scholarly journals Postoperative re-irradiation using stereotactic body radiotherapy for metastatic epidural spinal cord compression

2018 ◽  
Vol 29 (3) ◽  
pp. 332-338 ◽  
Author(s):  
Kei Ito ◽  
Keiji Nihei ◽  
Takuya Shimizuguchi ◽  
Hiroaki Ogawa ◽  
Tomohisa Furuya ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Local Control ◽  
Spinal Cord Compression ◽  
Stereotactic Body Radiotherapy ◽  
Prognostic Score ◽  
Prognostic Index ◽  
Cord Compression ◽  
Local Control Rate ◽  
Good Survival ◽  
Decompression Surgery

OBJECTIVEThis study aimed to clarify the outcomes of postoperative re-irradiation using stereotactic body radiotherapy (SBRT) for metastatic epidural spinal cord compression (MESCC) in the authors’ institution and to identify factors correlated with local control.METHODSCases in which patients with previously irradiated MESCC underwent decompression surgery followed by spine SBRT as re-irradiation between April 2013 and May 2017 were retrospectively reviewed. The surgical procedures were mainly performed by the posterior approach and included decompression and fixation. The prescribed dose for spine SBRT was 24 Gy in 2 fractions. The primary outcome was local control, which was defined as elimination, shrinkage, or no change of the tumor on CT or MRI obtained approximately every 3 months after SBRT. In addition, various patient-, treatment-, and tumor-specific factors were evaluated to determine their predictive value for local control.RESULTSTwenty-eight cases were identified in the authors’ institutional databases as meeting the inclusion criteria. The histology of the primary disease was thyroid cancer in 7 cases, lung cancer in 6, renal cancer in 3, colorectal cancer in 3, and other cancers in 9. The most common previous radiation dose was 30 Gy in 10 fractions (15 cases). The mean interval since the most recent irradiation was 16 months (range 5–132 months). The median duration of follow-up after SBRT was 13 months (range 4–38 months). The 1-year local control rate was 70%. In the analysis of factors related to local control, Bilsky grade, number of vertebral levels in the treatment target, the interval between the latest radiotherapy and SBRT, recursive partitioning analysis (RPA), the prognostic index for spinal metastases (PRISM), and the revised Tokuhashi score were not significantly correlated with local control. The favorable group classified by the Rades prognostic score achieved a significantly higher 1-year local control rate than the unfavorable group (1-year local control rate: 100% vs 33%; p < 0.01). Radiation-induced myelopathy and vertebral compression fracture were observed in 1 and 3 patients, respectively. No other grade 3 or greater toxicities were encountered.CONCLUSIONSThe results indicate that spine SBRT as postoperative re-irradiation was effective, and it was especially useful for patients classified as having a good survival prognosis according to the Rades score.

Prognostic factors for local control and survival in patients with spinal cord compression from myeloma

2012 ◽  
Vol 188 (7) ◽  
pp. 628-631 ◽  
Author(s):  
D. Rades ◽  
S. Douglas ◽  
T. Veninga ◽  
P. Poortmans ◽  
A. Bajrovic ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Prognostic Factors ◽  
Local Control ◽  
Spinal Cord Compression ◽  
Cord Compression

scholarly journals Is there any role for stereotactic body radiotherapy in the management of metastatic epidural spinal cord compression?

CNS Oncology ◽  
2015 ◽  
Vol 4 (1) ◽  
pp. 1-4 ◽  
Author(s):  
Simon S Lo ◽  
Charlotte D Kubicky ◽  
Eric L Chang ◽  
Arjun Sahgal
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Stereotactic Body Radiotherapy ◽  
Cord Compression

Repeat decompression surgery for recurrent spinal metastases

2010 ◽  
Vol 13 (1) ◽  
pp. 109-115 ◽  
Author(s):  
Ilya Laufer ◽  
Andrew Hanover ◽  
Eric Lis ◽  
Yoshiya Yamada ◽  
Mark Bilsky
Keyword(s):  
Spinal Cord ◽  
Survival Time ◽  
Median Survival ◽  
Spinal Cord Compression ◽  
Median Survival Time ◽  
Eastern Cooperative Oncology Group ◽  
Cord Compression ◽  
Decompression Surgery ◽  
High Grade

Object In this paper, the authors' goal was to determine the outcome of reoperation for recurrent epidural spinal cord compression in patients with metastatic spine disease. Methods A retrospective chart review was conducted of all patients who underwent spine surgery at the Memorial Sloan-Kettering Cancer Center between 1996 and 2007. Thirty-nine patients who underwent reoperation of the spine at the level previously treated with surgery were identified. Only patients whose reoperation was performed because of tumor recurrence leading to high-grade epidural spinal cord compression or recurrence with no further radiation options were included in the study. Patients who underwent reoperations exclusively for instrumentation failure were excluded. All patients underwent additional decompression via a posterolateral approach without removal of the spinal instrumentation. Results Patients underwent 1–4 reoperations at the same level. A median survival time of 12.4 months was noted after the first reoperation, and a median survival time of 9.1 months was noted after the last reoperation. At last follow-up 22 (65%) of 34 patients were ambulatory at the time of last follow-up or death, and the median time between loss-of-ambulation and death was 1 month. Functional status was maintained or improved by one Eastern Cooperative Oncology Group grade in 97% of patients. A major surgical complication rate of 5% was noted. Conclusions Reoperation represents a viable option in patients with high-grade epidural spinal cord compression who have recurrent metastatic tumors at previously operated spinal levels. In carefully selected patients, reoperation can prolong ambulation and result in good functional and neurological outcomes.

scholarly journals Essential Concepts for the Management of Metastatic Spine Disease: What the Surgeon Should Know and Practice

2019 ◽  
Vol 9 (1_suppl) ◽  
pp. 98S-107S ◽  
Author(s):  
Ori Barzilai ◽  
Stefano Boriani ◽  
Charles G. Fisher ◽  
Arjun Sahgal ◽  
Jorrit Jan Verlaan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Spinal Cord ◽  
Literature Review ◽  
Functional Status ◽  
Local Control ◽  
Spinal Cord Compression ◽  
Spinal Metastases ◽  
Cord Compression ◽  
Tumor Histology

Study Design: Literature review. Objective: To provide an overview of the recent advances in spinal oncology, emphasizing the key role of the surgeon in the treatment of patients with spinal metastatic tumors. Methods: Literature review. Results: Therapeutic advances led to longer survival times among cancer patients, placing significant emphasis on durable local control, optimization of quality of life, and daily function for patients with spinal metastatic tumors. Recent integration of modern diagnostic tools, precision oncologic treatment, and widespread use of new technologies has transformed the treatment of spinal metastases. Currently, multidisciplinary spinal oncology teams include spinal surgeons, radiation and medical oncologists, pain and rehabilitation specialists, and interventional radiologists. Consistent use of common language facilitates communication, definition of treatment indications and outcomes, alongside comparative clinical research. The main parameters used to characterize patients with spinal metastases include functional status and health-related quality of life, the spinal instability neoplastic score, the epidural spinal cord compression scale, tumor histology, and genomic profile. Conclusions: Stereotactic body radiotherapy revolutionized spinal oncology through delivery of durable local tumor control regardless of tumor histology. Currently, the major surgical indications include mechanical instability and high-grade spinal cord compression, when applicable, with surgery providing notable improvement in the quality of life and functional status for appropriately selected patients. Surgical trends include less invasive surgery with emphasis on durable local control and spinal stabilization.

Motor network recovery in patients with chronic spinal cord compression: a longitudinal study following decompression surgery

2018 ◽  
Vol 28 (4) ◽  
pp. 379-388 ◽  
Author(s):  
Kayla Ryan ◽  
Sandy Goncalves ◽  
Robert Bartha ◽  
Neil Duggal
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Surgical Intervention ◽  
Blood Oxygen Level Dependent ◽  
Cord Compression ◽  
Decompression Surgery ◽  
Blood Oxygen Level ◽  
Motor Network ◽  
Dependent Signal

OBJECTIVEThe authors used functional MRI to assess cortical reorganization of the motor network after chronic spinal cord compression and to characterize the plasticity that occurs following surgical intervention.METHODSA 3-T MRI scanner was used to acquire functional images of the brain in 22 patients with reversible cervical spinal cord compression and 10 control subjects. Controls performed a finger-tapping task on 3 different occasions (baseline, 6-week follow-up, and 6-month follow-up), whereas patients performed the identical task before surgery and again 6 weeks and 6 months after spinal decompression surgery.RESULTSAfter surgical intervention, an increased percentage blood oxygen level–dependent signal and volume of activation was observed within the contralateral and ipsilateral motor network. The volume of activation of the contralateral primary motor cortex was associated with functional measures both at baseline (r = 0.55, p < 0.01) and 6 months after surgery (r = 0.55, p < 0.01). The percentage blood oxygen level–dependent signal of the ipsilateral supplementary motor area 6 months after surgery was associated with increased function 6 months after surgery (r = 0.48, p < 0.01).CONCLUSIONSPlasticity of the contralateral and ipsilateral motor network plays complementary roles in maintaining neurological function in patients with spinal cord compression and may be critical in the recovery phase following surgery.

Decompression surgery and intraoperative radiation therapy (IORT) for metastatic spinal tumors

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 20515-20515
Author(s):  
K. Karasawa ◽  
N. Hanyu ◽  
T. Chang ◽  
G. Kuga ◽  
D. Yoshida ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Response Rate ◽  
Posterior Instrumentation ◽  
Cord Compression ◽  
Intraoperative Radiation Therapy ◽  
Spinal Tumors ◽  
Decompression Surgery ◽  
Intraoperative Radiation ◽  
Neurological Response

20515 Background: Metastatic spinal tumors often cause spinal cord compression and jeopardize the quality of life of the patients much. To decrease the local symptomatic recurrence rate, we have been adding IORT to decompression surgery. Methods: For those patients whose life expectancy was more than 6 months were eligible for this treatment. Posterior decompression by laminectomy of the involved vertebrae was performed. Following decompression, the patient was irradiated the lesions intraoperatively with electrons generated from Microtron by shielding the spinal cord with lead plate. The central aspects of the vertebrae were irradiated by scattered electrons detouring from the edge of the lead shield up to 40% of the administered dose. Following IORT, posterior instrumentation was performed. External beam radiotherapy might be added pre- and/or postoperatively when considered necessary. Results: 108 patients were treated between 1992–2005. There were 58 males and 50 females. Age ranged from 26 to 85 with a median of 62.5. By primary sites, 26 breast, 24 kidney, 18 colorectum, 17 lung 12 prostate and 11 thyroid cases were included. Irradiated spines were cervical in 6, thoracic in 76, and lumbar/sacral in 27. Overall median follow-up period was 12.7months. Median IORT dose was 20Gy (range 15–26Gy) and median electron energy was 16MeV (range 11–22MeV). There were 37 cases with preoperative RT and 41 cases with postoperative RT. Overall median survival time was 14.5months (breast 15.3, kidney 22.6, colorectum 5.7, lung 6.2, prostate 31.6, thyroid 60.6months). Neurological response rate was 73.1%. Ambulatory rates were 87.0% for success and 80.6% for rescue by Klimo's definition(2005). There were only 8 symptomatic relapses (7%). As for major complications, only one myelopathy has been observed. Conclusions: Decompression surgery and IORT for metastatic spinal tumors with impending spinal cord compression was a promising treatment modality with excellent local control and neurological response rate and with minimal toxicity especially for those patients with long-term prognosis. No significant financial relationships to disclose.

Single-stage repair of thoracic aortic aneurysm and spinal cord compression

2019 ◽  
Vol 27 (9) ◽  
pp. 754-756
Author(s):  
Akshay Kumar ◽  
Nimisha Shiwalkar ◽  
Purnadeo Narpaul Persaud ◽  
Arun Kumar Haridas
Keyword(s):  
Spinal Cord ◽  
Aortic Aneurysm ◽  
Spinal Cord Compression ◽  
Thoracic Aortic Aneurysm ◽  
Disease Process ◽  
Cord Compression ◽  
Single Stage ◽  
Decompression Surgery ◽  
Permanent Disability ◽  
Descending Thoracic Aortic Aneurysm

A ruptured thoracic aortic aneurysm complicated by spinal cord compression resulting in paraparesis although rare, can be a life-threatening condition. Despite treatment, patients may have a permanent disability due to the disease process itself or as a consequence of the surgical procedure. We describe an unusual case of descending thoracic aortic aneurysm complicated by vertebral erosion and paraparesis from spinal cord compression. The patient was successfully management by an interdisciplinary surgical approach utilizing a single-stage procedure comprising replacement of the aorta with a Dacron graft, spinal decompression surgery, and vertebral reconstruction using a titanium mesh cage.

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