Advertisement

Novalis Spinal Radiosurgery

  • David Ly
  • Christopher J. Anker
  • Meic H. Schmidt
Chapter
Part of the Tumors of the Central Nervous System book series (TCNS, volume 11)

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.

Keywords

Spinal Cord Compression Stereotactic Body Radiation Therapy Spinal Metastasis Spinal Lesion Biologic Equivalent Dose 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Anker CJ, Shrieve DC (2009) Basic principles of radiobiology applied to radiosurgery and radiotherapy of benign skull base tumors. Otolaryngol Clin North Am 42:601–621PubMedCrossRefGoogle Scholar
  2. ASTRO (2011) ACR–ASTRO practice guideline for the performance of stereotactic radiosurgery, pp 1–9. http://www.acr.org/~/media/F80A2737FF0F4753B6ABABA73E15D757.pdf
  3. 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 13:324–328PubMedCrossRefGoogle Scholar
  4. 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 7:151–160PubMedCrossRefGoogle Scholar
  5. 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 78:499–506PubMedCrossRefGoogle Scholar
  6. Cole JS, Patchell RA (2008) Metastatic epidural spinal cord compression. Lancet Neurol 7:459–466PubMedCrossRefGoogle Scholar
  7. 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 80:213–220PubMedCrossRefGoogle Scholar
  8. 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 29:3072–3077PubMedCrossRefGoogle Scholar
  9. 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 64:297–306PubMedCrossRefGoogle Scholar
  10. 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 117:3509–3516PubMedCrossRefGoogle Scholar
  11. Gerszten PC, Burton SA, Quinn AE, Agarwala SS, Kirkwood JM (2005) Radiosurgery for the treatment of spinal melanoma metastases. Stereotact Funct Neurosurg 83:213–221PubMedCrossRefGoogle Scholar
  12. 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) 32:193–199CrossRefGoogle Scholar
  13. Gerszten PC, Burton SA, Ozhasoglu C, McCue KJ, Quinn AE (2008) Radiosurgery for benign intradural spinal tumors. Neurosurgery 62:887–895PubMedCrossRefGoogle Scholar
  14. Gibbs IC, Patil C, Gerszten PC, Adler JR Jr, Burton SA (2009) Delayed radiation-induced myelopathy after spinal radiosurgery. Neurosurgery 64:A67–A72PubMedCrossRefGoogle Scholar
  15. Grosu AL, Andratschke N, Nieder C, Molls M (2002) Retreatment of the spinal cord with palliative radiotherapy. Int J Radiat Oncol Biol Phys 52:1288–1292PubMedCrossRefGoogle Scholar
  16. Hamilton AJ, Lulu BA, Fosmire H, Stea B, Cassady JR (1995) Preliminary clinical experience with linear accelerator-based spinal stereotactic radiosurgery. Neurosurgery 36:311–319PubMedCrossRefGoogle Scholar
  17. 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 33:382–387PubMedCrossRefGoogle Scholar
  18. Levine AM, Coleman C, Horasek S (2009) Stereotactic radiosurgery for the treatment of primary sarcomas and sarcoma metastases of the spine. Neurosurgery 64:A54–A59PubMedCrossRefGoogle Scholar
  19. 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 45:521–527PubMedCrossRefGoogle Scholar
  20. 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 81:1500–1505PubMedCrossRefGoogle Scholar
  21. 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 13:87–93PubMedCrossRefGoogle Scholar
  22. 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 76:1185–1192PubMedCrossRefGoogle Scholar
  23. 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 66:1446–1449PubMedCrossRefGoogle Scholar
  24. 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 70:847–852PubMedCrossRefGoogle Scholar
  25. 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 366:643–648PubMedCrossRefGoogle Scholar
  26. Petteys R, Sciubba D, Gokaslan Z (2009) Surgical management of metastatic spine disease. Semin Spine Surg 21:86–92CrossRefGoogle Scholar
  27. 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 70:211–219PubMedCrossRefGoogle Scholar
  28. 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 35:292–298PubMedCrossRefGoogle Scholar
  29. 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 116:2250–2257PubMedGoogle Scholar
  30. 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 74:723–731PubMedCrossRefGoogle Scholar
  31. 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 82:107–116PubMedCrossRefGoogle Scholar
  32. Sciubba DM, Gokaslan ZL (2006) Diagnosis and management of metastatic spine disease. Surg Oncol 15:141–151PubMedCrossRefGoogle Scholar
  33. Timmerman RD (2008) An overview of hypofractionation and introduction to this issue of seminars in radiation oncology. Semin Radiat Oncol 18:215–222PubMedCrossRefGoogle Scholar
  34. 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 52:111–121CrossRefGoogle Scholar
  35. 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 82:1744–1748PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  • David Ly
    • 1
  • Christopher J. Anker
    • 1
  • Meic H. Schmidt
    • 2
  1. 1.Department of Radiation Oncology, Huntsman Cancer HospitalUniversity of UtahSalt Lake CityUSA
  2. 2.Department of Neurosurgery, Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUSA

Personalised recommendations