• 제목/요약/키워드: vertebral metastasis

검색결과 43건 처리시간 0.022초

Burnt-out Metastatic Prostate Cancer

  • Shin, Dong Suk;Koo, Dong Hoe;Yoo, Suhyeon;Ju, Deok Yun;Jang, Cheol Min;Joo, Kwan Joong;Shin, Hyun Chul;Chae, Seoung Wan
    • Journal of Yeungnam Medical Science
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    • 제30권2호
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    • pp.116-119
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    • 2013
  • A burnt-out prostate cancer tumor is a very rare clinical entity. The term 'burnt-out' refers to a primary tumor that has spontaneously and nearly completely regressed without treatment. Since metastasis of prostate cancer is usually encountered in the presence of advanced disease, distant metastasis with an undetectable primary tumor is very rare. We report herein a case of a burnt-out prostate cancer tumor that metastasized to the thoracic (T) spine and caused cord compression. A 66-year-old man visited the Emergency Department due to weakness of both legs for the past two days. His blood and urine tests were normal at the time. His spine magnetic resonance imaging (MRI) scans looked like bone metastasis that involved the T-7 vertebral body and a posterior element, and caused spinal cord compression. Other images, including from the brain MRI, neck/chest/abdomino-pelvic computed tomography (CT) scan and 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) and endoscopy, revealed no lesions that suggested malignancy. After total corpectomy T-7 and screw fixation/fusion at T5 to T10, the pathology report revealed a metastatic carcinoma that was strongly positive for prostate-specific antigen (PSA). The serum PSA value was 1.5 ng/mL. The transrectal 12-core prostate biopsy and ultrasonography showed no definitive hypoechoic lesion, but one specimen had slight (only 1%) adenocarcinoma with a Gleason score of 6 (3+3). The final diagnosis was burned-out prostate cancer with an initial normal PSA value. Although metastatic disease with an unknown primary origin was confirmed, a more aggressive approach in seeking the primary origin could provide a more specific treatment strategy and greater clinical benefit to patients.

Helical tomotherapy for spine oligometastases from gastrointestinal malignancies

  • Choi, Yun-Seon;Kim, Jun-Won;Lee, Ik-Jae;Han, Hee-Ji;Baek, Jong-Geal;Seong, Jin-Sil
    • Radiation Oncology Journal
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    • 제29권4호
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    • pp.219-227
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    • 2011
  • Purpose: This study evaluated the treatment effectiveness and proper radiation dose of helical tomotherapy (HT) in spine oligometastases from gastrointestinal cancers. Materials and Methods: From 2006 to 2010, 20 gastrointestinal cancer patients were treated with HT for spine oligometastases (31 spine lesions). The gross tumor volume (GTV) was the tumor evident from magnetic resonance imaging images fused with simulation computed tomography images. Clinical target volume (CTV) encompassed involved vertebral bodies or dorsal elements. We assumed that the planning target volume was equal to the CTV. We assessed local control rate after HT for 31 spine metastases. Pain response was scored by using a numeric pain intensity scale (NPIS, from 0 to 10). Results: Spine metastatic lesions were treated with median dose of 40 Gy (range, 24 to 51 Gy) and median 5 Gy per fraction (range, 2.5 to 8 Gy) to GTV with median 8 fractions (range, 3 to 20 fraction). Median biologically equivalent dose (BED, ${\alpha}/{\beta}$ = 10 Gy) was 52 $Gy_{10}$ (range, 37.5 to 76.8 $Gy_{10}$) to GTV. Six month local control rate for spine metastasis was 90.3%. Overall infield failure rate was 15% and outfield failure rate was 75%. Most patients showed pain relief after HT (93.8%). Median local recurrence free survival was 3 months. BED over 57 $Gy_{10}$ and oligometastases were identified as prognostic factors associated with improved local progression free survival (p = 0.012, P = 0.041). Conclusion: HT was capable of delivering higher BED to metastatic lesions in close proximity of the spinal cord. Spine metastases from gastrointestinal tumors were sensitive to high dose radiation, and BED (${\alpha}/{\beta}$ = 10 Gy) higher than 57 $Gy_{10}$ could improve local control.

An Image-guided Radiosurgery for the Treatment of Metastatic Bone Tumors using the CyberKnife Robotic System

  • Cho, Chul-Koo
    • 대한골관절종양학회지
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    • 제13권1호
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    • pp.14-21
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    • 2007
  • Bone is a common site for metastatic spread from many kinds of malignancies. The morbidity associated with this metastatic spread can be significant, including severe pain. When it comes to spinal metastasis, occupying nearly 40% of skeletal metastases, the risks of complications, such as vertebral body collapse, nerve root impingement, or spinal cord compression, are also significant. Because of the necessity of preserving the integrity of the spinal column and the proximity of critical structures, surgical treatment has limitations when durable local control is desired. Radiotherapy, therefore, is often used as an adjunct treatment or as a sole treatment. A considerable limitation of standard radiotherapy is the reported recurrence rate or ineffective palliation of pain, either clinically or symptomatically. This may be due to limited radiation doses to tumor itself because of the proximity of critical structures. CyberKnife is an image-guided robotic radiosurgical system. The image guidance system includes a kilovoltage X-ray imaging source and amorphous silica detectors. The radiation delivery device is a mobile X-band linear accelerator (6 MV) mounted on a robotic arm. Highly conformal fields and hypofractionated radiotherapy schedules are increasingly being used as a means to achieve biologic dose escalation for body tumors. Therefore, we can give much higher doses to the targeted tumor volume with minimizing doses to the surrounding critical structures, resulting in more effective local control and less severe side effects, compared to conventional fractionated radiotherapy. A description of this technology and a review of clinical applications to bone metastases are detailed herein.

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내장신경차단시 조영제확산에 관한 연구 (The Spread of Contrast media in Splanchnic Nerve Block)

  • 이종석;윤덕미;오흥근
    • The Korean Journal of Pain
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    • 제2권1호
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    • pp.36-41
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    • 1989
  • Splanchnic nerve block is performed to relieve intractable upper abdominal pain caused by carcinoma of the pancreas, stomach, liver, or colon; and upper abdominal metastasis of tumors having more distant origins. We have performed splanchnic nerve blocks under control of X-ray fluoroscopy, for all cases of alcohol splanchnic nerve block at $L_1$ vertebra, to determine both the position of the needle tips and the spread of contrast media. During the period from December 1987 to August 1988, this method was used in 40 cases of malignancy at Severance Hospital and we clinically evaluated the location of the needle tip and the spread of contrast media. The results were as follows: 1) Our method was a retrocrural approach, the splanchnic nerve block, in all cases. 2) Most of the inserted needle points were located in the upper and anterolateral part of the $L_1$ vertebra on the antero posterior roentagenogram and in the upper quarter anteriorly on the lateral roentgenogram. 3) There was no specific relationship between the location of the needle and the spread of the contrast media. 4) The contrast media was spread around the needle and then upward along the anterior margin of the vertebral body in most of the cases. 5) Pain relief was obtained immediately in 37 cases (92.5%), but in 3 cases only after a second splanchnic nerve block.

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제 12 흉추체에 발생한 일차적 연골 육종 (증례 보고) (Chondrosarcoma of Thoracic Spine - A case report -)

  • 이승구;김기원;김정호
    • 대한골관절종양학회지
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    • 제3권2호
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    • pp.131-136
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    • 1997
  • 가톨릭 의과대학 정형외과에서는 32세 여자 환자의 제 12 흉추체에 발생한 발생 빈도가 드문, 일차성 연골 육종을 전방 도달법으로 추체 절제후 금속판 내고정과 함께 늑골 및 자가 해면골 이식술을 병행하여 치료후 42개월을 추적 관찰한 결과 국소재발 소견없이 정상생활 중이어서, 문헌고찰과 함께 보고하는 바이다.

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Percutaneous osteoplasty for painful bony lesions: a technical survey

  • Kim, Won-Sung;Kim, Kyung-Hoon
    • The Korean Journal of Pain
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    • 제34권4호
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    • pp.375-393
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    • 2021
  • Percutaneous osteoplasty (POP) is defined as the injection of bone cement into various painful bony lesions, refractory to conventional therapy, as an extended technique of percutaneous vertebroplasty (PVP). POP can be applied to benign osteochondral lesions and malignant metastatic lesions throughout the whole skeleton, whereas PVP is restricted to the vertebral body. Common spinal metastases occur in the thoracic (70%), lumbosacral (20%), and cervical (10%) vertebrae, in order of frequency. Extraspinal metastases into the ribs, scapulae, sternum, and humeral head commonly originate from lung and breast cancers; extraspinal metastases into the pelvis and femoral head come from prostate, urinary bladder, colon, and uterine cervical cancers. Pain is aggravated in the dependent (or weight bearing) position, or during movement (or respiration). The tenderness and imaging diagnosis should match. The supposed mechanism of pain relief in POP is the augmentation of damaged bones, thermal and chemical ablation of the nociceptive nerves, and local inhibition of tumor invasion. Adjacent (facet) joint injections may be needed prior to POP (PVP). The length and thickness of the applied needle should be chosen according to the targeted bone. Bone cement is also selected by its osteoconduction, osteoinduction, and osteogenesis. Needle route should be chosen as a shortcut to reach the target bony lesions, without damage to the nerves and vessels. POP is a promising minimally invasive procedure for immediate pain relief. This review provides a technical survey for POPs in painful bony lesions.

Pineal and Suprasellar Germinoma Cooccurence with Vertebra Plana: A Case Report

  • Toosi, Farrokh Seilanian;Aminzadeh, Behzad;Rad, Mohammad Faraji;Nekooei, Sirous;Nahidi, Mahsa;Keykhosravi, Ehsan
    • Brain Tumor Research and Treatment
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    • 제6권2호
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    • pp.73-77
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    • 2018
  • Germinoma is the most common type of intracranial germ cell tumors (GCTs). Pineal gland and suprasellar region are the most frequent sites of central nervous system (CNS) involvement. Intracranial masses caused by Langerhans cell histiocytosis (LCH) mimics features of CNS GCTs. LCH frequently involve spine and is the most common cause of vertebra plana in children. A 15-year-old boy presented with progressing symptoms of polydipsia, polyuria, general headache, nausea and severe back pain. Brain MRI showed brain tumor with simultaneous involvement of suprasellar region and pineal gland. An excisional biopsy of suprasellar mass was done. The pathologic assessment confirmed the diagnosis of germinoma. Patient's treatment continued accordingly. A spine MRI, done due to persistent backache, showed a vertebra plana. We reevaluated the primary diagnosis suspecting LCH. Germinoma of CNS was confirmed and a biopsy of vertebral lesion resulted in hemangioma. Thus we report a case of CNS germinoma with co-occurrence of vertebra plana. We emphasized the importance of histopathologic diagnosis of pineal/suprasellar masses and primary investigation of other CNS regions including spine for possible metastasis or comorbidities.

사이버나이프 6-D Skull Tracking의 유용성 평가 (The variability of 6-D Skull Tracking(6DST) in Cyberknife for Bone metastasis patients)

  • 이건호;배선명;송흥권;백금문
    • 대한방사선치료학회지
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    • 제30권1_2호
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    • pp.41-47
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    • 2018
  • 목 적 : 사이버나이프(Accuray Inc., Sunnyvale, CA)를 이용한 제1, 2경추의 정위체부방사선치료(Stereotactic Body Radiation Therapy, SBRT)시 사용가능한 Xsight Spine Tracking(XST)과 6-Dimensional Skull Tracking(6DST)의 비교를 통해 6DST의 유용성을 평가하고자 한다. 대상 및 방법 : 2017년 1월부터 9월까지 본원에서 사이버나이프를 이용하여 제1, 2경추에 SBRT를 진행한 환자 9명을 대상으로, 전산화단층촬영장치(Lightspeed VCT 64, General Electric Co. Waukesha, WI, USA)를 이용해서 컴퓨터 단층 영상(Computed tomography) 을 획득한 후 전산화치료계획시스템(Multiplan system Version 4.6, Accuray, US)를 이용해 제 1, 2경추에 대한 XST와 6DST가 가능한 계획을 수립하였다. 1차 영상 유도를 통해 환자 자세를 보정한 후 동일 환자에 대한 XST와 6DST를 순서대로 진행하고 측정된 결과값을 비교 평가하였다. 결 과 : 제1경추를 대상으로 XST을 실시한 후 측정된 6D Couch 의 Y, Z, X 축 값과 Roll, Pitch, Yaw 값 중 최대값은 0.9 mm, 0.9 mm, 0.7 mm과 $1.0^{\circ}$, $1.0^{\circ}$, $1.2^{\circ}$로 측정되었고, 6DST의 경우 0.7 mm, 0.7 mm, 0.9 mm과 $0.5^{\circ}$, $0.9^{\circ}$, $0.8^{\circ}$로 측정되었다. 제2경추의 XST를 실시했을 때 측정된 값 중 최대값은 0.7 mm, 0.7 mm, 0.8 mm과 $0.9^{\circ}$, $1.0^{\circ}$, $1.8^{\circ}$였고, 6DST의 경우 0.9 mm, 0.7 mm, 0.9 mm와 $0.9^{\circ}$, $0.9^{\circ}$, $1.0^{\circ}$로 측정되었다. 결 론 : 이번 연구를 통해서 제 1, 2 경추에 대한 XST와 6DST의 6D Couch 측정값이 모두 본원에서 기준으로 하고 있는 범위 안에서 측정되고 있음을 확인할 수 있었다. 또한 두 방법을 진행하는 과정에서 설정값 변경을 진행해야하는 XST보다 6DST가 영상유도절차를 간소화 시킬 수 있다는 것을 확인할 수 있었다. 따라서 제 1, 2 경추에 대한 SBRT를 진행할 경우 XST와 더불어서 6DST를 사용한다면 정확한 치료와 더불어서 치료 시간을 단축시킬 수 있을 것으로 사료된다.

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내장신경 반복차단예에 대한 임상적 연구 (A Clinical Evaluation of Repeated Splanchic Nerve Block)

  • 성낙순;윤덕미;오흥근
    • The Korean Journal of Pain
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    • 제3권2호
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    • pp.108-118
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    • 1990
  • Splanchnic nerve block (SNB) is performed to relieve intractable upper abdominal pain caused by carcinoma of the upper G-I tract. Not all patients achieve satisfactory pain relief; therefore, a second or third nerve block trial may need to be performed. In this study, an attempt was made to analyze the possible factors which might affect the result of repeated SNB in 42 the patients among 264 patients who received SNB at Severance Hospital during the period from January 1985 to December 1989. The results are as follows: 1) Among the 42 patients, including 30 males and 12 females, the fifties and forties were the major age groups. 2) Among the underlying diseases, stomach cancer was the most common (18 cases) and pancreatic cancer was next (14 cases). 3) The main locations of pain were the upper abdomen, epigastrium and entire abdomen in decreasing order. 4) Among the thirty-nine cases of first SNB combined with ascites, 13 cases received a repeat block, 81.0% of whom had had metastatic lesion. 5) There were 54.2% who had had single or combined treatment, operation, chemotherapy or radiotherapy before SNB. 6) Twently seven cases (64.3%) had received opioid medication for pain control. 7) In the 75% alcohol group, 11.7% of patients required a second block, and in the pure and 50% alcohol group, 9.6% of patients required a second block within two weeks of the first block. Three cases in both of these repeated block groups required a third block; representing 3.9%, of the 75% alcohol group and 1.6% of the pure and 50% alcohol group. 8) The volume of alcohol used was more than 16 ml bilaterally in both cases. 9) The points of the inserted needle were positioned in the upper and anterolateral part of the $L_1$ vertebra on both sides on the anteroposterior roentgenogram. The contrast media was spread upward along the anterior margin of the vertebral body and posteriorly in repeat block. The frequency of repeat block was higher in cases with ascites or metastasis. The instance of repeat block within 2 weeks of the first block was lower in the pure and 50% alcohol group than in the 75% alcohol group. Thus, alcohol concentration and patient status may be considered factors which influence the result of repeated SNB. We suggest early application of SNB in upper abdominal cancer patients.

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다양한 원발성 암의 척추전이 병변의 특징적인 자기공명영상 소견들: 병리학적으로 확인된 병변들의 후향적인 분석 (Characteristic MRI Findings of Spinal Metastases from Various Primary Cancers: Retrospective Study of Pathologically-Confirmed Cases)

  • 안찬식;이영한;김성준;조희우;서진석;송호택
    • Investigative Magnetic Resonance Imaging
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    • 제17권1호
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    • pp.8-18
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    • 2013
  • 목적: 척추전이의 자기공명영상 소견들 중 특정 원발성 암에 특이적인 소견들이 있는지 알아보고자 한다. 대상과 방법: 본 연구에서는 자기공명영상을 시행한 총 169개의 척추전이암 병변들 (56개는 폐암, 29개는 유방암, 20개는 대장암, 17개는 간세포암, 그리고 47개는 위암으로부터 기원)을 후향적으로 분석하였다. 각 병변의 크기, 위치, 침범 정도, 신호강도, 경계, 조영증강 양상, 그리고 골융해/골경화 특성들을 분석하여 원발성 암의 기원에 따라 차이가 있는지 보았다. 결과: 간세포암의 전이 병변들은 대장암을 제외하고는 (P=0.268) 다른 암에 비하여 크기가 유의하게 컸다 (P < 0.05). 경계가 좋은 병변은 폐암과 유방암에서 기원한 경우에서 더 흔히 관찰되었다 (P < 0.01). 간세포암을 제외한 모든 암에서 전이를 할 때 척추의 후부요소보다 척추체를 더 자주 침범하였다(P < 0.02). 대장암과 간세포암은 골외 침범을 더 자주 보였으나 통계학적 의미는 없었다 (P > 0.05). 간세포암과 위암의 전이병변들은 특징적인 조영증강 양상을 보였다. 결론: 일부 자기공명영상 소견들은 척추전이 병변이 어떤 원발성 암에서 기원한 것이지 예측하는 데 도움이 될 수 있다.