Controlling spine metastases with tumor 'separation surgery' and high-dose stereotactic radiosurgery
Researchers from Memorial Sloan-Kettering Cancer Center (New York, NY) have found that tumor "separation surgery" followed by high-dose hypofractionated stereotactic radiosurgery (SRS) or high-dose single-fraction SRS is safe and effective in controlling spinal metastases regardless of the radiosensitivity of the particular tumor type that has invaded the spine. This finding is fleshed out in the article "Local disease control for spinal metastases following 'separation surgery' and adjuvant hypofractionated or high-dose single-fraction stereotactic radiosurgery: outcome analysis in 186 patients. Clinical article," by Ilya Laufer, M.D., and colleagues, published today online in the Journal of Neurosurgery: Spine.
The authors reviewed and analyzed data in the charts of 186 patients who presented with epidural spinal cord compression due to spinal metastases. All of these patients underwent tumor separation surgery to decompress the spinal cord and stabilize the spine sometime between 2002 and 2011. During this procedure the tumor was dissected away from the spinal cord—or separated—providing a space between the spinal dura and any remaining tumor. Unlike in traditional spinal tumor surgery, extensive tumor resection was not pursued to reduce surgical morbidity. The spine was also stabilized with screws and rods.
Within 2 to 4 weeks after surgery, stereotactic radiosurgery (SRS) was performed to deliver radiation to the remaining metastatic tumor without damaging the spinal cord. In 40 patients (21.5%) radiation was delivered in a single 24-Gray (Gy) dose to the tumor (high-dose single-fraction SRS). In 37 patients (19.9%) a median total dose of 27 Gy (range 24 to 30 Gy) was delivered in three fractions (high-dose hypofractionated SRS), and in 109 patients (58.6%) a median total dose of 30 Gy (range 18 to 36 Gy) was delivered in five or six fractions (low-dose hypofractionated SRS).
In their review and analysis, the authors identified the following:
- Better local tumor control in patients who underwent high-dose hypofractionated SRS than in those who underwent low-dose hypofractionated SRS.
- The 1-year cumulative local progression rates were 4.1% in the high-dose group and 22.6% in the latter group.
- The difference in tumor progression–free survival between these two groups was statistically significant.
- In the group of patients who underwent single-fraction SRS, the 1-year cumulative local progression rates was 9.0%.
- There was no statistically significant difference in tumor progression–free survival between this group and the high-dose hypofractionated SRS group.
- Other variables were examined to determine their effect on local tumor control, specifically individual patient characteristics, radiosensitivity of the metastatic tumor to conventional radiation, response to preoperative radiotherapy, grade of spinal cord compression, and extent of spinal cord decompression.
- None of these variables significantly correlated with progression-free survival.
- This lack of correlation confirms that the "tumor response to high-dose radiation is independent of these characteristics."
The authors begin their paper by stating the rationale behind treatment of metastatic spine tumors. Care "is palliative with the goal of improving or maintaining neurological function, achieving spine stability, relieving pain, and providing durable tumor control." The object is to make the patient as comfortable and neurologically functional as long as possible despite the presence of systemic disease. In this situation sometimes less surgery is better.
According to coauthor Dr. Mark Bilsky, "The strategy of separation surgery followed by high-dose hypofractionated or single-fraction radiation has revolutionized our ability to provide meaningful palliation for this very complicated patient population with metastatic spine tumors. This limited surgery consisting of spinal cord decompression and posterior segmental fixation is well tolerated and can be performed with limited morbidity. Instead of attempting gross total resection followed by conventional external beam radiation, separation surgery followed by SRS provides excellent durable tumor control of residual vertebral body tumors and even large paraspinal tumors, while minimizing the extent of surgical intervention. The integration and wide availability of SRS as a postoperative adjuvant following separation surgery will help shift treatment paradigms for metastatic spine tumors to ultimately provide better palliation for these patients."
More information: Laufer I, Iorgulescu JB, Chapman T, Lis E, Shi W, Zhang Z, Cox BW, Yamada Y, Bilsky MH. Local disease control for spinal metastases following "separation surgery" and adjuvant hypofractionated or high-dose single-fraction stereotactic radiosurgery: outcome analysis in 186 patients. Clinical article. Journal of Neurosurgery: Spine, published online January 22, 2013, ahead of print; DOI: 10.3171/2012.11.SPINE12111
Journal reference: Journal of Neurosurgery: Spine
Provided by Journal of Neurosurgery
- Less brain swelling occurs with multiple sessions of SRS for common brain tumor Nov 04, 2009 | not rated yet | 0
- Lower-dose fractionated stereotactic radiotherapy results in better hearing preservation Dec 17, 2008 | not rated yet | 0
- Radiation therapy technique successfully treats pain in patients with advanced cancer Nov 03, 2009 | not rated yet | 0
- Robotic radiosurgery offers palliative care for hilar lung tumors Nov 02, 2010 | not rated yet | 0
- Photons vs. protons for treatment of spinal cord gliomas Dec 22, 2010 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Pressure-volume curve: Elastic Recoil Pressure don't make sense
May 18, 2013 From pressure-volume curve of the lung and chest wall (attached photo), I don't understand why would the elastic recoil pressure of the lung is...
If you became brain-dead, would you want them to pull the plug?
May 17, 2013 I'd want the rest of me to stay alive. Sure it's a lousy way to live but it beats being all-the-way dead. Maybe if I make it 20 years they'll...
MRI bill question
May 15, 2013 Dear PFers, The hospital gave us a $12k bill for one MRI (head with contrast). The people I talked to at the hospital tell me that they do not...
Ratio of Hydrogen of Oxygen in Dessicated Animal Protein
May 13, 2013 As an experiment, for the past few months I've been consuming at least one portion of Jell-O or unflavored Knox gelatin per day. I'm 64, in very...
Alcohol and acetaminophen
May 13, 2013 Edit: sorry for the typo in the title , can't edit I looked around on google quite a bit and it's very hard to find precise information on the...
Marie Curie's leukemia
May 13, 2013 Does anyone know what might be the cause of Marie Curie's cancer
- More from Physics Forums - Medical Sciences
More news stories
For combat veterans suffering from post-traumatic stress disorder, 'fear circuitry' in the brain never rests
Chronic trauma can inflict lasting damage to brain regions associated with fear and anxiety. Previous imaging studies of people with post-traumatic stress disorder, or PTSD, have shown that these brain regions can over-or ...
Neuroscience May 18, 2013 | 5 / 5 (1) | 0 |
The neural machinery underlying our olfactory sense continues to be an enigma for neuroscience. A recent review in Neuron seeks to expand traditional ideas about how neurons in the olfactory bulb might encode information about ...
Neuroscience May 17, 2013 | not rated yet | 0 |
(Medical Xpress)—What if the quality of your work depends more on your focus on the piano keys or canvas or laptop than your musical or painting or computing skills? If target users can be convinced, they ...
Neuroscience May 17, 2013 | 3.7 / 5 (3) | 0 |
Neurological disorders can have a devastating impact on the lives of sufferers and their families.
Neuroscience May 17, 2013 | 5 / 5 (1) | 0 |
If you're a left-brain thinker, chances are you use your right hand to hold your cell phone up to your right ear, according to a newly published study from Henry Ford Hospital in Detroit.
Neuroscience May 16, 2013 | 2 / 5 (2) | 0 |
Patients with treatment-resistant major depression saw dramatic improvement in their illness after treatment with ketamine, an anesthetic, according to the largest ketamine clinical trial to-date led by researchers from the ...
4 hours ago | 4.5 / 5 (2) | 0 |
Regular consumption of coffee is associated with a reduced risk of primary sclerosing cholangitis (PSC), an autoimmune liver disease, Mayo Clinic research shows. The findings were being presented at the Digestive Disease ...
4 hours ago | not rated yet | 0 |
Research presented at Digestive Disease Week (DDW) explores new methods for managing digestive health through diet and lifestyle.
4 hours ago | not rated yet | 0
An increasing number of U.S. children are experiencing gastrointestinal issues that require interventions to resolve, according to research presented at Digestive Disease Week (DDW).
18 hours ago | not rated yet | 0 |
The use of a smartphone application significantly improves patients' preparation for a colonoscopy, according to new research presented today at Digestive Disease Week (DDW). The preparation process, which begins days in ...
3 hours ago | not rated yet | 0
There are significant cost and risk factors associated with two procedures commonly used to diagnose or treat gastrointestinal problems, according to research presented at Digestive Disease Week (DDW).
3 hours ago | not rated yet | 0