• Radiation Oncology Journal
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• v.33 no.1
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• pp.1-11
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• 2015

With the progress of image-guided localization, body immobilization system, and computerized delivery of intensity-modulated radiation delivery, it became possible to perform spine radiosurgery. The next question is how to translate the high technology treatment to the clinical application. Clinical trials have been performed to demonstrate the feasibility of spine radiosurgery and efficacy of the treatment in the setting of spine metastasis, leading to the randomized trials by a cooperative group. Radiosurgery has also demonstrated its efficacy to decompress the spinal cord compression in selected group of patients. The experience indicates that spine radiosurgery has a potential to change the clinical practice in the management of spine metastasis and spinal cord compression.

• Radiation Oncology Journal
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• v.31 no.4
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• pp.260-266
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• 2013

A clear consensus has not been established regarding the best treatment for solitary bone metastasis. Here, we reviewed the medical records of patients with a controlled primary malignancy who had only solitary spine metastasis without metastasis to the extraspinal bone or viscera and underwent treatment between April 2007 and December 2012 with stereotactic body radiosurgery using CyberKnife, with a total dose of 24 Gy in three to four fractions. During that time, there were only four cases. This was effective in each case, and all the four patients had no local failure and remained alive at a median follow-up of 68 months (range, 64 to 80 months). Although our experience is limited, this study suggests that stereotactic body radiotherapy could be a feasible, safe, effective, and noninvasive alternative treatment for solitary spine metastasis in patients who are medically inoperable or unsuitable for surgery.

• Journal of Korean Neurosurgical Society
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• v.30 no.5
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• pp.666-669
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• 2001

We report a case of meningeal hemangiopericytoma presenting as metastasis in the vertebral body and pedicle of the thoracic spine. Hemangiopericytoma is a rare vascular neoplasm. Although the tumor has a strong propensity for both local recurrence and extracranial metastasis, metastasis to thoracic spine is very rare and only two cases were found in the literature. A 44-year-old woman with paraparesis and pain in the thoracic and lower legs was examined by plain radiographs and magnetic resonance imaging. The intracranial hemangiopericytoma was operated 3 years ago. Magnetic resonance imaging demonstrated a tumor invading the left vertebral body and pedicle of the 11th thoracic spine, and compressing the dural sac. The patient was gradually improved after surgical removal of the lesions and the histologic findings were characteristics of hemangiopericytoma.

• Journal of Korean Neurosurgical Society
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• v.59 no.1
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• pp.37-43
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• 2016

Objective : The aim of this multicenter, matched-pair study was to compare the outcomes of stereotactic radiosurgery (SRS) and conventional external radiation therapy (RT) when used as a primary treatment in spine metastasis from hepatocellular carcinoma (HCC). Methods : From 2005 to 2012, 28 patients underwent SRS as the primary treatment in spine metastasis from HCC. Based on sex, age, number of spine metastasis, Child-Pugh classification, interval from original tumor to spine metastasis, and year of treatment, 28 patients who underwent RT were paired. Outcomes of interest were pain relief, progression free survival, toxicities, and further treatment. Results : The perioperative visual analog scale (VAS) decrease was larger in SRS group than in RT group, but the difference was not significant (3.7 vs. 2.8, p=0.13). When pain medication was adjusted, the number of patients with complete (n=6 vs.3) or partial (n=12 vs.13) relief was larger in SRS group than in RT group; however, the difference was not significant (p=0.83). There was no significant difference in progression free survival (p=0.48). In SRS group, 32.1% of patients had 1 or more toxicities whereas the percentage in RT group was 63.0%, a significant difference (p=0.04). Six SRS patients and 7 RT patients received further intervention at the treated segment. Conclusion : Clinical and radiological outcome were not significantly different between the two treatments. Toxicities, however, were more prevalent in the RT group.

• Journal of Korean Neurosurgical Society
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• v.55 no.1
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• pp.57-60
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• 2014

Rhabdoid tumor of the kidney (RTK) is a rare malignancy in infancy. Central nervous system involvement in RTK is already known. However, solitary spinal metastasis in RTK has been hardly reported. The authors report a case of metastatic RTK to spine causing paraplegia in an 8-month-old girl. Since the patient was young, the diagnosis of spine metastasis was delayed until paraplegia was seen after radical nephrectomy. Thorough neurological examination should be performed for early diagnosis of spinal metastasis in young patients with RTK. If there are any abnormal signs in neurologic examination, magnetic resonance images of brain and spine are recommended.

• Investigative Magnetic Resonance Imaging
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• v.20 no.1
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• pp.1-8
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• 2016

The spine is the most common location for skeletal metastases, and the incidence of spinal metastasis shows an increasing tendency. Because metastatic spinal tumors progress from an anterior element to a posterior element resulting in continuing destruction of the pedicles, epidural extension and involvement of neural structures of the metastatic tumor are eventually visible. Therefore, it is clinically significant for radiologists to understand the pathophysiology of spinal metastasis and to assess the involvement of neural structures and the disintegration of spinal instability related to the pathophysiology. As MRI is also the best imaging modality for diagnosing spinal metastasis, radiologists should accurately assess spinal metastasis and provide practical information to physicians. Therefore, we will describe some analysis points focusing on the understanding of pathophysiology of spinal metastasis and the next step toward a more extensive clinical approach using MR imaging.

• Journal of Korean Neurosurgical Society
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• v.61 no.3
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• pp.415-423
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• 2018

Objective : To identify the perioperative factors associated with instrument failure in patients undergoing a partial corpectomy with instrumentation (PCI) for spinal metastasis. Methods : We assessed the one hundred twenty-four patients with who underwent PCI for a metastatic spine from 1987 to 2011. Outcome measure was the risk factor related to implantation failure. The preoperative factors analyzed were age, sex, ambulation, American Spinal Injury Association grade, bone mineral density, use of steroid, primary tumor site, number of vertebrae with metastasis, extra-bone metastasis, preoperative adjuvant chemotherapy, and preoperative spinal radiotherapy. The intraoperative factors were the number of fixed vertebrae, fixation in osteolytic vertebrae, bone grafting, and type of surgical approach. The postoperative factors included postoperative adjuvant chemotherapy and spinal radiotherapy. This study was supported by the National Research Foundation grant funded by government. There were no study-specific biases related to conflicts of interest. Results : There were 15 instrumentation failures (15/124, 12.1%). Preoperative ambulatory status and primary tumor site were not significantly related to the development of implant failure. There were no significant associations between insertion of a bone graft into the partial corpectomy site and instrumentation failure. The preoperative and operative factors analyzed were not significantly related to instrumentation failure. In univariable and multivariable analyses, postoperative spinal radiotherapy was the only significant variable related to instrumentation failure (p=0.049 and 0.050, respectively). Conclusion : When performing PCI in patients with spinal metastasis followed by postoperative spinal radiotherapy, the surgeon may consider the possibility of instrumentation failure and find other strategies for augmentation than the use of a bone graft for fusion.

• The Journal of Korean Society for Radiation Therapy
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• v.27 no.1
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• pp.79-86
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• 2015

Purpose : The purpose of this study was to determine the proper treatment time of stereotactic body radiation therapy for spine metastasis cancer by using the image guidance system of CyberKnife(Accuray Incorporated, USA) which is able to correct movements of patients during the treatment. Materials and Methods : Fifty seven spine metastasis cancer patients who have stereotactic body radiation therapy of CyberKnife participate, 8 of them with cervical spine cancer, 26 of them with thoracic spine cancer, and 23 of them with lumbar spine cancer. X-ray images acquired during the treatment were classified by treatment site. From the starting point of treatment, motion tendency of patients is analyzed in each section which is divided into every 5 minutes. Results : In case of cervical spine, there is sudden increase of variation in 15 minutes after the treatment starts in rotational direction. In case of thoracic spine, there is no significantly variable section. However, variation increases gradually with the passage of time so that it is assumed that noticeable value comes up in approximately 40 minutes. In case of lumbar spine, sharp increase of variation is seen in 20 minutes in translational and rotational direction. Conclusion : Without having corrections during the treatment, proper treatment time is considered as less than 15 minutes for cervical spine, 40 minutes for thoracic spine, and 20 minutes for lumbar spine. If treatment time is longer than these duration, additional patient alignments are required or PTV margin should be enlarged.

• Korean Journal of Head & Neck Oncology
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• v.28 no.2
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• pp.143-145
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• 2012

Follicular thyroid cancer(FTC) accounts for about 10-15% of thyroid cancer. Distant metastasis is common, usually to lung, bone and brain. 71-years-old man visited neurosurgery outpatient department. He complained of recent 6kg weight loss, left upper extremity pain with weakness and back pain. The radiologic findings showed multiple bone metastasis including thoracic spine and left scapular resulting from FTC. There was a probable brain metastatic lesion on right temporal fossa. The core biopsy of thyroid and thoracic spine(T11) confirmed metastatic follicular carcinoma. Radioactive iodine therapy and radiotherapy was done following total thyroidectomy. We report a unique case of multiple bone metastasis from follicular carcinoma of thyroid with literature review.

• Molecules and Cells
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• v.43 no.10
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• pp.898-898
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• 2020