scholarly journals Radiation-induced vertebral compression fracture following spine stereotactic radiosurgery: clinicopathological correlation

2013 ◽  
Vol 18 (5) ◽  
pp. 430-435 ◽  
Author(s):  
Ameen Al-Omair ◽  
Roger Smith ◽  
Tim-Rasmus Kiehl ◽  
Louis Lao ◽  
Eugene Yu ◽  
...  
Keyword(s):  
Tumor Progression ◽  
Stereotactic Radiosurgery ◽  
Vertebral Compression Fracture ◽  
Compression Fracture ◽  
Spinal Tumors ◽  
High Dose ◽  
Diagnostic Challenge ◽  
New Era ◽  
Radiation Induced ◽  
Dose Radiation

Spine stereotactic radiosurgery (SRS) is increasingly being used to treat metastatic spinal tumors. As the experience matures, high rates of vertebral compression fracture (VCF) are being observed. What is unknown is the mechanism of action; it has been postulated but not confirmed that radiation itself is a contributing factor. This case report describes 2 patients who were treated with spine SRS who subsequently developed signal changes on MRI consistent with tumor progression and VCF; however, biopsy confirmed a diagnosis of radiation-induced necrosis in 1 patient and fibrosis in the other. Radionecrosis is a rare and serious side effect of high-dose radiation therapy and represents a diagnostic challenge, as the authors have learned from years of experience with brain SRS. These cases highlight the issues in the new era of spine SRS with respect to relying on imaging alone as a means of determining true tumor progression. In those scenarios in which it is unclear based on imaging if true tumor progression has occurred, the authors recommend biopsy to rule out radiation-induced effects within the bone prior to initiating salvage therapies.

scholarly journals Pathological characteristics of spine metastases treated with high-dose single-fraction stereotactic radiosurgery

2017 ◽  
Vol 42 (1) ◽  
pp. E7 ◽  
Author(s):  
Evangelia Katsoulakis ◽  
Ilya Laufer ◽  
Mark Bilsky ◽  
Narasimhan P. Agaram ◽  
Michael Lovelock ◽  
...  
Keyword(s):  
Overall Survival ◽  
Tumor Progression ◽  
Stereotactic Radiosurgery ◽  
Surgical Intervention ◽  
Compression Fracture ◽  
Vertebral Compression Fractures ◽  
High Dose ◽  
Single Fraction ◽  
Spine Radiosurgery

OBJECTIVE Spine radiosurgery is increasingly being used to treat spinal metastases. As patients are living longer because of the increasing efficacy of systemic agents, appropriate follow-up and posttreatment management for these patients is critical. Tumor progression after spine radiosurgery is rare; however, vertebral compression fractures are recognized as a more common posttreatment effect. The use of radiographic imaging alone posttreatment may makeit difficult to distinguish tumor progression from postradiation changes such as fibrosis. This is the largest series from a prospective database in which the authors examine histopathology of samples obtained from patients who underwent surgical intervention for presumed tumor progression or mechanical pain secondary to compression fracture. The majority of patients had tumor ablation and resulting fibrosis rather than tumor progression. The aim of this study was to evaluate tumor histopathology and characteristics of patients who underwent pathological sampling because of radiographic tumor progression, fibrosis, or collapsed vertebrae after receiving high-dose single-fraction stereotactic radiosurgery. METHODS Between January 2005 and January 2014, a total of 582 patients were treated with linear accelerator–based single-fraction (18–24 Gy) stereotactic radiosurgery. The authors retrospectively identified 30 patients (5.1%) who underwent surgical intervention for 32 lesions with vertebral cement augmentation for either mechanical pain or instability secondary to vertebral compression fracture (n = 17) or instrumentation (n = 15) for radiographic tumor progression. Radiation and surgical treatment, histopathology, and long-term outcomes were reviewed. Survival and time to recurrence were calculated using the Kaplan-Meier method. RESULTS The mean age at the time of radiosurgery was 59 years (range 36–80 years). The initial pathological diagnoses were obtained for all patients and primarily included radioresistant tumor types, including renal cell carcinoma in 7 (22%), melanoma in 6 (19%), lung carcinoma in 4 (12%), and sarcoma in 3 (9%). The median time to surgical intervention was 24.7 months (range 1.6–50.8 months). The median follow-up and overall survival for all patients were 42.5 months and 41 months (overall survival range 7–86 months), respectively. The majority of assessed lesions showed no evidence of tumor on pathological review (25 of 32, 78%), while a minority of lesions revealed residual tumor (7 of 32, 22%). The median survival for patients after tumor recurrence was 5 months (range 2–70 months). CONCLUSIONS High-dose single-fraction radiosurgery is tumor ablative in the majority of instances. In a minority of cases, tumor persists and salvage treatments should be considered.

scholarly journals Stereotactic radiosurgery for hemangiomas and ependymomas of the spinal cord

2003 ◽  
Vol 15 (5) ◽  
pp. 1-5 ◽  
Author(s):  
Stephen I. Ryu ◽  
Daniel H. Kim ◽  
Steven D. Chang
Keyword(s):  
Spinal Cord ◽  
Stereotactic Radiosurgery ◽  
Therapeutic Option ◽  
Spinal Tumors ◽  
High Dose ◽  
Significant Treatment ◽  
Conventional Radiation ◽  
Conformal Treatment ◽  
Dose Radiation

Object The optimal treatment for intramedullary spinal tumors is controversial, because both resection and conventional radiation therapy are associated with potential morbidity. Stereotactic radiosurgery can theoretically deliver highly conformal, high-dose radiation to surgically untreatable lesions while simultaneously mitigating radiation exposure to large portions of the spinal cord. The purpose of this study was to evaluate the authors' initial experience with frameless stereotactic radiosurgery for intramedullary spinal tumors. Methods Between 1998 and 2003, 10 intramedullary spinal tumors were treated with stereotactic radiosurgery at the authors' institution. Seven hemangioblastomas and three ependymomas were treated in four men and three women. These patients either had recurrent tumors, had undergone several previous surgeries, had medical contraindications to surgery, or had declined open resection. Conformal treatment planning delivered a prescribed dose of 1800 to 2500 cGy (mean 2100 cGy) to the lesions in one to three stages. No significant treatment-related complications have been recorded. The mean radiographic and clinical follow-up duration was 12 months (range 1–24 months). One ependymoma and two hemangioblastomas were smaller on follow-up neuroimaging. The remaining tumors were stable at the time of follow-up imaging. Conclusions Stereotactic radiosurgery for intramedullary spinal tumors is feasible and safe in selected cases and may prove to be another therapeutic option for these challenging lesions.

scholarly journals Image-guided radiosurgery in the treatment of spinal metastases

2001 ◽  
Vol 11 (6) ◽  
pp. 1-7 ◽  
Author(s):  
Martin J. Murphy ◽  
Steven Chang ◽  
Iris Gibbs ◽  
Quynh-Tu Le ◽  
David Martin ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Therapeutic Option ◽  
Spinal Metastases ◽  
Target Volume ◽  
Outpatient Setting ◽  
Spinal Tumors ◽  
High Dose ◽  
Radiation Beam ◽  
Image Guided ◽  
Frameless Radiosurgery

Object The authors describe a new method for treating metastatic spinal tumors in which noninvasive, image-guided, frameless stereotactic radiosurgery is performed. Stereotactic radiosurgery delivers a high dose of radiation in a single or limited number of fractions to a lesion while maintaining delivery of a low dose to adjacent normal structures. Methods Image-guided radiosurgery was developed by coupling an orthogonal pair of real-time x-ray cameras to a dynamically manipulated robot-mounted linear accelerator that guides the radiation beam to treatment sites associated with radiographic landmarks. This procedure can be conducted in an outpatient setting without the use of frame-based skeletal fixation. The system relies on skeletal landmarks or implanted fiducial markers to locate treatment targets. Four patients with spinal metastases underwent radiosurgery with total prescription doses of 1000 to 1600 cGy in one or two fractions. Alignment of the treatment dose with the target volume was accurate to within 1.5 mm. During the course of each treatment fraction, patient movement was less than 0.5 mm on average. Dosimetry was highly conformal, with a demonstrated ability to deliver 1600 cGy to the perimeter of an irregular target volume while keeping exposure to the cord itself below 800 cGy. Conclusions These experiences indicate that frameless radiosurgery is a viable therapeutic option for metastatic spine disease.

A REVIEW OF IMAGE-GUIDED INTENSITY-MODULATED RADIOTHERAPY FOR SPINAL TUMORS

Neurosurgery ◽  
2007 ◽  
Vol 61 (2) ◽  
pp. 226-235 ◽  
Author(s):  
Yoshiya Yamada ◽  
D. Michael Lovelock ◽  
Mark H. Bilsky
Keyword(s):  
Spinal Cord ◽  
Intensity Modulated Radiotherapy ◽  
Spinal Tumors ◽  
Tumor Control ◽  
High Dose ◽  
Single Fraction ◽  
Image Guided ◽  
Intensity Modulated ◽  
Very High ◽  
Dose Radiation

Abstract OBJECTIVE A new paradigm for the radiotherapeutic management of paraspinal tumors has emerged. Intensity-modulated radiotherapy (IMRT) has gained wide acceptance as a way of delivering highly conformal radiation to tumors. IMRT is capable of sparing sensitive structures such as the spinal cord of high-dose radiation even if only several millimeters away from the tumor. Image-guided treatment tools such as cone beam computed tomography coupled with IMRT have reduced treatment errors associated with traditional radiotherapy, making highly accurate and conformal treatment feasible. METHODS This review discusses the physics of image-guided radiotherapy, including immobilization, the radiobiological implications of hypofractionation, as well as outcomes. Image-guided technology has improved the accuracy of IMRT to within 2 mm of error. Thus, the marriage of image guidance with IMRT (IG IMRT) has allowed the safe treatment of spinal tumors to a high dose without increasing the risk of radiation-related toxicity. With the use of near real-time image-guided verification, very-high-dose radiation has been given for tumors in standard fractionation, hypofractionated, and single fraction schedules to doses beyond levels traditionally believed safe in terms of spinal cord tolerance. RESULTS Clinical results, in terms of treatment-related toxicity and tumor control, have been very favorable. With follow-up periods extending beyond 30 months, tumor control rates with single fraction IG IMRT (1800–2400 cGy) are in excess of 90%, regardless of histology, and without serious sequelae such as radiation myelopathy. Patients also report correspondingly high rates of palliation. Excellent results, both in terms of tumor control and minimal toxicity, have been consistently reported in the literature. CONCLUSION IG IMRT represents a significant technological advance. Paraspinal IG IMRT is proof of principle, making it possible to give very-high-dose radiation within close proximity to the spinal cord. By reducing treatment-related uncertainties, margins around tumors can be shortened, thereby reducing the volume of normal tissue that must be irradiated to tumoricidal doses, reducing the likelihood of toxicity. Similarly, higher doses of radiation can be administered safely, improving the likelihood of eradication. Dose escalation can be done to increase the likelihood of tumor cell kill without increasing the dose given to nearby sensitive structures.

High dose radiation induced meningioma

2004 ◽  
Vol 18 (6) ◽  
pp. 617-621 ◽  
Author(s):  
SN Shenoy ◽  
KG Munish ◽  
A Raja
Keyword(s):  
High Dose ◽  
Radiation Induced ◽  
Dose Radiation

scholarly journals Taurine-EVA copolymer-paraffin rods dosimeters for EPR high-dose radiation dosimetry

Nukleonika ◽  
2014 ◽  
Vol 59 (1) ◽  
pp. 9-13
Author(s):  
Ahmed M. Maghraby ◽  
A. Mansour ◽  
A. A. Abdel-Fattah
Keyword(s):  
Ethylene Vinyl Acetate ◽  
High Dose ◽  
Radiation Doses ◽  
Modulation Amplitude ◽  
Molten Mixture ◽  
Radiation Induced ◽  
Epr Signal ◽  
High Doses ◽  
Dose Radiation ◽  
Eva Copolymer

Abstract Taurine/EPR rods (3 × 10 mm) have been prepared by a simple technique in the laboratory where taurine powder was mixed with a molten mixture of paraffin wax and an ethylene vinyl acetate (EVA) copolymer. The binding mixture EVA/Paraffin does not present interference or noise in the EPR signal before or after irradiation. The rods show good mechanical properties for safe and multi-use handling. An EPR investigation of radiation induced radicals in taurine rods revealed that there are two types of radicals produced after exposure to gamma radiation (60Co). EPR spectra were recorded and analyzed - also the microwave power saturation and modulation amplitude were studied and optimized. Response of taurine to different radiation doses (1.5-100 kGy) was studied and found to follow a linear relationship up to 100 kGy. Radiation induced radicals in taurine persists and showed a noticeable stability over 94 days following irradiation. Uncertainities associated with the evaluation of radiation doses using taurine dosimeters were discussed and tabulated. It was found that taurine possesses good dosimetric properties using EPR spectroscopy in high doses in addition to its simple spectrum.

scholarly journals The impact of decompression with instrumentation on local failure following spine stereotactic radiosurgery

2017 ◽  
Vol 27 (4) ◽  
pp. 436-443 ◽  
Author(s):  
Jacob A. Miller ◽  
Ehsan H. Balagamwala ◽  
Camille A. Berriochoa ◽  
Lilyana Angelov ◽  
John H. Suh ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Competing Risks ◽  
Cumulative Incidence ◽  
Vertebral Compression Fracture ◽  
Compression Fracture ◽  
Local Failure ◽  
Control Group ◽  
Spinal Decompression ◽  
Grade 3 ◽  
The Impact

OBJECTIVESpine stereotactic radiosurgery (SRS) is a safe and effective treatment for spinal metastases. However, it is unknown whether this highly conformal radiation technique is suitable at instrumented sites given the potential for microscopic disease seeding. The authors hypothesized that spinal decompression with instrumentation is not associated with increased local failure (LF) following SRS.METHODSA 2:1 propensity-matched retrospective cohort study of patients undergoing SRS for spinal metastasis was conducted. Patients with less than 1 month of radiographic follow-up were excluded. Each SRS treatment with spinal decompression and instrumentation was propensity matched to 2 controls without decompression or instrumentation on the basis of demographic, disease-related, dosimetric, and treatment-site characteristics. Standardized differences were used to assess for balance between matched cohorts.The primary outcome was the 12-month cumulative incidence of LF, with death as a competing risk. Lesions demonstrating any in-field progression were considered LFs. Secondary outcomes of interest were post-SRS pain flare, vertebral compression fracture, instrumentation failure, and any Grade ≥ 3 toxicity. Cumulative incidences analysis was used to estimate LF in each cohort, which were compared via Gray’s test. Multivariate competing-risks regression was then used to adjust for prespecified covariates.RESULTSOf 650 candidates for the control group, 166 were propensity matched to 83 patients with instrumentation. Baseline characteristics were well balanced. The median prescription dose was 16 Gy in each cohort. The 12-month cumulative incidence of LF was not statistically significantly different between cohorts (22.8% [instrumentation] vs 15.8% [control], p = 0.25). After adjusting for the prespecified covariates in a multivariate competing-risks model, decompression with instrumentation did not contribute to a greater risk of LF (HR 1.21, 95% CI 0.74–1.98, p = 0.45). The incidences of post-SRS pain flare (11% vs 14%, p = 0.55), vertebral compression fracture (12% vs 22%, p = 0.04), and Grade ≥ 3 toxicity (1% vs 1%, p = 1.00) were not increased at instrumented sites. No instrumentation failures were observed.CONCLUSIONSIn this propensity-matched analysis, LF and toxicity were similar among cohorts, suggesting that decompression with instrumentation does not significantly impact the efficacy or safety of spine SRS. Accordingly, spinal instrumentation may not be a contraindication to SRS. Future studies comparing SRS to conventional radiotherapy at instrumented sites in matched populations are warranted.

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