Radiosurgery as primary treatment of metastatic tumors of the spine: Quality of life and adjuvant surgical approach after Cyberknife.

Abstract

e19643 Background: Conventional radiotherapy and open surgery only performs a limited role in the treatment of metastatic tumors of the spine The effectiveness of spinal radiosurgery as primary treatment for the spinal metastases was investigated. Methods: From December 2007 to December 2009, a total of 167 patients were treated in the Cyberknife center of the Seoul Wooridul Hospital. Our workload was 347 metastatic tumors (mean 2.07 per patients). Magnetic resonance imaging and PET for tumor response evaluation were taken at intervals of 3-6 months. Quality of life studies were taken at interval of 1-3 months for the Oswestry Disability Index, visual analog scale. Results: The patients age ranges was 25-79 years with mean of 58 years. The most common metastatic tumors were breast cancer (36 cases), lung cancer (34 cases). and hepatoma (16 cases). The prescription dose range 8-40 Gy with a mean of 19.7 Gy. The most common indication for Cyberknife was pain in 92.2%(154/167) of patients. The mean Oswestry Disability Index score before Cyberknife was 24.3, and the mean visual analog scale score was 4.3 before radiosurgry. After Cyberknife, the mean Oswestry Disability Index score was increased up to 25.6. The mean of post-Cyberknife visual analog scale score was down to 3.2. The overall response rate of pain relief was 97%, and the local control rate including stable diseases was seen in 92% after radiosurgery. Multivariate logistic regression modeling found that the Oswestry Disability Index score at presentation was the only independent variable that correlated significantly with survival (p < 0.0001). Adjuvant invasive surgery as like laminectomy, corpectomy and vertebroplasty after Cyberknife was experienced by only 3.8% of tumors. Conclusions: We expect Cyberknife radiosurgery to become a useful palliative and primary treatment of metastatic tumors of the spine. Noninvasive radiosurgery should be considered as the primary treatment modality rather than invasive surgical approach for the spinal metastases. No significant financial relationships to disclose.