Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Clinical Results of $Cyberknife^{(R)}$ Radiosurgery for Spinal Metastases

  • Chang, Ung-Kyu (Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Science) ;
  • Youn, Sang-Min (Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Science) ;
  • Park, Sukh-Que (Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Science) ;
  • Rhee, Chang-Hun (Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Science)
  • Published : 2009.12.28
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : Primary treatment of spinal metastasis has been external beam radiotherapy. Recent advance of technology enables radiosurgery to be extended to extracranial lesions. The purpose of this study was to determine the clinical effectiveness and safety of stereotactic radiosurgery using Cyberknife in spinal metastasis. Methods : From June, 2002 to December, 2007, 129 patients with 167 spinal metastases were treated with Cyberknife. Most of the patients (94%) presented with pain and nine patients suffered from motor deficits. Twelve patients were asymptomatic. Fifty-three patients (32%) had previous radiation therapy. Using Cyberknife, 16-39 Gy in 1-5 fractions were delivered to spinal metastatic lesions. Radiation dose was not different regarding the tumor pathology or tumor volume. Results : After six months follow-up, patient evaluation was possible in 108 lesions. Among them, significant pain relief was seen in 98 lesions (91%). Radiological data were obtained in 83 lesions. The mass size was decreased or stable in 75 lesions and increased in eight lesions. Radiological control failure cases were hepatocellular carcinoma (5 cases), lung cancer (1 case), breast cancer (1 case) and renal cell carcinoma (1 case). Treatment-related radiation injury was not detected. Conclusion : Cyberknife radiosurgery is clinically effective and safe for spinal metastases. It is true even in previously irradiated patients. Compared to conventional radiation therapy, Cyberknife shows higher pain control rate and its treatment process is more convenient for patients. Thus, it can be regarded as a primary treatment modality for spinal metastases.

Keywords

References

  1. Adler JR Jr, Murphy MJ, Chang SD, Hancock SL : Image-guided robotic radiosurgery. Neurosurgery 44 : 1299-1306; discussion 1306-1307, 1999 https://doi.org/10.1097/00006123-199906000-00079
  2. Andrews DW, Bednarz G, Evans JJ, Downes B : A review of 3 current radiosurgery systems. Surg Neurol 66 : 559-564, 2006 https://doi.org/10.1016/j.surneu.2006.08.002
  3. Flickinger JC, Kondziolka D, Lunsford LD, Coffey RJ, Goodman ML, Shaw EG, et al. : A multi-institutional experience with stereotactic radiosurgery for solitary brain metastasis. Int J Radiat Oncol Biol Phys 28 : 797-802, 1994 https://doi.org/10.1016/0360-3016(94)90098-1
  4. Gagnon GJ, Henderson FC, Gehan EA, Sanford D, Collins BT, Moulds JC, et al. : Cyberknife radiosurgery for breast cancer spine metastases : a matched-pair analysis. Cancer 110 : 1796-1802, 2007 https://doi.org/10.1002/cncr.22977
  5. Gerszten PC, Burton SA, Belani CP, Ramalingam S, Friedland DM, Ozhasoglu C, et al. : Radiosurgery for the treatment of spinal lung metastases. Cancer 107 : 2653-2661, 2006 https://doi.org/10.1002/cncr.22299
  6. Gerszten PC, Burton SA, Ozhasoglu C, McCue KJ, Quinn AE : Radiosurgery for benign intradural spinal tumors. Neurosurgery 62 : 887-895; discussion 895-896, 2008 https://doi.org/10.1227/01.neu.0000318174.28461.fc
  7. Gerszten PC, Burton SA, Ozhasoglu C, Vogel WJ, Welch WC, Baar J, et al. : Stereotactic radiosurgery for spinal metastases from renal cell carcinoma. J Neurosurg Spine 3 : 288-295, 2005 https://doi.org/10.3171/spi.2005.3.4.0288
  8. Gerszten PC, Burton SA, Ozhasoglu C, Welch WC : Radiosurgery for spinal metastases : clinical experience in 500 cases from a single institution. Spine 32 : 193-199, 2007 https://doi.org/10.1097/01.brs.0000251863.76595.a2
  9. Gerszten PC, Burton SA, Welch WC, Brufsky AM, Lembersky BC, Ozhasoglu C, et al. : Single-fraction radiosurgery for the treatment of spinal breast metastases. Cancer 104 : 2244-2254, 2005 https://doi.org/10.1002/cncr.21467
  10. Gerszten PC, Ozhasoglu C, Burton SA, Vogel W, Atkins B, Kalnicki S, et al. : Evaluation of CyberKnife frameless real-time image-guided stereotactic radiosurgery for spinal lesions. Stereotact Funct Neurosurg 81 : 84-89, 2003 https://doi.org/10.1159/000075109
  11. Gerszten PC, Ozhasoglu C, Burton SA, Vogel WJ, Atkins BA, Kalnicki S, et al. : CyberKnife frameless stereotactic radiosurgery for spinal lesions : clinical experience in 125 cases. Neurosurgery 55 : 89-98; discussion 98-99, 2004
  12. Gibbs IC : Spinal and paraspinal lesions : the role of stereotactic body radiotherapy. Front Radiat Ther Oncol 40 : 407-414, 2007
  13. Gibbs IC, Kamnerdsupaphon P, Ryu MR, Dodd R, Kiernan M, Chang SD, et al. : Image-guided robotic radiosurgery for spinal metastases. Radiother Oncol 82 : 185-190, 2007 https://doi.org/10.1016/j.radonc.2006.11.023
  14. Grant R, Papadopoulos SM, Sandler HM, Greenberg HS : Metastatic epidural spinal cord compression : current concepts and treatment. J Neurooncol 19 : 79-92, 1994 https://doi.org/10.1007/BF01051052
  15. Hall EJ, Brenner DJ : The radiobiology of radiosurgery : rationale for different treatment regimes for AVMs and malignancies. Int J Radiat Oncol Biol Phys 25 : 381-385, 1993 https://doi.org/10.1016/0360-3016(93)90367-5
  16. Hamilton AJ, Lulu BA, Fosmire H, Stea B, Cassady JR : Preliminary clinical experience with linear accelerator-based spinal stereotactic radiosurgery. Neurosurgery 36 : 311-319, 1995 https://doi.org/10.1227/00006123-199502000-00010
  17. Jacobs WB, Perrin RG : Evaluation and treatment of spinal metastases : an overview. Neurosurg Focus 11 : e10, 2001
  18. Lomax NJ, Scheib SG : Quantifying the degree of conformity in radiosurgery treatment planning. Int J Radiat Oncol Biol Phys 55 : 1409-1419, 2003 https://doi.org/10.1016/S0360-3016(02)04599-6
  19. Ryu S, Jin JY, Jin R, Rock J, Ajlouni M, Movsas B, et al. : Partial volume tolerance of the spinal cord and complications of single-dose radiosurgery. Cancer 109 : 628-636, 2007 https://doi.org/10.1002/cncr.22442
  20. Ryu S, Jin R, Jin JY, Chen Q, Rock J, Anderson J, et al. : Pain control by image-guided radiosurgery for solitary spinal metastasis. J Pain Symptom Manage 35 : 292-298, 2008 https://doi.org/10.1016/j.jpainsymman.2007.04.020
  21. Ryu SI, Chang SD, Kim DH, Murphy MJ, Le QT, Martin DP, et al. : Image-guided hypo-fractionated stereotactic radiosurgery to spinal lesions. Neurosurgery 49 : 838-846, 2001 https://doi.org/10.1097/00006123-200110000-00011
  22. Schiff D, O'Neill BP, Suman VJ : Spinal epidural metastasis as the initial manifestation of malignancy : clinical features and diagnostic approach. Neurology 49 : 452-456, 1997 https://doi.org/10.1212/WNL.49.2.452
  23. Shaw E, Kline R, Gillin M, Souhami L, Hirschfeld A, Dinapoli R, et al. : Radiation therapy oncology group : radiosurgery quality assurance guidelines. Int J Radiat Oncol Biol Phys 27 : 1231-1239, 1993
  24. Steenland E, Leer JW, van Houwelingen H, Post WJ, van den Hout WB, Kievit J, et al. : The effect of a single fraction compared to multiple fractions on painful bone metastases : a global analysis of the dutch bone metastasis study. Radiother Oncol 52 : 101-109, 1999 https://doi.org/10.1016/S0167-8140(99)00110-3
  25. Tong D, Gillick L, Hendrickson FR : The palliation of symptomatic osseous metastases : final results of the study by the radiation therapy oncology group. Cancer 50 : 893-899, 1982 https://doi.org/10.1002/1097-0142(19820901)50:5<893::AID-CNCR2820500515>3.0.CO;2-Y
  26. Tsai JT, Lin JW, Chiu WT, Chu WC : Assessment of image-guided CyberKnife radiosurgery for metastatic spine tumors. J Neurooncol 94 : 119-127, 2009 https://doi.org/10.1007/s11060-009-9814-7

Cited by

  1. Unexpected Seizure Attack in a Patient with Spinal Metastasis Diagnosed as Posterior Reversible Encephalopathy Syndrome vol.50, pp.1, 2009, https://doi.org/10.3340/jkns.2011.50.1.60
  2. Stereotactic radiosurgery for spinal metastases: a literature review vol.11, pp.2, 2013, https://doi.org/10.1590/s1679-45082013000200020
  3. Successful Treatment of Infantile Fibrosarcoma Spinal Metastasis by Chemotherapy and Stereotactic Hypofractionated Radiotherapy vol.54, pp.6, 2009, https://doi.org/10.3340/jkns.2013.54.6.528
  4. What type of patients with lesions of the pancreas and spine are suitable candidates for treatment with the CyberKnife robotic radiosurgical system? vol.13, pp.1, 2014, https://doi.org/10.1017/s1460396912000568
  5. Timing of stereotactic radiosurgery and surgery and wound healing in patients with spinal tumors: a systematic review and expert opinions vol.36, pp.6, 2014, https://doi.org/10.1179/1743132814y.0000000380
  6. Developments in Stereotactic Body Radiotherapy vol.10, pp.12, 2018, https://doi.org/10.3390/cancers10120497
  7. Image-Guided Robotic Radiosurgery for the Treatment of Same Site Spinal Metastasis Recurrences vol.11, pp.None, 2009, https://doi.org/10.3389/fonc.2021.642314