Abstract
BackgroundIntramedullary metastasis (IMM) is a rare disease with poor prognosis. The incidence of IMMs has increased, which has been linked to improved systemic treatment in many cancers. Surgery and/or radiotherapy are the most commonly used treatments; only small-sample retrospective studies and case reports on stereotactic body radiotherapy (SBRT) have reported acceptable results in terms of local control and clinical improvement, with no reported toxicity. Thus, we performed this monocentric retrospective study on five cases treated with SBRT for IMMs, which we supplemented with a systematic review of the literature.MethodsWe included all patients treated for IMM with SBRT. The target tumor volume, progression-free survival, prescription patterns in SBRT, survival without neurological deficit, neurological functional improvement after treatment, and overall survival were determined. Results: Five patients treated with a median dose of 30 Gy in a median number of fractions of 5 (prescribed at a median isodose of 86%) included. The median follow-up duration was 23 months. Two patients showed clinical improvement. Three patients remained stable. Radiologically, 25% of patients had complete response and 50% had stable disease. No significant treatment-related toxicity was observed. Conclusion: SBRT appears to be a safe, effective, and rapid treatment option for palliative patients.
Highlights
The development of intramedullary metastases (IMMs) is a rare event, and Intramedullary metastasis (IMM) account for 4.2–8.5% of central nervous system metastases [1]
Systematic review We identified 9 articles reporting on the treatment of intramedullary metastasis by means of stereotactic body radiotherapy (SBRT)
Fifty-four patients with a total of 69 intramedullary metastases were included in the analysis
Summary
The development of intramedullary metastases (IMMs) is a rare event, and IMMs account for 4.2–8.5% of central nervous system metastases [1]. The application of stereotactic body radiation therapy (SBRT) in the management of spinal lesions has recently emerged, and it was initially used to treat vertebral metastases [2] It is considered a safe and effective option [3, 4]. Surgery and/or radiotherapy are the most commonly used treatments; only small-sample retrospective studies and case reports on stereotactic body radiotherapy (SBRT) have reported acceptable results in terms of local control and clinical improvement, with no reported toxicity. We performed this monocentric retrospective study on five cases treated with SBRT for IMMs, which we supplemented with a systematic review of the literature
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