Image-guided radiosurgery for single spinal metastasis

Abstract

8033 Background: The precision and accuracy of image-guided spinal radiosurgery has been previously demonstrated. We have extended on the spinal radiosurgery to treat a single spinal metastasis. This study was carried out to determine the clinical efficacy of spinal radiosurgery for treatment of spinal metastases with or without cord compression. Methods: A total of 49 patients with 61 lesions of spinal metastasis were treated with radiosurgery at Henry Ford Hospital from May 2001 to May 2003. All patients had pathologically-proven primary cancers and had either synchronous or metachronous metastases to the spine. The majority of the patients had back pain as the presenting symptom and 17 lesions were associated with neurologic signs. The involved spine was treated with single dose radiosurgery. The range of radiation dose was 10 –16 Gy in 2 Gy increments. The entire radiosurgery procedure was performed on an out-patient basis. Endpoints of analysis were pain control, neurologic improvement, and radiologic tumor control. Results: The median time to pain relief was 14 days and the earliest time of pain relief was within 24 hours. The median duration of pain relief was 13.3 months. Complete and partial pain relief was achieved in 37.7 % and 47.6% of the lesions treated, respectively. Relapse of pain at the treated site was noted in 6.9%. Neurologic improvement and radiologic tumor control were noted in patients with cord compression by epidural soft tissue mass. Progressive metastasis in the adjacent spines was seen only in 4.9%. There was no acute or subacute radiation toxicity detected clinically during the maximum follow up of 24 months. Conclusions: A large single dose spinal radiosurgery achieves a rapid and durable pain relief as well as radiological tumor control and neurologic improvement. Tumor progression to the immediately adjacent spine was rare. The results support the use of single dose spinal radiosurgery as an effective treatment option for single spinal metastasis with or without spinal cord compression. No significant financial relationships to disclose.