howard I.; DiGiacinto, George V.; Yagoda, Alan; Whitmore, Willet F.; Choi, In Sup

doi:10.1200/jco.1986.4.12.1851

Cited by 83 publications

(42 citation statements)

References 26 publications

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“…The inferior margin of the cage is positioned ®rst, and the superior margin is impacted into place with gentle distraction of the interspace at 2 years while none of those treated with radiotherapy alone survived two years. 16,32 70% of surgical patients had signi®cant neurologic improvement compared to 45% of radiated patients. Other authors have reported survival rates of 30% or more at ®ve years following aggressive resection of solitary renal metastases.…”

Section: Discussionmentioning

confidence: 98%

Spinal cord decompression: an endoscopically assisted approach for metastatic tumors

2001

Spinal Cord

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Study design: The paper describes a technique for complete vertebrectomy and spinal cord decompression, followed by a formal anterior column reconstruction, using endoscopic instruments. This procedure is indicated for patients with radioresistant metastasis of the thoracic spine, particularly those involving the upper thoracic segments where a thoracotomy is di cult and carries a high morbidity, and for patients with pulmonary disease who cannot tolerate a standard thoracotomy. Results in nine consecutive cases are reported. Objectives: To demonstrate the feasibility and bene®ts of endoscopically assisted decompression and stabilization through a single, extrapleural, posterolateral approach. Setting: The Cleveland Clinic, Cleveland, Ohio, USA. Methods: Posterolateral decompression of the thoracic spinal cord o ers potential advantages over traditional combined procedures (anterior thoracotomy and posterior instrumentation), including reduced operative time, decreased morbidity, and reduced hospital stay. Previous studies have not demonstrated the same neurological bene®t for posterolateral decompression as for anterior vertebrectomy and decompression, however, Surgical indications, rationale and technique for an improved posterolateral approach, augmented by endoscopic methods, are provided, and initial clinical results are described. Results: Drawbacks to the traditional posterolateral decompressions have included poor visualization of the spinal cord and anterior tumor, poor access to tumor on the side contralateral to the approach, and the need to manipulate the spinal cord to completely remove both adjacent tumor and tumor adherent to the dura. Transpedicular decompression using endoscopy is described in nine patients. The mean operative time for the combined procedure was 6.0 h, with a mean blood loss of 1677 cc. Neurological recovery and maintenance were excellent. Inpatient days averaged 6.5, and ICU days averaged 1.4. Two patients died of disease eight and 14 months post-op, and seven were living, with disease, 3 ± 36 months after surgery. Conclusions: Endoscopically assisted decompression can reduce morbidity, hospitalization, and treatment costs while matching the e cacy of traditional combined procedures. Endoscopy provides a readily available and easily applied tool that dramatically improves the surgeon's vision, providing light, magni®cation, and a direct view of remote structures. Spinal Cord (2001) 39, 482 ± 487

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Section: Discussionmentioning

confidence: 98%

Spinal cord decompression: an endoscopically assisted approach for metastatic tumors

2001

Spinal Cord

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“…6,18 Further study has focused specifically on the role of spinal SRS in the treatment of RCC metastasis to the spine, the promise of more therapeutic radiation dosing holding particular promise in the treatment of what was traditionally considered a radioresistant histology. 5,17,20,22,23 RCC metastases often progress despite EBRT, sometimes necessitating surgical intervention. Surgical management of RCC metastases, however, is associated with higher complication rates than the management of lesions of other, less hemorrhagic histological types.…”

Section: Discussionmentioning

confidence: 99%

“…9,15 Pertinently, RCC is historically considered a radioresistant tumor, particularly in the setting of EBRT. 5,17,20,22,23 Even in the setting of spinal SRS, Gerszten et al noted lower overall radiographic tumor control of RCC lesions in comparison with other histologies. 11 Nevertheless, several series have demonstrated the clinical efficacy of spinal SRS in treating radioresistant RCC lesions and elucidated factors that may contribute to treatment failure.…”

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confidence: 99%

Factors affecting survival in 37 consecutive patients undergoing de novo stereotactic radiosurgery for contiguous sites of vertebral body metastasis from renal cell carcinoma

Sellin

Reichardt

Bishop

et al. 2015

SPI

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OBJECT Palliative resection of renal cell carcinoma (RCC) spinal metastasis is indicated in cases of neurological compromise or mechanical instability, whereas conventional external beam radiotherapy (EBRT) is commonly used for pain control. Recently, spinal stereotactic radiosurgery (SRS) has emerged as a safe alternative, delivering higher therapeutic doses of radiation to spinal metastases. To better understand factors affecting survival in patients undergoing spinal SRS for metastatic RCC, the authors performed a retrospective analysis of a consecutive series of cases at a tertiary cancer center. METHODS Patients harboring contiguous sites of vertebral body involvement from metastatic RCC who received upfront spinal SRS treatment at The University of Texas MD Anderson Cancer Center between 2005 and 2012 were identified. Demographic data, pain scores, radiographic data, overall survival, complications, status of systemic disease, neurological and functional status, and time between primary diagnosis and diagnosis of metastasis (systemic and spinal) were analyzed to determine their influence on survival. RESULTS Thirty-seven patients receiving treatment for 40 distinct, contiguous sites of disease were included. The median overall survival after spinal SRS was 16.3 months (range 7.4–25.3 months). Univariate analysis revealed several factors significantly associated with improved overall survival. Local progression after spinal SRS was associated with worse overall survival compared with sustained local control (HR 3.4, 95% CI 1.6–7.4, p = 0.002). Median survival in patients with a Karnofsky Performance Scale (KPS) score ≥ 70 was longer than in patients with a KPS score < 70 (HR 4.7, 95% CI 2.1–10.7, p < 0.001). Patients with neurological deficits at the time of spinal SRS had a shorter median survival than those without (HR 4.2, 95% CI 1.4–12.0, p = 0.008). Individuals with nonprogressive systemic disease at the time of spinal SRS had a longer median survival than those with systemic progression at the time of treatment (HR 8.3, 95% CI 3.3–20.7, p < 0.001). Median survival in patients experiencing any metastasis < 12 months after primary RCC diagnosis was shorter than in patients experiencing any metastasis > 12 months after primary diagnosis, a difference that approached but did not attain significance (HR 1.9, 95% CI 0.90–4.1, p = 0.09). On multivariate analysis, local progression of disease after spinal SRS, metastasis < 12 months after primary, KPS score ≤ 70, and progression of systemic disease at time of spinal SRS all remained significant factors influencing survival (respectively, HR 3.7, p = 0.002; HR 2.6, p = 0.026; HR 4.0, p = 0.002; and HR 13.2, p < 0.001). CONCLUSIONS We identified several factors associated with survival after spinal SRS for RCC metastases, including local progression, time between first metastasis and primary RCC diagnosis, KPS score, presence of neurological deficits, and progressive metastatic disease. These factors should be taken into consideration when considering a patient for spinal SRS for RCC metastases.

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“…Among these, only nine patients (7.4%) suffered postoperative wound-related complications. Five studies reported no complications (7,21,24,(28)(29)(30)35,38). Among these eight, only studies by Young et al (38) and Laohacharoensombat et al (35) reported the surgery-radiotherapy interval, which was 7 and 14 days, respectively.…”

Section: Evaluation Of the Datamentioning

confidence: 99%

“…The relationship was significant in four studies, but did not reach statistical significance in four others. From 15 studies we were able to extract information on 309 previously irradiated patients that were treated surgically, with wound complication rates of 11-50% (2,7,8,10,14,(21)(22)(23)(24)(25)(26)(27)(28)(29)(30).…”

Section: Evaluation Of the Datamentioning

confidence: 99%

Timing of surgery and radiotherapy in the management of metastatic spine disease: A systematic review

Fisher¹

2010

Int J Oncol

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Abstract. The last decade has witnessed a dramatic change in management of metastatic spine disease, with an increased role for surgery and emerging use of stereotactic radiotherapy, often in combination. Patients may be treated with radiotherapy followed by surgery, or have surgery and then adjuvant radiotherapy. In both cases, the surgeon and oncologist need to select the optimal timing for surgery and radiotherapy to minimize wound complications while obtaining maximum oncolytic effects. The purpose of this review was to determine the optimal timing of surgery and radiotherapy in patients surgically treated for spinal metastases. A systematic review utilizing Medline, Embase, Paper First, Web of Science, Google Scholar, and the Cochrane Database of Systematic Reviews was performed. References were screened to further identify relevant studies and basic science literature reviewed. A total of 46 reports discussing the timing of surgery after radiotherapy, describing experience in 5836 patients, were identified. Only one retrospective study addressed the research question and suggested that surgery within seven days of radiation increases the rate of postoperative wound complications. Timing of adjuvant radiotherapy following surgery was addressed in 51 reports describing 7090 patients. None of the studies specifically answered the research question. The time interval between radiotherapy and surgery was reported as 5-21 days in nine studies. Based on this systematic review together with the understanding of general principles of wound healing and effects of radiation on wound healing, the optimal radiotherapy-surgery/surgery-radiotherapy time interval should be at least one week to minimize wound complications.

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Surgical treatment of spinal cord compression in kidney cancer.

Cited by 83 publications

References 26 publications

Spinal cord decompression: an endoscopically assisted approach for metastatic tumors

Spinal cord decompression: an endoscopically assisted approach for metastatic tumors

Factors affecting survival in 37 consecutive patients undergoing de novo stereotactic radiosurgery for contiguous sites of vertebral body metastasis from renal cell carcinoma

Timing of surgery and radiotherapy in the management of metastatic spine disease: A systematic review

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