Updates in the management of intradural spinal cord tumors: a radiation oncology focus

Abstract

Primary spinal cord tumors represent a hetereogeneous group of central nervous system malignancies whose management is complex given the relatively uncommon nature of the disease and variety of tumor subtypes, functional neurologic deficits from the tumor, and potential morbidities associated with definitive treatment. Advances in neuroimaging; integration of diagnostic, prognostic, and predictive molecular testing into tumor classification; and developments in neurosurgical techniques have refined the current role of radiotherapy in the multimodal management of patients with primary spinal cord tumors, and corroborated the need for prospective, multidisciplinary discussion and treatment decision making. Radiotherapeutic technological advances have dramatically improved the entire continuum from treatment planning to treatment delivery, and the development of stereotactic radiosurgery and proton radiotherapy provides new radiotherapy options for patients treated in the definitive, adjuvant, or salvage setting. The objective of this comprehensive review is to provide a contemporary overview of the management of primary intradural spinal cord tumors, with a focus on radiotherapy.

Neutrophil to lymphocyte ratio influences impact of steroids on efficacy of immune checkpoint inhibitors in lung cancer brain metastases

“…Our study aimed to investigate the impact of steroids and NLR in NSCLCBM patients. In concordance with the literature, our study showed that the use of upfront steroids was associated with reduced OS and PFS in NSCLCBM treated with ICI 11 – 14 . Arbour et al 13 reported that upfront use of steroids (> 10 mg of prednisone) was associated with decreased OS in patients with NSCLC.…”

“…The interaction between radiation therapy and ICI has been previously documented 11 . In our cohort, 126 patients of 171 received only SRS, eight patient received only WBRT, 34 patients received WBRT and SRS and zero patients only underwent a craniotomy after the diagnosis of BM.…”

“…The relationship between ICI and radiotherapy has been demonstrated to be important 11 . We found that patients receiving WBRT with ICI had a poor prognosis.…”

“…In patients without targetable driver mutations, immune checkpoint inhibitors (ICIs) are commonly-used systemic therapeutic options for managing intracranial metastases 6 , 7 . While early trials provided some evidence for intracranial efficacy 8 – 10 , the wide-scale use of ICI in patients with NSCLC has provided an opportunity for retrospective investigation 11 .…”

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

“…Given the scarcity of intramedullary metastases, high-level 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 ].…”