Separation Surgery for Spinal Metastases: A Review on Surgical Treatment Goals
|
|
- Adela Holt
- 5 years ago
- Views:
Transcription
1 WScJ : 5-9, 6 Separation Surgery for Spinal Metastases: A Review on Surgical Treatment Goals Gabriel A. Smith, Arunit J. Chugh, Michael Steinmetz Department of Neurosurgery, Case Western Reserve University School of Medicine, University Hospitals, Cleveland, OH Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland Clinic Foundation, Cleveland, OH Abstract Spinal metastases occur in nearly half of all patients with cancer and may cause instability, intractable pain, and neurologic injury secondary to epidural spinal cord compression (ESCC). A multidisciplinary approach to these patients is critical, and surgery must always be considered. Circumferential decompression and stabilization, if necessary, preserves short term function while creating borders between neural elements and metastatic tissue. After surgery, stereotactic radiotherapy can be delivered, which may achieve local control rates of nearly 8% at years depending the underlying tumor etiology. In this review, we aim to elucidate the surgical decisionmaking and goals for separation surgery in patients with ESCC. Key words: Separation surgery, Spinal cord compression, spinal metastases, spinal radiosurgery Introduction Metastatic Spinal Disease Spinal metastases are estimated to occur in 4% of all patients with cancer (). Metastatic disease can cause spinal instability, spinal cord compression which can lead to neurologic injury, and pain (,,8). Epidural spinal cord compression (ESCC) affects up to % of all patients with cancer and approximately 8, admissions annually occur from spinal cord compression according to the nationwide inpatient sample (7,,9). In patients with spinal cord compression, preservation of neurologic function is the goal of treatment to maintain quality of life. A multidisciplinary approach to patients with ESCC is critical. In addition to systemic therapy, surgical and radiotherapy are often needed to preserve quality of life. In a randomized controlled study of surgical decompression with conventional radiotherapy, Patchell et al, demonstrated superiority of combined surgery and radiotherapy for recovery and maintenance of neurologic function and World Spinal Column Journal, Volume 7 / No: / January 6 survival (). While surgery provides spinal stabilization and neural element decompression, prompt radiotherapy can lead to long-term local tumor control as low as 8% for even radioresistant tumors (6,,8,). Stereotactic Radiosurgery Stereotactic spinal radiosurgery (SRS) and external beam radiotherapy (EBRT) have emerged as the mainstay of treatment for metastatic disease to the spine. EBRT has shown histology-specific sensitivity. Radiosensitive malignances such as lymphoma and multiple myeloma have -year local control rates of up to 8 to 9%, however, radioresistant tumors such as renal cell carcinoma or melanoma may be as low as % (9,,8). The emergence of high-dose hypofractionated SRS has revolutionized radiotherapy for metastatic lesions. Gerszten et al, treated spinal metastases without epidural extension using multiand single-fractionated SRS each demonstrating 9% and 7% local disease control for cases of failed EBRT and firstline therapy (). One cohort of radiosurgery for ESCC 5
2 Separation Spinal Surgery due to radioresistant lesions described a 65% reduction in tumor volume at months and 8% rate of improvement in function at month follow-up (4-6). This data suggests SRS is capable of achieving local control rates for refractory cases to EBRT or as first-line therapy for radioresistant tumors. Separation Surgery The hallmarks of separation surgery are to decompress the neural elements away from epidural encroaching disease of at least - millimeters prior to radiotherapy. Patients with acute neurologic decline and a known lesion should be considered for urgent decompression immediately if medically cleared. However, surgical treatment for ESCC without neurologic deficits remains a point of debate. The ESCC scale developed by Bilsky et al, provides a common vocabulary to stratify patients based upon low-grade versus high-grade compression radiographically (Table ) (-,9). Surgical decision-making must take into account the radiosensitivity of the known primary, stability of the lesion, and overall prognosis of the patient (,,4,5,9). In high grade lesions, neurologic compromise may be imminent and SRS can take up to months to show tumor volume reduction. Thus, these patients should be considered for decompression at least to avoid neurologic compromise and preserve quality of life. Lesions abutting the spinal cord but without true circumferential compression present a dilemma as SRS can be toxic to neural elements at high doses. Sahgal et al, have shown radiation induced myelopathy can occur with as low as -4Gy per single fraction of radiation delivered when ESCC is present (7). EBRT can be delivered safely, however, radioresistant tumors such as renal cell carcinoma or melanoma may be refractory in many instances. By achieving separation of just - millimeters, tumoricidal radiation doses can be delivered safely in these select patients. Thus, surgery should be considered in patients with lower grades of ESCC if SRS is necessary. Surgical approach is dictated by the location of the epidural disease (Figure A-F). Dorsal epidural decompression can be achieved via wide laminectomy, however, ventral and lateral decompression often warrants removal of posterior elements and may require stabilization. Wide unilateral or bilateral transpedicular approaches with a high-speed drill allows maximal exposure of ventral, lateral, or circumferential epidural tumor without manipulation of the spinal cord (Figure ). In the thoracic spine, nerve roots below T can be sacrificed to improve exposure. Once lateral decompression is adequate, the posterior aspect of the vertebral body can resected to allow for down-going curettes to be used to push any remaining epidural tumor away from the thecal sac. In cases with severe destruction of the vertebral body, anterior reconstruction may be necessary for stabilization. Spinal Instrumentation Posterior spinal instrumentation should be considered when posterior element resection is performed, in cases of instability, or in select cases prophylactically (Figure A-F). The Spinal Instability Neoplastic Scores (SINS) is a validated decision-making tool, which can help surgeons preoperatively determine if stabilization is needed (Table ) (5,7,8,6). Moussazadeh et al, examined 8 patients who underwent decompression and fixation without anterior reconstruction at their institution over a 7 year period from 4 to. The median follow-up time was 99 days and only 9 patients (.8%) demonstrated hardware failure. Patients with chest wall resection and construct length longer than six contiguous spinal levels exhibited a statistically significant higher risk of hardware failure. Thus, instrumentation of at least two levels above and below is recommended in most cases and has been shown to low rates of hardware failure. Cross-links should be avoided to prevent scatter artifact during treatment. Bioactive materials to promote fusion after stabilization are avoided in these patients secondary to the adjuvant radiation that will be delivered. Table : Epidural Spinal Cord Compression Scale Grade Grade a Grade b Grade c Grade Grade Bone-only Disease Epidural Disease without Thecal Sac Compression Deformation of Thecal Sac Deformation of Thecal Sac and Spinal Cord Abutment Spinal Cord Compression with CSF visible Spinal Cord Compression without CSF visible Low-Grade ESCC High-Grade ESCC 6 World Spinal Column Journal, Volume 7 / No: / January 6
3 GA Smith et al. a B C D E F Figure : Epidural Compression. Axial images displaying epidural mass lesions causing dorsolateral (A), ventral (B), and circumferential (C) compression of the thecal sac and spinal cord. D-F: Surgical Approaches. Wide laminectomy (D) with resection of laminae as well as the medial facet joints is shown for dorsal epidural compression. Unilateral transpedicular approach (E) with resection of laminae as well is shown for ventrolateral epidural compression. Bilateral transpedicular approach (F) with resection of laminae as well as both pedicles is shown for circumferential compression. B E a C D F Figure : 7 year-old male with salivary gland myoepithelial carcinoma refractory to initial radiotherapy with worsening of pain and sudden neurologic decline. Preoperative MRI with Gadolinium T Sagittal and Axial (A and B) and Axial T (C) images demonstrated high grade cord compression. He underwent a T6-T posterior decompression and instrumentation with right sided T8 transpedicular approach for ventral tumor separation. Patient tolerated the procedure well and returned to full strength postoperatively. MRI with gadolinium T Sagittal and Axial (D and E) and T Axial (F) confirmed adequate decompression and separation making him a candidate for SRS postoperatively. World Spinal Column Journal, Volume 7 / No: / January 6 7
4 Separation Spinal Surgery Table : Spinal Instability Neoplastic Score (SINS) 8 Spine Location - Junctional (Occiput-C, C7-T, T-L, L5-S) - Mobile (C-C6, L-L4) - Semi Rigid (T-T) - Rigid (S-S5) Mechanical or Postural Pain - Yes - No (Occasional Pain but not Mechanical) - Pain Free Lesion Bone lesion quality - Lytic - Mixed Lytic/Blastic - Blastic Radiographic Spinal Alignment - Subluxation/Translation Present - De Novo Deformity (kyphosis/scoliosis) - Normal Alignment Vertebral Body Collapse - >5% collapse - <5% collapse - No Collapse with >5% Involvement - None of the Above Posterior Element Involvement - Bilateral - Unilateral - None of the Above Score Vertebral compression fracture (VCF) after SRS for spinal metastases has been estimated to occur between -9% of cases (4). Boehling et al, reviewed vertebral bodies in 9 patients prospectively who received SRS in,, or 5 fractions. They found % of patients developed VCF after SRS. The most common histology for fracture was renal cell carcinoma (/6, 8%) in their study. This data suggests prophylactic spinal stabilization at the time of separation surgery may be warranted for certain histologies, but further research must be performed to make concrete conclusions. 4 Post-operatively, CT myelography or high resolution MRI should be performed for procedural planning and simulation for treatment. EBRT, single- or multifractionated SRS should be planned and prescribed prior to discharge. Bilsky et al described 86 patients treated with decompression separation surgery followed by adjuvant hypofractionated or single dose SRS with 6 having highgrade cord compression. Patients received hypofractionated SRS within.6 months following surgery and cumulative local progression at year was 6.4% (). This data suggests excellent local control rates if prompt radiotherapy can be delivered after separation surgery is performed. Conclusions For patients with ESCC, surgical considerations must take into account neurologic status, primary histology, patient prognosis, and radiotherapy options available to the patient. In patients with neurologic decline, urgent decompression must be considered. SRS requires separation - millimeters to be performed safely. Outside of select instances of radiosensitive tumors, separation surgery should be considered for ESCC abutting the spinal cord. Stabilization following decompression is necessary in most cases and should be performed posteriorly in the majority of cases. A multidisciplinary approach to this patient population is critical to maintain quality of life and improve survival. Patient selection is critical to give patient s access to optimal medical and surgical management moving forward. Prospective studies on adjuvant radiotherapy timing and dosing for different histologies is the frontier and must be performed to create treatment paradigms unique to specific patient populations. REFERENCES. Bilsky M, Smith M: Surgical approach to epidural spinal cord compression. Hematol Oncol Clin North Am :7-7, 6. Bilsky MH, Laufer I, Burch S: Shifting paradigms in the treatment of metastatic spine disease. Spine (Phila Pa 976) 4:S-7, 9. Bilsky MH, Laufer I, Fourney DR, Groff M, Schmidt MH, Varga PP, et al: Reliability analysis of the epidural spinal cord compression scale. J Neurosurg Spine :4-8, 4. Boehling NS, Grosshans DR, Allen PK, McAleer MF, Burton AW, Azeem S, et al: Vertebral compression fracture risk after stereotactic body radiotherapy for spinal metastases. J Neurosurg Spine 6:79-86, 5. Campos M, Urrutia J, Zamora T, Roman J, Canessa V, Borghero Y, et al: The Spine Instability Neoplastic Score: an independent reliability and reproducibility analysis. Spine J 4: , 4 6. Choi CY, Adler JR, Gibbs IC, Chang SD, Jackson PS, Minn AY, et al: Stereotactic radiosurgery for treatment of spinal metastases recurring in close proximity to previously irradiated spinal cord. Int J Radiat Oncol Biol Phys 78:499-56, 8 World Spinal Column Journal, Volume 7 / No: / January 6
5 GA Smith et al. 7. Fisher CG, DiPaola CP, Ryken TC, Bilsky MH, Shaffrey CI, Berven SH, et al: A novel classification system for spinal instability in neoplastic disease: An evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine (Phila Pa 976) 5:E-9, 8. Fourney DR, Frangou EM, Ryken TC, Dipaola CP, Shaffrey CI, Berven SH, et al: Spinal instability neoplastic score: an analysis of reliability and validity from the spine oncology study group. J Clin Oncol 9:7-77, 9. Gerszten PC, Burton SA: Clinical assessment of stereotactic IGRT: spinal radiosurgery. Med Dosim :7-6, 8. Gerszten PC, Burton SA, Ozhasoglu C, Welch WC: Radiosurgery for spinal metastases: Clinical experience in 5 cases from a single institution. Spine (Phila Pa 976) :9-99, 7. Gerszten PC, Mendel E, Yamada Y: Radiotherapy and radiosurgery for metastatic spine disease: What are the options, indications, and outcomes? Spine (Phila Pa 976) 4:S78-9, 9. Gilbert RW, Kim JH, Posner JB: Epidural spinal cord compression from metastatic tumor: Diagnosis and treatment. Ann Neurol :4-5, 978. Laufer I, Iorgulescu JB, Chapman T, Lis E, Shi W, Zhang Z, et al: Local disease control for spinal metastases following separation surgery and adjuvant hypofractionated or high-dose single-fraction stereotactic radiosurgery: Outcome analysis in 86 patients. J Neurosurg Spine 8:7-4, 4. Laufer I, Rubin DG, Lis E, Cox BW, Stubblefield MD, Yamada Y, et al: The NOMS framework: Approach to the treatment of spinal metastatic tumors. Oncologist 8:744-75, 5. Liu JK, Laufer I, Bilsky MH: Update on management of vertebral column tumors. CNS Oncol :7-47, 4 6. Lo SS, Ryu S, Chang EL, Galanopoulos N, Jones J, Kim EY, et al: ACR Appropriateness Criteria(R) Metastatic Epidural Spinal Cord Compression and Recurrent Spinal Metastasis. J Palliat Med 8:57-584, 5 7. Mak KS, Lee LK, Mak RH, Wang S, Pile-Spellman J, Abrahm JL, et al: Incidence and treatment patterns in hospitalizations for malignant spinal cord compression in the United States, Int J Radiat Oncol Biol Phys 8:84-8, 8. Moulding HD, Elder JB, Lis E, Lovelock DM, Zhang Z, Yamada Y, et al: Local disease control after decompressive surgery and adjuvant highdose single-fraction radiosurgery for spine metastases. J Neurosurg Spine :87-9, 9. Moussazadeh N, Laufer I, Yamada Y, Bilsky MH: Separation surgery for spinal metastases: Effect of spinal radiosurgery on surgical treatment goals. Cancer Control :68-74, 4. National Collaborating Centre for C: National Institute for Health and Clinical Excellence: Guidance, in Metastatic Spinal Cord Compression: Diagnosis and Management of Patients at Risk of or with Metastatic Spinal Cord Compression. Cardiff (UK): National Collaborating Centre for Cancer (UK) National Collaborating Centre for Cancer., 8. Ortiz Gomez JA: The incidence of vertebral body metastases. Int Orthop 9:9-, 995. Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, et al: Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: A randomised trial. Lancet 66:64-648, 5. Rades D, Veninga T, Stalpers LJ, Basic H, Rudat V, Karstens JH, et al: Outcome after radiotherapy alone for metastatic spinal cord compression in patients with oligometastases. J Clin Oncol 5:5-56, 7 4. Ryu S, Pugh SL, Gerszten PC, Yin FF, Timmerman RD, Hitchcock YJ, et al: RTOG 6 phase / study of image guided stereotactic radiosurgery for localized (-) spine metastases: Phase results. Pract Radiat Oncol 4:76-8, 4 5. Ryu S, Pugh SL, Gerszten PC, Yin FF, Timmerman RD, Hitchcock YJ, et al: RTOG 6 Phase II/III Study of Image-Guided Stereotactic Radiosurgery for Localized (-) Spine Metastases: Phase II Results. Int J Radiat Oncol Biol Phys 8:S-s, 6. Ryu S, Rock J, Jain R, Lu M, Anderson J, Jin JY, et al: Radiosurgical decompression of metastatic epidural compression. Cancer 6:5-57, 7. Sahgal A, Ma L, Gibbs I, Gerszten PC, Ryu S, Soltys S, et al: Spinal cord tolerance for stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys 77:548-55, 8. Sze WM, Shelley M, Held I, Mason M: Palliation of metastatic bone pain: Single fraction versus multifraction radiotherapy - a systematic review of the randomised trials. Cochrane Database Syst Rev:Cd47, 4 9. Wong DA, Fornasier VL, MacNab I: Spinal metastases: The obvious, the occult, and the impostors. Spine (Phila Pa 976) 5:-4, 99 Manuscript submitted September 4, 5. Accepted October 5, 5. Address correspondence to: Gabriel A. Smith, Department of Neurological Surgery, University Hospitals Case Medical Center, Euclid Avenue, Cleveland, Ohio 446, Phone: Gabriel.Smith@UHHospitals.org World Spinal Column Journal, Volume 7 / No: / January 6 9
See the corresponding editorial in this issue, pp J Neurosurg Spine 18: , 2013 AANS, 2013
See the corresponding editorial in this issue, pp 205 206. J Neurosurg Spine 18:207 214, 2013 AANS, 2013 Local disease control for spinal metastases following separation surgery and adjuvant hypofractionated
More information8/3/2017. Spine SBRT: A Clinician's Update On Techniques and Outcomes. Disclosures. Outline
Spine SBRT: A Clinician's Update On Techniques and Outcomes Chia-Lin (Eric) Tseng, MD FRCPC Radiation Oncologist Sunnybrook Health Sciences Centre University of Toronto August 3, 2017 Disclosures I have
More information9:00-9:10 am Metastatic Epidural Cervical Spinal Cord Compression CSRS San Diego, 2015 Michael G. Fehlings, MD
9:00-9:10 am Metastatic Epidural Cervical Spinal Cord Compression CSRS San Diego, 2015 Michael G. Fehlings, MD 1 BACKGROUND After the lungs and the liver, metastases most frequently arise in osseous tissues;
More informationTr e at m e n t decisions regarding metastatic spine disease. Reliability analysis of the epidural spinal cord compression scale.
J Neurosurg Spine 13:324 328, 2010 Reliability analysis of the epidural spinal cord compression scale Clinical article Mar k H. Bi l s k y, M.D., 1,2 Ilya La u f e r, M.D., 2 Da r y l R. Fo u r n e y,
More informationInterobserver agreement for the spine instability neoplastic score varies according to the experience of the evaluator
CLINICAL SCIENCE Interobserver agreement for the spine instability neoplastic score varies according to the experience of the evaluator William Gemio Jacobsen Teixeira, I Pedro Ricardo de Mesquita Coutinho,
More informationThe use of surgery in the elderly. for management of metastatic epidural spinal cord compression
The use of surgery in the elderly Bone Tumor Simulators for management of metastatic epidural spinal cord compression Justin E. Bird, M.D. Assistant Professor Orthopaedic Oncology and Spine Surgery Epidemiology
More informationMore than 1.6 million new cases of cancer are diagnosed. Stereotactic radiosurgery for spinal metastases with or without separation surgery.
spine clinical article J Neurosurg Spine 22:409 415, 2015 Stereotactic radiosurgery for spinal metastases with or without separation surgery Berkeley G. Bate, MD, 1 Nickalus R. Khan, MD, 1 Brent Y. Kimball,
More informationA new score predicting the survival of patients with spinal cord compression from myeloma
Douglas et al. BMC Cancer 2012, 12:425 RESEARCH ARTICLE Open Access A new score predicting the survival of patients with spinal cord compression from myeloma Sarah Douglas 1, Steven E Schild 2 and Dirk
More informationMetastatic Spinal Disease
Metastatic Spinal Disease Mr Neil Chiverton Consultant Spinal Surgeon, Sheffield Objectives The scale and nature of the problem NICE recommendations Surgical decision making Case illustrations Incidence
More informationACR Appropriateness Criteria â Metastatic Epidural Spinal Cord Compression and Recurrent Spinal Metastasis
JOURNAL OF PALLIATIVE MEDICINE Volume 18, Number 7, 2015 ª Mary Ann Liebert, Inc. DOI: 10.1089/jpm.2015.28999.sml Special Report ACR Appropriateness Criteria â Metastatic Epidural Spinal Cord Compression
More informationPage 1 of 6 PATIENT PRESENTATION
PATIENT PRESENTATION Suspected spinal cord compression (severe pain or abnormal neurology, or incidental finding on MRI- not intended for traumatic injuries. If in emergency center, triage patient as emergent.)
More informationVertebral compression fractures after stereotactic body radiation therapy: a large, multi-institutional, multinational evaluation
clinical article J Neurosurg Spine 24:928 936, 2016 Vertebral compression fractures after stereotactic body radiation therapy: a large, multi-institutional, multinational evaluation Maha Saada Jawad, MD,
More informationACR Appropriateness Criteria Metastatic Epidural Spinal Cord Compression and Recurrent Spinal Metastasis EVIDENCE TABLE
. Cole JS, Patchell RA. Metastatic epidural spinal cord compression. Lancet Neurol. 2008;7(5):59-66. 2. Loblaw DA, Mitera G, Ford M, Laperriere NJ. A 20 updated systematic review and clinical practice
More informationDisclosure SBRT. SBRT for Spinal Metastases 5/2/2010. No conflicts of interest. Overview
Stereotactic Body Radiotherapy (SBRT) for Recurrent Spine Tumors Arjun Sahgal M.D., F.R.C.P.C. Assistant Professor Princess Margaret Hospital Sunnybrook Health Sciences Center University of Toronto Department
More informationMalignant epidural spinal cord compression: the role of external beam radiotherapy
REVIEW C URRENT OPINION Malignant epidural spinal cord compression: the role of external beam radiotherapy Tanya Holt a, Peter Hoskin b, Ernesto Maranzano c, Arjun Sahgal d, Steven E. Schild e, Samuel
More informationCase Conference: SBRT for spinal metastases D A N I E L S I M P S O N M D 3 / 2 7 / 1 2
Case Conference: SBRT for spinal metastases D A N I E L S I M P S O N M D 3 / 2 7 / 1 2 Case 79 yo M with hx of T3N0 colon cancer diagnosed in 2008 metastatic liver disease s/p liver segmentectomy 2009
More informationThe current status and future of radiotherapy for spinal bone metastases
J Orthop Sci (2015) 20:585 592 DOI 10.1007/s00776-015-0720-x REVIEW ARTICLE The current status and future of radiotherapy for spinal bone metastases Yasuo Ejima 1 Yoshiro Matsuo 1 Ryohei Sasaki 1 Received:
More informationDepartment of Orthopedic Surgery, Henan Province People s Hospital, Henan, People s Republic of China; 2
Int J Clin Exp Med 2018;11(3):2465-2470 www.ijcem.com /ISSN:1940-5901/IJCEM0060812 Original Article Validation of a scoring system predicting survival and function outcome in patients with metastatic epidural
More informationDisclosure. Paul Medin teaches radiosurgery courses sponsored by BrainLAB Many animals (and humans) were harmed to make this presentation possible!
Disclosure The tolerance of the nervous system to SBRT: dogma, data and recommendations Paul Medin, PhD Paul Medin teaches radiosurgery courses sponsored by BrainLAB Many animals (and humans) were harmed
More informationRole of Posterior Fixation Technique in Surgeries for Pathological Fractures of the Dorsal and Lumbar Spine Secondary to Neoplastic Causes
Med. J. Cairo Univ., Vol. 83, No. 1, March: 293-298, 2015 www.medicaljournalofcairouniversity.net Role of Posterior Fixation Technique in Surgeries for Pathological Fractures of the Dorsal and Lumbar Spine
More informationJ Neurosurg Spine 18:
See the corresponding editorial in this issue, pp 48 49. J Neurosurg Spine 8:4 45, AANS, Radiation-induced vertebral compression fracture following spine stereotactic radiosurgery: clinicopathological
More information8/2/2018. Acknowlegements: TCP SPINE. Disclosures
A Presentation for the AAPM Annual meeting, Aug 2, 2018 Nashville, TN Stereotactic Radiosurgery for Spinal Metastases: Tumor Control Probability Analyses and Recommended Reporting Standards for Future
More information20. Background. Oligometastases. Oligometastases: bone (including spine) and lymph nodes
125 20. Oligometastases Background The oligometastatic state can be defined as 1 3 isolated metastatic sites, typically occurring more than six months after successful treatment of primary disease. 1 In
More informationModern approaches to the management of metastatic epidural spinal cord compression
CNS Oncology For reprint orders, please contact: reprints@futuremedicine.com Modern approaches to the management of metastatic epidural spinal cord compression Zain A Husain*,1, Arjun Sahgal 2, Eric L
More informationThe vertebral column is the primary osseous target of
spine clinical article J Neurosurg Spine 23:228 232, 2015 Predictors of delayed failure of structural kyphoplasty for pathological compression fractures in cancer patients Gary Rajah, MD, 1 David Altshuler,
More informationKim, Hyoungmin 1 ; Lee, Choon-Ki 1 ; Yeom, Jin S. 1 ; Lee, Jae Hyup 1 ; Lee, Suk- Joong 2 ; Chang, Bong-Soon 1
The Predictive Value of the Spinal Instability Neoplastic Score (SINS) System for Adverse Events of Pathologic Fracture and Spinal Cord Compression in Patients with Single Spinal Metas tasis. Kim, Hyoungmin
More informationRenal cell cancer (RCC) metastases have been traditionally
J Neurosurg Spine 21:711 718, 2014 AANS, 2014 Spine stereotactic body radiotherapy for renal cell cancer spinal metastases: analysis of outcomes and risk of vertebral compression fracture Clinical article
More informationSpinal cord compression as a first presentation of cancer: A case report
J Pain Manage 2013;6(4):319-322 ISSN: 1939-5914 Nova Science Publishers, Inc. Spinal cord compression as a first presentation of cancer: A case report Nicholas Lao, BMSc(C), Michael Poon, MD(C), Marko
More informationSpinal metastases are diagnosed in approximately
CLINICAL ARTICLE J Neurosurg Spine 29:2 8, 218 Postoperative re-irradiation using stereotactic body radiotherapy for metastatic epidural spinal cord compression Kei Ito, MD, 1, Keiji Nihei, MD, PhD, 1
More informationanalysis for LC with tumor volume (p = 0.272), number of treated levels (p = 0.819), gross tumor volume (GTV)
Clinical article J Neurosurg Spine 24:829 836, 2016 Single-fraction versus multifraction spinal stereotactic radiosurgery for spinal metastases from renal cell carcinoma: secondary analysis of Phase I/II
More information4.x Oligometastases: evidence for dose-fractionation
4.x Oligometastases: evidence for dose-fractionation Background 4.x.1. The oligometastatic state can be defined as 1-3 isolated metastatic sites, typically occurring more than six months after successful
More informationMetastatic epidural spinal cord compression (MESCC)
SPINE Volume 39, Number 9, pp E587 - E592 2014, Lippincott Williams & Wilkins LITERATURE REVIEW Direct Decompressive Surgery Followed by Radiotherapy Versus Radiotherapy Alone for Metastatic Epidural Spinal
More informationRadiotherapy symptoms control in bone mets. Francesco Cellini GemelliART. Ernesto Maranzano,MD. Session 5: Symptoms management
Session 5: Symptoms management Radiotherapy symptoms control in bone mets Francesco Cellini GemelliART Ernesto Maranzano,MD Director of Oncology Department Chief of Radiation Oncology Centre S. Maria Hospital
More informationagreed MSCC pathways and guidelines).
Referral of Patients with Spinal Metastatic Disease and Suspected Metastatic Spinal Cord Compression (to be used in association with locally West Midlands Clinical Networks and Clinical Senate Coversheet
More informationSurgical Treatment of Spine Surgery Experience Primary Spinal Neoplasms ( ) Ziya L. Gokaslan, MD, FACS Approximately 3500 spine tumor
Surgical Treatment of Primary Spinal Neoplasms Ziya L. Gokaslan, MD, FACS Donlin M. Long Professor Professor of Neurosurgery, Oncology & Orthopaedic Surgery Vice Chairman Director of Spine Program Department
More informationPostoperative stereotactic body radiotherapy for spinal metastases
Review Article Page 1 of 11 Postoperative stereotactic body radiotherapy for spinal metastases Majed Alghamdi 1,2, Chia-Lin Tseng 1, Sten Myrehaug 1, Pejman Maralani 3, Chris Heyn 3, Hany Soliman 1, Young
More informationInternational Spine Radiosurgery Consortium Consensus Guidelines for Target Volume Definition in Spinal Stereotactic Radiosurgery
CME International Journal of Radiation Oncology biology physics www.redjournal.org Clinical Investigation: Central Nervous System Tumor International Spine Radiosurgery Consortium Consensus Guidelines
More informationPalliative RT. Jiraporn Setakornnukul, M.D. Radiation Oncology Division Siriraj Hospital, Mahidol University
Palliative RT Jiraporn Setakornnukul, M.D. Radiation Oncology Division Siriraj Hospital, Mahidol University Scope Brain metastasis Metastasis epidural spinal cord compression SVC obstruction Bone pain
More informationConsensus guidelines for postoperative stereotactic body radiation therapy for spinal metastases: results of an international survey
CLINICAL ARTICLE J Neurosurg Spine 26:299 306, 2017 Consensus guidelines for postoperative stereotactic body radiation therapy for spinal metastases: results of an international survey Kristin J. Redmond,
More informationand Strength of Recommendations
ASTRO with ASCO Qualifying Statements in Bold Italics s patients with T1-2, N0 non-small cell lung cancer who are medically operable? 1A: Patients with stage I NSCLC should be evaluated by a thoracic surgeon,
More informationGUIDELINES FOR RADIOTHERAPY IN SPINAL CORD COMPRESSION THE CHRISTIE, GREATER MANCHESTER & CHESHIRE. Version:
GUIDELINES FOR RADIOTHERAPY IN SPINAL CORD COMPRESSION THE CHRISTIE, GREATER MANCHESTER & CHESHIRE Procedure Reference: Document Owner: Dr V. Misra Version: Accountable Committee: V4 Acute Oncology Group
More informationWorkshop. Eric M. Massicotte, MD, MSc, MBA, FRCSC Associate Professor University of Toronto
Workshop Eric M. Massicotte, MD, MSc, MBA, FRCSC Associate Professor University of Toronto Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored,
More informationConflict of interest disclosure
Stereotactic Body Radiation Therapy (SBRT) I: Radiobiology and Clinical Experience Brian Kavanagh, M.D., MPH University of Colorado Eric Chang, M.D. UT MD Anderson Conflict of interest disclosure I have
More informationEn bloc spondylectomy for spinal metastases: a review of techniques
Neurosurg Focus 15 (5):Article 6, 2003, Click here to return to Table of Contents En bloc spondylectomy for spinal metastases: a review of techniques KEVIN C. YAO, M.D., STEFANO BORIANI, M.D., ZIYA L.
More informationSpinal metastases are present in approximately 30%
CLINICAL ARTICLE J Neurosurg Spine 28:72 78, 2018 Safety and utility of kyphoplasty prior to spine stereotactic radiosurgery for metastatic tumors: a clinical and dosimetric analysis Ori Barzilai, MD,
More informationHarrington rod stabilization for pathological fractures of the spine NARAYAN SUNDARESAN, M.D., JOSEPH H. GALICICH, M.D., AND JOSEPH M. LANE, M.D.
J Neurosurg 60:282-286, 1984 Harrington rod stabilization for pathological fractures of the spine NARAYAN SUNDARESAN, M.D., JOSEPH H. GALICICH, M.D., AND JOSEPH M. LANE, M.D. Neurosurgery and Orthopedic
More informationPètra Braam 1*, Philippe Lambin 2 and Johan Bussink 1
Braam et al. Trials (2016) 17:61 DOI 10.1186/s13063-016-1178-7 STUDY PROTOCOL Open Access Stereotactic versus conventional radiotherapy for pain reduction and quality of life in spinal metastases: study
More informationMetachronous presentation of metastasis from renal cell carcinoma: evaluation and management of spinal metastasis
Case report Metachronous presentation of metastasis from renal cell carcinoma: evaluation and ( ) 75 75 82 Metachronous presentation of metastasis from renal cell carcinoma: evaluation and management of
More informationCurrent Concepts and Trends in Spinal Radiosurgery. Edward M. Marchan
Current Concepts and Trends in Spinal Radiosurgery Edward M. Marchan Spinal Neoplasia The spine is the most common site of skeletal metastatic disease. (70%) 40% of bony metastases involve the vertebrae
More informationPalliative radiotherapy in lung cancer
New concepts and insights regarding the role of radiation therapy in metastatic disease Umberto Ricardi University of Turin Department of Oncology Radiation Oncology Palliative radiotherapy in lung cancer
More informationMetastatic disease of the Spine
Metastatic disease of the Spine Jwalant S. Mehta MS (Orth); MCh (Orth); D Orth; FRCS (Tr & Orth) Consultant Spine Surgeon The Royal Orthopaedic Hospital Birmingham Children s Hospital MSCC Metastatic Spinal
More informationSkeletal metastases are a significant source of cancer-related
J Neurosurg Spine 17:11 18, 2012 Single-session and multisession CyberKnife radiosurgery for spine metastases University of Pittsburgh and Georgetown University experience Clinical article Dwight E. Heron,
More informationReirradiation spine stereotactic body radiation therapy for spinal metastases: systematic review
LITERATURE REVIEW Reirradiation spine stereotactic body radiation therapy for spinal metastases: systematic review International Stereotactic Radiosurgery Society practice guidelines Sten Myrehaug, MD,
More informationVertebral Body Compression Fracture Following Spine SBRT
RADIATION ONCOLOGY & MOLECULAR RADIATION SCIENCES Vertebral Body Compression Fracture Following Spine SBRT Kristin J. Redmond, MD, MPH Disclosure & Disclaimer An honorarium is provided by Accuray for this
More informationA new instrument for estimation of survival in elderly patients irradiated for metastatic spinal cord compression from breast cancer
Rades et al. Radiation Oncology (2015) 10:173 DOI 10.1186/s13014-015-0483-8 RESEARCH A new instrument for estimation of survival in elderly patients irradiated for metastatic spinal cord compression from
More informationDisclosures. Disclosures 27/01/2019. Modern approach and pitfalls in metastatic spine surgery. None.. Jeremy Reynolds
Modern approach and pitfalls in metastatic spine surgery Jeremy Reynolds Spine Lead Oxford Bone and Soft Tissue Sarcoma Service MSCC Lead Thames Valley Cancer Network Clinical Lead Oxford Spine 1 Disclosures
More informationJ Korean Soc Spine Surg 2018 Jun;25(2): Originally published online June 30, 2018;
Journal of Korean Society of Spine Surgery The Spinal Instability Neoplastic Score (SINS) as a Surgical Decision-Making Tool for the Treatment of Spine Metastasis Sang-Min Park, M.D., Hyoungmin Kim, M.D.,
More informationMinimally Invasive Radiofrequency Ablation Treatment of Metastatic Spinal Tumors
Minimally Invasive Radiofrequency Ablation Treatment of Metastatic Spinal Tumors 1 Objectives Demographics of spinal tumors Treatment options and goals Adoption of RF ablation for pain palliation by NCCN
More informationTania Kaprealian, M.D. Assistant Professor UCLA Department of Radiation Oncology August 22, 2015
Tania Kaprealian, M.D. Assistant Professor UCLA Department of Radiation Oncology August 22, 2015 Most common brain tumor, affecting 8.5-15% of cancer patients. Treatment options: Whole brain radiation
More informationSystematic review Cervical artificial disc replacement versus fusion in the cervical spine: a systematic review (...)
Systematic review Cervical artificial disc replacement versus fusion in the cervical spine: a systematic review (...) 59 59 66 Cervical artificial disc replacement versus fusion in the cervical spine:
More informationCASE REPORT. Department of Radiology and Radiation Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
Nagoya J. Med. Sci. 75. 263 ~ 271, 2013 CASE REPORT STEREOTACTIC RADIOTHERAPY FOR SPINAL INTRADURAL METASTASES DEVELOPING WITHIN OR ADJACENT TO THE PREVIOUS IRRADIATION FIELD REPORT OF THREE CASES Yoshimasa
More informationA PATIENT WITH TWO EPISODES OF THORACIC SPINAL CORD COMPRESSION CAUSED BY PRIMARY LYMPHOMA AND METASTATIC CARCINOMA OF THE PROSTATE, 11 YEARS APART
A PATIENT WITH TWO EPISODES OF THORACIC SPINAL CORD COMPRESSION CAUSED BY PRIMARY LYMPHOMA AND METASTATIC CARCINOMA OF THE PROSTATE, 11 YEARS APART Shih-Huang Tai, 1 Yu-Chang Hung, 1 Jian-Chin Chen, 2
More informationSurvival Rate and Neurological Outcome after Operation for Advanced Spinal Metastasis (Tomita s Classification Type 4)
Original Article DOI 10.3349/ymj.2009.50.5.689 pissn: 0513-5796, eissn: 1976-2437 Yonsei Med J 50(5): 689-696, 2009 Survival Rate and Neurological Outcome after Operation for Advanced Spinal Metastasis
More informationSUCCESSFUL TREATMENT OF METASTATIC BRAIN TUMOR BY CYBERKNIFE: A CASE REPORT
SUCCESSFUL TREATMENT OF METASTATIC BRAIN TUMOR BY CYBERKNIFE: A CASE REPORT Cheng-Ta Hsieh, 1 Cheng-Fu Chang, 1 Ming-Ying Liu, 1 Li-Ping Chang, 2 Dueng-Yuan Hueng, 3 Steven D. Chang, 4 and Da-Tong Ju 1
More informationSPINAL STEREOTACTIC BODY RADIOTHERAPY
1. Introduction SPINAL STEREOTACTIC BODY RADIOTHERAPY Metastasis to the spinal column is an emergent problem in cancer patients which is not rare and occurs in almost 40%. (1) The aim in management of
More informationManagement of single brain metastasis: a practice guideline
PRACTICE GUIDELINE SERIES Management of single brain metastasis: a practice guideline A. Mintz MD,* J. Perry MD, K. Spithoff BHSc, A. Chambers MA, and N. Laperriere MD on behalf of the Neuro-oncology Disease
More informationThe surgical treatment of metastatic disease of the spine
The surgical treatment of metastatic disease of the spine Péter Banczerowski National Institute of Neurosurgery, Budapest Spine tumours 15% of the primary tumours of the CNS affect the spine The spine
More informationSBRT for lung metastases: Case report
SBRT for lung metastases: Case report Guillermo de Velasco MD, PhD University Hospital 12 de Octubre @H12O_GUCancer @g_develasco Case report 71 years old man Smoker DM 2005 Right radical nephrectomy Histology:
More informationACR Appropriateness Criteria Spinal Bone Metastases EVIDENCE TABLE
1. Fisher CG, DiPaola CP, Ryken TC, et al. A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group.
More informationMetastatic Spinal Cord Compression
Metastatic Spinal Cord Compression Dr Zacharias Tasigiannopoulos Clinical Oncologist Colney centre Department of Oncology Norwich, UK Introduction 2-5% of cancer patients have an episode of MSCC Initial
More informationRecommendations for cross-sectional imaging in cancer management, Second edition
www.rcr.ac.uk Recommendations for cross-sectional imaging in cancer management, Second edition Tumours of the spinal cord Faculty of Clinical Radiology www.rcr.ac.uk Contents Primary spinal cord tumours
More informationA Novel Classification System for Spinal Instability in Neoplastic Disease
A Novel Classification System for Spinal Instability in Neoplastic Disease An Evidence-Based Approach and Expert Consensus From the Spine Oncology Study Group Charles G. Fisher, MD, MHSc, FRCSC,* Christian
More informationSpinal cord compression as the initial presentation of colorectal cancer: case report and review of the literature
Spinal cord compression as the initial presentation of colorectal cancer: case report and review of the literature Magdalena M. Gilg 1, Gerhard Bratschitsch 1, Ulrike Wiesspeiner 2, Roman Radl 1, Andreas
More informationModern management in vertebral metastasis
43 B. Costachescu, C.E. Popescu Modern management in vertebral metastasis Modern management in vertebral metastasis B. Costachescu, C.E. Popescu Department of Neurosurgery, Division of Spine Surgery, University
More informationSUBAXIAL CERVICAL SPINE TRAUMA- DIAGNOSIS AND MANAGEMENT
SUBAXIAL CERVICAL SPINE TRAUMA- DIAGNOSIS AND MANAGEMENT 1 Anatomy 3 columns- Anterior, middle and Posterior Anterior- ALL, Anterior 2/3 rd body & disc. Middle- Posterior 1/3 rd of body & disc, PLL Posterior-
More informationPalliative transpedicular partial corpectomy without anterior vertebral reconstruction in lower thoracic and thoracolumbar junction spinal metastases
Chang et al. Journal of Orthopaedic Surgery and Research (2015) 10:113 DOI 10.1186/s13018-015-0255-z RESEARCH ARTICLE Palliative transpedicular partial corpectomy without anterior vertebral reconstruction
More informationDespite advances in the care of primary malignant
J Neurosurg Spine 14:537 542, 2011 Efficacy and cost-effectiveness analysis of external beam and stereotactic body radiation therapy in the treatment of spine metastases: a matched-pair analysis Clinical
More informationfocus Neurosurg Focus 42 (1):E8, 2017
neurosurgical focus Neurosurg Focus 42 (1):E8, 2017 Frequency of symptomatic vertebral body compression fractures requiring intervention following single-fraction stereotactic radiosurgery for spinal metastases
More informationSpine metastases: are minimally invasive surgical techniques living up to the hype?
For reprint orders, please contact: reprints@futuremedicine.com CNS Oncology Spine metastases: are minimally invasive surgical techniques living up to the hype? Fahed Zairi*,1, Marie-Helene Vieillard 2
More informationBone metastases of solid tumors Diagnosis and management by
Bone metastases of solid tumors Diagnosis and management by Dr/RASHA M Abd el Motagaly oncology consultant Nasser institute adult oncology unit 3/27/2010 1 Goals 1- Know the multitude of problem of bone
More informationTable 1. Results of Treatment for Spinal Cord Compression: Radiotherapy Alone Authors Years Patients (n) % Motor % Worse
Table 1. Results of Treatment for Spinal Cord Compression: Radiotherapy Alone Authors Years Patients (n) % Motor % Worse Improved Mones et al.[82] 1966 41 34 - Khan et al.[83] 1967 82 42 - Cobb et al.[84]
More informationMetastatic disease to the spine is common, accounting
clinical article J Neurosurg Spine 25:52 58, 2016 Stereotactic body radiotherapy for metastatic spinal sarcoma: a detailed patterns-of-failure study Jonathan E. Leeman, MD, 1 Mark Bilsky, MD, 1 Ilya Laufer,
More informationA rare case of cervical epidural extramedullary plasmacytoma presenting with monoparesis
Romanian Neurosurgery Volume XXXI Number 1 2017 January - March Article A rare case of cervical epidural extramedullary plasmacytoma presenting with monoparesis Okan Turk, Ibrahim Burak Atci, Hakan Yilmaz,
More informationThe effect of early versus delayed radiation therapy on length of hospital stay in the palliative setting
Original Article on Palliative Radiotherapy The effect of early versus delayed radiation therapy on length of hospital stay in the palliative setting Taylor R. Cushman 1, Shervin Shirvani 2, Mohamed Khan
More informationStereotactic Radiosurgery. Extracranial Stereotactic Radiosurgery. Linear accelerators. Basic technique. Indications of SRS
Stereotactic Radiosurgery Extracranial Stereotactic Radiosurgery Annette Quinn, MSN, RN Program Manager, University of Pittsburgh Medical Center Using stereotactic techniques, give a lethal dose of ionizing
More informationStereotactic Body Radiotherapy with Helical Tomotherapy for Pain Palliation in Spine Metastasis
Technology in Cancer Research and Treatment ISSN 1533-0346 2013 February 22. Epub ahead of print. Adenine Press (2013) Stereotactic Body Radiotherapy with Helical Tomotherapy for Pain Palliation in Spine
More informationManaging Bone Pain in Metastatic Disease. Rachel Schacht PA-C Medical Oncology and Hematology Associates Presented on 11/2/2018
Managing Bone Pain in Metastatic Disease Rachel Schacht PA-C Medical Oncology and Hematology Associates Presented on 11/2/2018 None Disclosures Managing Bone Pain in Metastatic Disease This lecture will
More informationbrain SPINE 2 SRS Matures into breast lung spine LUNG Dr. Robert Timmerman Discusses SBRT for Inoperable Lung Cancer BRAIN
NEWS AND ADVANCES IN THE MANAGEMENT AND TREATMENT OF SERIOUS DISEASE brain SPINE 2 SRS Matures into Mainstream Extracranial Technique lung spine breast LUNG Dr. Robert Timmerman Discusses SBRT for Inoperable
More informationIGRT Protocol Design and Informed Margins. Conflict of Interest. Outline 7/7/2017. DJ Vile, PhD. I have no conflict of interest to disclose
IGRT Protocol Design and Informed Margins DJ Vile, PhD Conflict of Interest I have no conflict of interest to disclose Outline Overview and definitions Quantification of motion Influences on margin selection
More informationSurvival and Intracranial Control of Patients With 5 or More Brain Metastases Treated With Gamma Knife Stereotactic Radiosurgery
ORIGINAL ARTICLE Survival and Intracranial Control of Patients With 5 or More Brain Metastases Treated With Gamma Knife Stereotactic Radiosurgery Ann C. Raldow, BS,* Veronica L. Chiang, MD,w Jonathan P.
More informationSubmillimeter alignment of more than three contiguous vertebrae in spinal SRS/SBRT with 6-degree couch
Received: 26 January 2017 Revised: 14 June 2017 Accepted: 21 June 2017 DOI: 10.1002/acm2.12153 RADIATION ONCOLOGY PHYSICS Submillimeter alignment of more than three contiguous vertebrae in spinal SRS/SBRT
More informationCraniovertebral junction (CVJ) metastases are a. Management of Metastatic Lesions to the Craniovertebral Junction
WScJ 1: 50-57, 2016 Management of Metastatic Lesions to the Craniovertebral Junction Thomas Kosztowski 1, Rory Goodwin 1, Risheng Xu 1, Daniel Aghion 1, Jaroslaw Hepel 2, Ziya Gokaslan 3, Adetokunbo Oyelese
More informationOriginal Article Clinics in Orthopedic Surgery 2015;7:
Original Article Clinics in Orthopedic Surgery 2015;7:344-350 http://dx.doi.org/10.4055/cios.2015.7.3.344 Factors Affecting Survival in Patients Undergoing Palliative Spine Surgery for Metastatic Lung
More informationABSTRACT. Research Paper
/, 2017, Vol. 8, (No. 42), pp: 72860-72871 Stereotactic ablative body radiotherapy for spinal metastasis from hepatocellular carcinoma: its oncologic outcomes and risk of vertebral compression fracture
More informationSubaxial Cervical Spine Trauma Dr Hesarikia BUMS
Subaxial Cervical Spine Trauma Dr. Hesarikia BUMS Subaxial Cervical Spine From C3-C7 ROM Majority of cervical flexion Lateral bending Approximately 50% rotation Ligamentous Anatomy Anterior ALL, PLL, intervertebral
More informationStereotactic Radiosurgery and Stereotactic Body Radiation Therapy
Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy Policy Number: Original Effective Date: MM.05.008 05/12/1999 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST 03/01/2013 Section:
More informationStereotactic body radiotherapy for de novo spinal metastases: systematic review
LITERATURE REVIEW J Neurosurg Spine 27:295 302, 2017 Stereotactic body radiotherapy for de novo spinal metastases: systematic review International Stereotactic Radiosurgery Society practice guidelines
More informationImaging of bone metastases
Imaging of bone metastases Antoine Feydy Service de Radiologie B Hôpital Cochin APHP Université Paris Descartes antoine.feydy@aphp.fr MEXICO 2016 INTRODUCTION Diagnostic Imaging Imaging Modalities Strengths,
More informationCyberKnife Radiosurgery for Malignant Spinal Tumors
CyberKnife Radiosurgery for Malignant Spinal Tumors Characterization of Well-Suited Patients Berndt Wowra, MD,* Stefan Zausinger, MD, Christian Drexler, PhD,* Markus Kufeld, MD,* Alexander Muacevic, MD,*
More information