scholarly journals Factors associated with adjacent-level tumor progression in patients receiving surgery followed by radiosurgery for metastatic epidural spinal cord compression

2021 ◽  
Vol 50 (5) ◽  
pp. E15
Author(s):  
Vikram B. Chakravarthy ◽  
Hammad A. Khan ◽  
Shaarada Srivatsa ◽  
Todd Emch ◽  
Samuel T. Chao ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Tumor Progression ◽  
Spinal Cord Compression ◽  
Subgroup Analysis ◽  
Cord Compression ◽  
Tumor Type ◽  
Adjacent Level ◽  
Factors Associated ◽  
Patient Reported ◽  
Index Level

OBJECTIVE Separation surgery followed by spine stereotactic radiosurgery (SSRS) has been shown to achieve favorable rates of local tumor control and patient-reported outcomes in patients with metastatic epidural spinal cord compression (MESCC). However, rates and factors associated with adjacent-level tumor progression (ALTP) in this population have not yet been characterized. The present study aimed to identify factors associated with ALTP and examine its association with overall survival (OS) in patients receiving surgery followed by radiosurgery for MESCC. METHODS Thirty-nine patients who underwent separation surgery followed by SSRS for MESCC were identified using a prospectively collected database and were retrospectively reviewed. Radiological measurements were collected from preoperative, postoperative, and post-SSRS MRI. Statistical analysis was conducted using the Kaplan-Meier product-limit method and Cox proportional hazards test. Subgroup analysis was conducted for patients who experienced ALTP into the epidural space (ALTP-E). RESULTS The authors’ cohort included 39 patients with a median OS of 14.7 months (range 2.07–96.3 months). ALTP was observed in 16 patients (41.0%) at a mean of 6.1 ± 5.4 months postradiosurgery, of whom 4 patients (10.3%) experienced ALTP-E. Patients with ALTP had shorter OS (13.0 vs 17.1 months, p = 0.047) compared with those without ALTP. Factors associated with an increased likelihood of ALTP included the amount of bone marrow infiltrated by tumor at the index level, amount of residual epidural disease following separation surgery, and prior receipt of radiotherapy at the index level (p < 0.05). Subgroup analysis revealed that primary tumor type, amount of preoperative epidural disease, time elapsed between surgery and radiosurgery, and prior receipt of radiotherapy at the index level were significantly associated with ALTP-E (p < 0.05). CONCLUSIONS To the authors’ knowledge, this study is the first to identify possible risk factors for ALTP, and they suggest that it may be associated with shorter OS in patients receiving surgery followed by radiosurgery for MESCC. Future studies with higher power should be conducted to further characterize factors associated with ALTP in this population.

scholarly journals NCOG-03. FACTORS ASSOCIATED WITH ADJACENT LEVEL TUMOR PROGRESSION IN PATIENTS RECEIVING SEPARATION SURGERY FOLLOWED BY SPINE STEREOTACTIC RADIOSURGERY FOR METASTATIC EPIDURAL SPINAL CORD COMPRESSION

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii129-ii129
Author(s):  
Vikram Chakravarthy ◽  
Hammad Khan ◽  
Shaarada Srivatsa ◽  
Konrad Knusel ◽  
Todd Emch ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Bone Marrow ◽  
Stereotactic Radiosurgery ◽  
Spinal Cord Compression ◽  
Primary Tumor ◽  
Cord Compression ◽  
Adjacent Level ◽  
Factors Associated ◽  
Tumor Histology ◽  
Local Bone

Abstract INTRODUCTION Separation surgery followed by spine stereotactic radiosurgery (SSRS) has been shown to achieve favorable rates of local tumor control and patient-reported outcomes in patients with metastatic epidural spinal cord compression (MESCC). If left untreated, MESCC causes severe pain, progressive neurological impairment, and eventual paraplegia with a median survival of 3-6 months. The present study aimed to identify factors associated with adjacent level progression and examine its impact on overall survival (OS) in this population. METHODS This study included 39 patients who received separation surgery followed by SSRS for MESCC. Preoperative, postoperative, and post-SSRS MRIs were used to measure amount of epidural disease, amount of local bone marrow involvement, and adjacent level epidural (AEP) and osseous (AOP) progression. Factors associated with AEP and AOP were examined using the log-rank test and cox proportional hazards modeling. RESULTS Median OS in our cohort was 14.7 mo (2.07-96.3). AEP and AOP were observed in 4/39 (10.3%) and 16/39 (41.0%) patients at a mean of 6.1±5.4 mo and 5.3±5.3 mo post-SSRS, respectively. AEP (7.52 vs. 17.1 mo, p = 0.014) and AOP (13.0 vs. 17.1 mo, p = 0.047) were each significantly associated with decreased OS. Factors associated with AEP included primary tumor histology, low-dose hypofractionated SSRS, increased time from surgery to SSRS, and greater amount of local epidural disease preoperatively (p &lt; 0.05). Factors associated with AOP included greater amount of local bone marrow infiltration by tumor pre- and postoperatively and greater amount of local epidural disease postoperatively (p &lt; 0.05). Primary tumor histology and increased time from surgery to SSRS were associated with AOP by trend (p &lt; 0.10). CONCLUSION This study identifies factors associated with adjacent level progression and shows that AEP and AOP are associated with shorter OS in patients receiving separation surgery followed by SSRS for MESCC.

scholarly journals Hybrid surgery–radiosurgery therapy for metastatic epidural spinal cord compression: A prospective evaluation using patient-reported outcomes

2017 ◽  
Vol 5 (2) ◽  
pp. 104-113 ◽  
Author(s):  
Ori Barzilai ◽  
Mary-Kate Amato ◽  
Lily McLaughlin ◽  
Anne S Reiner ◽  
Shahiba Q Ogilvie ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Stereotactic Radiosurgery ◽  
Spinal Cord Compression ◽  
Patient Reported Outcomes ◽  
Cord Compression ◽  
Pain Severity ◽  
Hybrid Surgery ◽  
Hybrid Therapy ◽  
Therapy Effect ◽  
Patient Reported

Abstract Background Patient-reported outcomes (PRO) represent an important measure of cancer therapy effect. For patients with metastatic epidural spinal cord compression (MESCC), hybrid therapy using separation surgery and stereotactic radiosurgery preserves neurologic function and provides tumor control. There is currently a paucity of data reporting PRO after such combined modality therapy for MESCC. Delineation of hybrid surgery–radiosurgery therapy effect on PRO validates the hybrid approach as an effective therapy resulting in meaningful symptom relief. Patients and Methods Brief Pain Inventory (BPI) and MD Anderson Symptom Inventory—Spine Tumor (MDASI-SP), PROs validated in the cancer population, were prospectively collected. Patients with MESCC who underwent separation surgery followed by stereotactic radiosurgery were included. Separation surgery included a posterolateral approach without extensive cytoreductive tumor excision. A median postoperative radiosurgery dose of 2700 cGy was delivered. The change in PRO 3 months after the hybrid therapy represented the primary study outcome. Preoperative and postoperative evaluations were analyzed using the Wilcoxon signed-rank test for matched pairs. Results One hundred eleven patients were included. Hybrid therapy resulted in a significant reduction in the BPI items “worst” and “right now” pain (P < .0001), and in all BPI constructs (severity, interference with daily activities, and pain experience, P < .001). The MDASI-SP demonstrated reduction in spine-specific pain severity and interference with general activity (P < .001), along with decreased symptom interference (P < .001). Conclusions Validated PRO instruments showed that in patients with MESCC, hybrid therapy with separation surgery and radiosurgery results in a significant decrease in pain severity and symptom interference. These prospective data confirm the benefit of hybrid therapy for treatment of MESCC and should facilitate referral of patients with MESCC for surgical evaluation.

scholarly journals Comparison of 5 × 5 Gy and 10 × 3 Gy for metastatic spinal cord compression using data from three prospective trials

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Dirk Rades ◽  
Jon Cacicedo ◽  
Antonio J. Conde-Moreno ◽  
Barbara Segedin ◽  
Darejan Lomidze ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Motor Function ◽  
Spinal Cord Compression ◽  
Treatment Time ◽  
Cord Compression ◽  
Metastatic Spinal Cord Compression ◽  
Motor Deficits ◽  
Tumor Type ◽  
Ambulatory Status ◽  
Local Progression

Abstract Background In a palliative situation like metastatic spinal cord compression (MSCC), overall treatment time of radiotherapy should be as short as possible. This study compared 5 × 5 Gy in 1 week to 10 × 3 Gy in 2 weeks in a prospective cohort. Methods Forty patients receiving 5 × 5 Gy in a phase II trial were matched 1:2 to 213 patients receiving 10 × 3 Gy in two previous prospective studies for tumor type, ambulatory status, time developing motor deficits, interval between tumor diagnosis and MSCC and visceral metastases. These factors were consistent in all three patients (triple) used for each 1:2 matching. Groups were compared for local progression-free survival (LPFS), motor function, ambulatory status, and overall survival (OS). Results After matching, 32 triples remained for analyses (N = 96 in total). Six-month LPFS-rates were 94% after 5 × 5 Gy and 87% after 10 × 3 Gy (p = 0.36), 6-month OS-rates 43% and 35% (p = 0.74). Improvement of motor function was achieved in 59% and 34% of patients (p = 0.028); overall response rates (improvement or no further progression of motor deficits) were 94% and 89% (p = 0.71). Post-treatment ambulatory rates were 81% after 5 × 5 Gy and 85% after 10 × 3 Gy (p = 0.61). Of non-ambulatory patients, 50% (6/12) and 46% (11/24) regained the ability to walk (p = 1.00). Conclusions 5 × 5 Gy in 1 week appeared similarly effective as 10 × 3 Gy in 2 weeks. These results may not be applicable to long-term survivors and should be confirmed in a randomized trial directly comparing 5 × 5 Gy and 10 × 3 Gy. Trial registration clinicaltrials.gov NCT03070431. Registered 27 February 2017.

scholarly journals C.02 Predictors of survival in a surgical series of Metastatic Spinal Cord Compression and a complete external validation of 8 models in a prospective multi-centre study

2018 ◽  
Vol 45 (s2) ◽  
pp. S14-S14
Author(s):  
A Nater ◽  
LA Tetreault ◽  
B Kopjar ◽  
PM Arnold ◽  
MB Dekutoski ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Primary Tumor ◽  
External Validation ◽  
Cord Compression ◽  
Prognostic Models ◽  
Tumor Type ◽  
Multi Centre Study ◽  
Organ Metastasis ◽  
Preoperative Predictors

Background: We aimed to identify preoperative predictors of survival in Metastatic Epidural Spinal Cord Compression (MESCC) patients surgically treated, examine how these predictors relate to eight prognostic models, and to perform the first full external validation of these models in accordance with the TRIPOD statement. Methods: 142 surgically treated MESCC patients were enrolled in a prospective, multicenter cohort study and followed for 12 months or until death. Cox proportional hazards (PH) regressions were used. Non-collinear predictors with <10% missing data, ≥10 events per stratum and p<0.05 in univariable analysis were tested through a backward stepwise selection. For the original and revised Tokuhashi, Tomita, modified Bauer, van der Linden, Bartels, OSRI, Bartels and Bollen, we examined calibration and discrimination; survival stratified by risk groups with the Kaplan-Meier method and log-rank test. Results: Primary tumor, organ metastasis and SF-36v2 PC were associated with survival in multivariable analysis; corrected discrimination was 0.68. These three predictors were common to most current prognostic models. However, calibration was poor overall while discrimation was possibly helpful. Conclusions: Primary tumor type (breast, prostate and thyroid), absence of organ metastasis, and a lower degree of physical disability are preoperative predictors of longer survival in surgical MESCC patients. Clinicians should use these 8 prognostic models with caution.

scholarly journals Intramedullary lesion expansion on magnetic resonance imaging in patients with motor complete cervical spinal cord injury

2012 ◽  
Vol 17 (3) ◽  
pp. 243-250 ◽  
Author(s):  
Bizhan Aarabi ◽  
J. Marc Simard ◽  
Joseph A. Kufera ◽  
Melvin Alexander ◽  
Katie M. Zacherl ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Therapeutic Effects ◽  
Female Ratio ◽  
Factors Associated ◽  
Cord Injury ◽  
Principal Factors ◽  
Mri Study

Object The authors performed a study to determine if lesion expansion occurs in humans during the early hours after spinal cord injury (SCI), as has been established in rodent models of SCI, and to identify factors that might predict lesion expansion. Methods The authors studied 42 patients with acute cervical SCI and admission American Spinal Injury Association Impairment Scale Grades A (35 patients) and B (7 patients) in whom 2 consecutive MRI scans were obtained 3–134 hours after trauma. They recorded demographic data, clinical information, Injury Severity Score (ISS), admission MRI-documented spinal canal and cord characteristics, and management strategies. Results The characteristics of the cohort were as follows: male/female ratio 37:5; mean age, 34.6 years; and cause of injury, motor vehicle collision, falls, and sport injuries in 40 of 42 cases. The first MRI study was performed 6.8 ±2.7 hours (mean ± SD) after injury, and the second was performed 54.5 ± 32.3 hours after injury. The rostrocaudal intramedullary length of the lesion on the first MRI scan was 59.2 ± 16.1 mm, whereas its length on the second was 88.5 ± 31.9 mm. The principal factors associated with lesion length on the first MRI study were the time between injury and imaging (p = 0.05) and the time to decompression (p = 0.03). The lesion's rate of rostrocaudal intramedullary expansion in the interval between the first and second MRI was 0.9 ± 0.8 mm/hour. The principal factors associated with the rate of expansion were the maximum spinal cord compression (p = 0.03) and the mechanism of injury (p = 0.05). Conclusions Spinal cord injury in humans is characterized by lesion expansion during the hours following trauma. Lesion expansion has a positive relationship with spinal cord compression and may be mitigated by early surgical decompression. Lesion expansion may be a novel surrogate measure by which to assess therapeutic effects in surgical or drug trials.

scholarly journals The Prevalence of Asymptomatic and Symptomatic Spinal Cord Compression on Magnetic Resonance Imaging: A Systematic Review and Meta-analysis

2020 ◽  
pp. 219256822093449
Author(s):  
Sam S. Smith ◽  
Max E. Stewart ◽  
Benjamin M. Davies ◽  
Mark R. N. Kotter
Keyword(s):  
Magnetic Resonance Imaging ◽  
Systematic Review ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Spinal Cord Compression ◽  
Subgroup Analysis ◽  
Meta Analysis ◽  
Cord Compression ◽  
Healthy Population ◽  
Resonance Imaging

Study Design: Systematic review and meta-analysis. Objectives: Cervical spinal cord compression (SCC) due to degenerative changes of the spine is a frequent finding on magnetic resonance imaging (MRI). While most people remain asymptomatic, a proportion develop symptoms of degenerative cervical myelopathy (DCM). DCM is an often-progressive neurological disease that can cause quadriplegia. The epidemiology of SCC and DCM is poorly understood. We sought to estimate the prevalence of degenerative cervical SCC and DCM from cross-sectional cohorts undergoing MRI. Methods: We conducted a systematic review and meta-analysis of MRI reports on human subjects older than 16 years with degenerative SCC. A predetermined search strategy was used to identify relevant literature on MEDLINE. Title and abstract screenings were followed by full text screening. Data was extracted and analyzed by fixed or random-effects models. Results: The present search returned 1506 publications. Following our exclusion criteria, 19 studies were included. Subgroup analysis of 3786 individuals estimated the prevalence of asymptomatic SCC in a healthy population as 24.2% with a significantly higher prevalence of SCC in older populations compared with younger populations and American/European populations compared with Asian populations. Subgroup analysis of 1202 individuals estimated the prevalence of DCM in a healthy population as 2.3%. Conclusions: We present the first estimates of the prevalence of asymptomatic SCC and DCM. Studies investigating the epidemiology of SCC are heterogeneous in methodology and results. These data indicate the need for more studies into the epidemiology of SCC and DCM performed with consistent methodologies.

178 Hybrid Surgery-Radiosurgery Therapy for Metastatic Epidural Spinal Cord Compression (MESCC): A Prospective Evaluation Using Patient-Reported Outcomes

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 246-247
Author(s):  
Ori Barzilai ◽  
Mary Kate Amato ◽  
Lily McLaughlin ◽  
Anne Reiner ◽  
Shahiba Ogilvie ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Patient Reported Outcomes ◽  
Cord Compression ◽  
Pain Severity ◽  
Primary Study ◽  
Hybrid Surgery ◽  
Hybrid Therapy ◽  
Therapy Effect ◽  
Patient Reported

Abstract INTRODUCTION Patient-reported outcomes (PRO) represent an important measure of cancer therapy effect. For patients with metastatic epidural spinal cord compression (MESCC), hybrid therapy using separation surgery and stereotactic radiosurgery (SRS) preserves neurologic function and provides tumor control. There is currently a paucity of data reporting PRO after such combined modality therapy for MESCC. Delineation of hybrid surgery-radiosurgery therapy effect on PRO validates the hybrid approach as an effective therapy resulting in meaningful symptom relief. METHODS Brief Pain Inventory (BPI) and MD Anderson Symptom Inventory Spine Tumor (MDASI-SP), PROs validated in the cancer population, were prospectively collected. Patients with MESCC who underwent separation surgery followed by SRS were included. Separation surgery included a posterolateral approach without extensive cytoreductive tumor excision. A median post-operative radiosurgery dose of 2700 cGy was delivered. The change in PRO three months after the hybrid therapy represented the primary study outcome. Pre- and post-operative evaluations were analyzed using the Wilcoxon signed-rank test for matched pairs. RESULTS >One hundred and eleven patients were included. Hybrid therapy resulted in a significant reduction in the BPI items “worst” and “right now” pain (P < 0.0001), and in all BPI constructs (severity, interference with daily activities, and Pain Experience, P < 0.001). The MDASI-SP demonstrated reduction in spine specific pain severity and interference with general activity (P < 0.001), along with decreased symptom interference (P < 0.001). CONCLUSION Validated PRO instruments showed that in patients with MESCC, hybrid separation surgery-radiosurgery therapy results in a significant decrease in pain severity and symptom interference. These prospective data confirm the benefit of hybrid therapy for treatment of MESCC and should facilitate referral of patients with MESCC for surgical evaluation.

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