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Novalis Spinal Radiosurgery

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Tumors of the Central Nervous System, Volume 11

Part of the book series: Tumors of the Central Nervous System ((TCNS,volume 11))

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Abstract

Stereotactic radiosurgery (SRS) is a noninvasive approach to delivering high doses of conformal radiation. The majority of spinal tumors are metastatic lesions, and it is estimated that 30–90 % of cancer patients will develop metastatic spinal lesions. The potential benefit of spinal SRS may arise in cases of reirradiation where conformal dose distribution and a noninvasive approach are desired. Current techniques require a high degree of precision with patient simulation. Retrospective studies have favored a spinal SRS fractionation schema of ≥14 Gy in one fraction in previously unirradiated patients, with the majority of 1-year local and pain control estimates above 80 %. Radiation-induced myelopathy from spinal SRS is exceedingly rare, but may occur 6–12 months after treatment. Follow-up after spinal SRS is important since intervention after radiation-induced myelopathy may alleviate neurologic symptoms. Randomized clinical trials are examining the feasibility and ability of spinal SRS to deliver improved outcomes for pain relief compared with conventional three-dimensional conformal external beam radiotherapy.

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References

  • Anker CJ, Shrieve DC (2009) Basic principles of radiobiology applied to radiosurgery and radiotherapy of benign skull base tumors. Otolaryngol Clin North Am 42:601–621

    Article  PubMed  Google Scholar 

  • ASTRO (2011) ACR–ASTRO practice guideline for the performance of stereotactic radiosurgery, pp 1–9. http://www.acr.org/~/media/F80A2737FF0F4753B6ABABA73E15D757.pdf

  • Bilsky MH, Laufer I, Fourney DR, Groff M, Schmidt MH, Varga PP, Vrionis FD, Yamada Y, Gerszten PC, Kuklo TR (2010) Reliability analysis of the epidural spinal cord compression scale. J Neurosurg Spine 13:324–328

    Article  PubMed  Google Scholar 

  • Chang EL, Shiu AS, Mendel E, Mathews LA, Mahajan A, Allen PK, Weinberg JS, Brown BW, Wang XS, Woo SY, Cleeland C, Maor MH, Rhines LD (2007) Phase I/II study of stereotactic body radiotherapy for spinal metastasis and its pattern of failure. J Neurosurg Spine 7:151–160

    Article  PubMed  Google Scholar 

  • Choi CY, Adler JR, Gibbs IC, Chang SD, Jackson PS, Minn AY, Lieberson RE, Soltys SG (2010) Stereotactic radiosurgery for treatment of spinal metastases recurring in close proximity to previously irradiated spinal cord. Int J Radiat Oncol Biol Phys 78:499–506

    Article  PubMed  Google Scholar 

  • Cole JS, Patchell RA (2008) Metastatic epidural spinal cord compression. Lancet Neurol 7:459–466

    Article  PubMed  Google Scholar 

  • Daly ME, Choi CY, Gibbs IC, Adler JR Jr, Chang SD, Lieberson RE, Soltys SG (2011) Tolerance of the spinal cord to stereotactic radiosurgery: insights from hemangioblastomas. Int J Radiat Oncol Biol Phys 80:213–220

    Article  PubMed  Google Scholar 

  • Fourney DR, Frangou EM, Ryken TC, Dipaola CP, Shaffrey CI, Berven SH, Bilsky MH, Harrop JS, Fehlings MG, Boriani S, Chou D, Schmidt MH, Polly DW, Biagini R, Burch S, Dekutoski MB, Ganju A, Gerszten PC, Gokaslan ZL, Groff MW, Liebsch NJ, Mendel E, Okuno SH, Patel S, Rhines LD, Rose PS, Sciubba DM, Sundaresan N, Tomita K, Varga PP, Vialle LR, Vrionis FD, Yamada Y, Fisher CG (2011) Spinal instability neoplastic score: an analysis of reliability and validity from the spine oncology study group. J Clin Oncol 29:3072–3077

    Article  PubMed  Google Scholar 

  • Gagnon GJ, Nasr NM, Liao JJ, Molzahn I, Marsh D, McRae D, Henderson FC Sr (2009) Treatment of spinal tumors using cyberknife fractionated stereotactic radiosurgery: pain and quality-of-life assessment after treatment in 200 patients. Neurosurgery 64:297–306

    Article  PubMed  Google Scholar 

  • Garg AK, Wang XS, Shiu AS, Allen P, Yang J, McAleer MF, Azeem S, Rhines LD, Chang EL (2011) Prospective evaluation of spinal reirradiation by using stereotactic body radiation therapy: The University of Texas MD Anderson Cancer Center experience. Cancer 117:3509–3516

    Article  PubMed  Google Scholar 

  • Gerszten PC, Burton SA, Quinn AE, Agarwala SS, Kirkwood JM (2005) Radiosurgery for the treatment of spinal melanoma metastases. Stereotact Funct Neurosurg 83:213–221

    Article  PubMed  Google Scholar 

  • Gerszten PC, Burton SA, Ozhasoglu C, Welch WC (2007) Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution. Spine (Phila Pa 1976) 32:193–199

    Article  Google Scholar 

  • Gerszten PC, Burton SA, Ozhasoglu C, McCue KJ, Quinn AE (2008) Radiosurgery for benign intradural spinal tumors. Neurosurgery 62:887–895

    Article  PubMed  Google Scholar 

  • Gibbs IC, Patil C, Gerszten PC, Adler JR Jr, Burton SA (2009) Delayed radiation-induced myelopathy after spinal radiosurgery. Neurosurgery 64:A67–A72

    Article  PubMed  Google Scholar 

  • Grosu AL, Andratschke N, Nieder C, Molls M (2002) Retreatment of the spinal cord with palliative radiotherapy. Int J Radiat Oncol Biol Phys 52:1288–1292

    Article  PubMed  Google Scholar 

  • Hamilton AJ, Lulu BA, Fosmire H, Stea B, Cassady JR (1995) Preliminary clinical experience with linear accelerator-based spinal stereotactic radiosurgery. Neurosurgery 36:311–319

    Article  PubMed  CAS  Google Scholar 

  • Hwang YJ, Sohn MJ, Lee BH, Kim SY, Seo JW, Han YH, Lee JY, Cha SJ, Kim YH (2012) Radiosurgery for metastatic spinal tumors: follow-up MR findings. AJNR Am J Neuroradiol 33:382–387

    Article  PubMed  CAS  Google Scholar 

  • Levine AM, Coleman C, Horasek S (2009) Stereotactic radiosurgery for the treatment of primary sarcomas and sarcoma metastases of the spine. Neurosurgery 64:A54–A59

    Article  PubMed  Google Scholar 

  • Lohr F, Debus J, Frank C, Herfarth K, Pastyr O, Rhein B, Bahner ML, Schlegel W, Wannenmacher M (1999) Noninvasive patient fixation for extracranial stereotactic radiotherapy. Int J Radiat Oncol Biol Phys 45:521–527

    Article  PubMed  CAS  Google Scholar 

  • Mahadevan A, Floyd S, Wong E, Jeyapalan S, Groff M, Kasper E (2011) Stereotactic body radiotherapy reirradiation for recurrent epidural spinal metastases. Int J Radiat Oncol Biol Phys 81:1500–1505

    Article  PubMed  Google Scholar 

  • Moulding HD, Elder JB, Lis E, Lovelock DM, Zhang Z, Yamada Y, Bilsky MH (2010) Local disease control after decompressive surgery and adjuvant high-dose single-fraction radiosurgery for spine metastases. J Neurosurg Spine 13:87–93

    Article  PubMed  Google Scholar 

  • Nguyen QN, Shiu AS, Rhines LD, Wang H, Allen PK, Wang XS, Chang EL (2010) Management of spinal metastases from renal cell carcinoma using stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys 76:1185–1192

    Article  PubMed  Google Scholar 

  • Nieder C, Grosu AL, Andratschke NH, Molls M (2006) Update of human spinal cord reirradiation tolerance based on additional data from 38 patients. Int J Radiat Oncol Biol Phys 66:1446–1449

    Article  PubMed  Google Scholar 

  • Park C, Papiez L, Zhang S, Story M, Timmerman RD (2008) Universal survival curve and single fraction equivalent dose: useful tools in understanding potency of ablative radiotherapy. Int J Radiat Oncol Biol Phys 70:847–852

    Article  PubMed  Google Scholar 

  • Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, Mohiuddin M, Young B (2005) Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet 366:643–648

    Article  PubMed  Google Scholar 

  • Petteys R, Sciubba D, Gokaslan Z (2009) Surgical management of metastatic spine disease. Semin Spine Surg 21:86–92

    Article  Google Scholar 

  • Ropper AE, Cahill KS, Hanna JW, McCarthy EF, Gokaslan ZL, Chi JH (2012) Primary vertebral tumors: a review of epidemiologic, histological and imaging findings, part II: locally aggressive and malignant tumors. Neurosurgery 70:211–219

    Article  PubMed  Google Scholar 

  • Ryu S, Jin R, Jin JY, Chen Q, Rock J, Anderson J, Movsas B (2008) Pain control by image-guided radiosurgery for solitary spinal metastasis. J Pain Symptom Manage 35:292–298

    Article  PubMed  Google Scholar 

  • Ryu S, Rock J, Jain R, Lu M, Anderson J, Jin JY, Rosenblum M, Movsas B, Kim JH (2010) Radiosurgical decompression of metastatic epidural compression. Cancer 116:2250–2257

    PubMed  Google Scholar 

  • Sahgal A, Ames C, Chou D, Ma L, Huang K, Xu W, Chin C, Weinberg V, Chuang C, Weinstein P, Larson DA (2009) Stereotactic body radiotherapy is effective salvage therapy for patients with prior radiation of spinal metastases. Int J Radiat Oncol Biol Phys 74:723–731

    Article  PubMed  Google Scholar 

  • Sahgal A, Ma L, Weinberg V, Gibbs IC, Chao S, Chang UK, Werner-Wasik M, Angelov L, Chang EL, Sohn MJ, Soltys SG, Letourneau D, Ryu S, Gerszten PC, Fowler J, Wong CS, Larson DA (2012) Reirradiation human spinal cord tolerance for stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys 82:107–116

    Article  PubMed  Google Scholar 

  • Sciubba DM, Gokaslan ZL (2006) Diagnosis and management of metastatic spine disease. Surg Oncol 15:141–151

    Article  PubMed  Google Scholar 

  • Timmerman RD (2008) An overview of hypofractionation and introduction to this issue of seminars in radiation oncology. Semin Radiat Oncol 18:215–222

    Article  PubMed  Google Scholar 

  • Yarnold J (1999) 8 Gy single fraction radiotherapy for the treatment of metastatic skeletal pain: randomised comparison with a multifraction schedule over 12 months of patient follow-up. Bone Pain Trial Working Party. Radiother Oncol 52:111–121

    Article  Google Scholar 

  • Zelefsky MJ, Greco C, Motzer R, Magsanoc JM, Pei X, Lovelock M, Mechalakos J, Zatcky J, Fuks Z, Yamada Y (2012) Tumor control outcomes after hypofractionated and single-dose stereotactic image-guided intensity-modulated radiotherapy for extracranial metastases from renal cell carcinoma. Int J Radiat Oncol Biol Phys 82:1744–1748

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, 1950 Circle of Hope, Salt Lake City, UT, 84112, USA

    David Ly & Christopher J. Anker

  2. Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA

    Meic H. Schmidt

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  1. David Ly
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  2. Christopher J. Anker
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  3. Meic H. Schmidt
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Correspondence to Meic H. Schmidt .

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Editors and Affiliations

  1. Kean University, Room 213, Library building, Union, New Jersey, USA

    M.A. Hayat

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Ly, D., Anker, C.J., Schmidt, M.H. (2014). Novalis Spinal Radiosurgery. In: Hayat, M. (eds) Tumors of the Central Nervous System, Volume 11. Tumors of the Central Nervous System, vol 11. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-7037-9_20

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  • DOI: https://doi.org/10.1007/978-94-007-7037-9_20

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  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-007-7036-2

  • Online ISBN: 978-94-007-7037-9

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