• Neurosurgery · Dec 2019

    Postoperative Stereotactic Body Radiotherapy for Spinal Metastases and the Impact of Epidural Disease Grade.

    • Majed Alghamdi, Arjun Sahgal, Hany Soliman, Sten Myrehaug, Yang Victor X D VXD Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada., Sunit Das, Jefferson Wilson, Mikki Campbell, Young K Lee, Monica Cawricz, Leo Da Costa, Eshetu G Atenafu, and Chia-Lin Tseng.
    • Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
    • Neurosurgery. 2019 Dec 1; 85 (6): E1111-E1118.

    BackgroundPostoperative stereotactic body radiotherapy (pSBRT) is an emerging indication for spinal metastases (SM).ObjectiveTo report our experience with pSBRT for SM.MethodsA retrospective chart review was performed for prospectively collected data of patients treated between September 2008 to December 2015 with pSBRT and followed with serial spinal MRIs every 2 to 3 mo until death or last follow-up. Univariate and multivariable analyses were performed to identify predictive factors.ResultsA total of 83 spinal segments in 47 patients treated with a median dose of 24 Gy in 2 fractions were included, with mostly lung and breast primaries. A total of 59.3% had preoperative high-grade epidural disease (ED) and 39.7% were unstable. The 12-mo cumulative incidence of local failure was 17% for all segments, and 33.3%, 21.8%, and 0% in segments with postoperative high-grade, low-grade, and no ED, respectively. Downgrading preoperative ED was predictive of better local control (P = .03). The grade of postoperative ED was also predictive for local control (P < .0001), as was a longer interval between prior radiotherapy and pSBRT in those previously irradiated (P = .004). The 12-mo overall survival rate was 55%. One case of radiculopathy, 3 vertebral compression fractures, and no cases of myelopathy, hardware failure, or skin breakdown were observed.ConclusionpSBRT is an effective and safe treatment. The association between downgrading preoperative ED and better local control following pSBRT is confirmed and supports the concept of separation surgery.Copyright © 2019 by the Congress of Neurological Surgeons.

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