BACKGROUND: Surgical decompression of metastatic epidural compression (MEC) improved ambulatory function. Spine radiosurgery can accurately target the epidural tumor and deliver high radiation doses for tumor control. Therefore, a clinical trial was performed to quantitatively determine the degree of epidural decompression by radiosurgery of metastatic epidural compression. METHODS: Sixty-two patients with a total of 85 lesions of metastatic epidural compression were treated. Epidural compression was diagnosed by magnetic resonance imaging (MRI) scans. Main criteria of inclusion were neurological status with muscle power 4 of 5 or better. Radiosurgery was performed to the involved spine segment, including the epidural mass with median dose of 16 Gy (range 12-20 Gy) in a single session. All patients had prospective clinical follow-up, ranging from 1-48 months (median 11.5 months), and 36 patients had pretreatment and post-treatment imaging, ranging from 2-33 months (median 9.3 months). Primary endpoints were epidural tumor control and thecal sac decompression. RESULTS: The mean epidural tumor volume reduction was 65 +/- 14% at 2 months after radiosurgery. The epidural tumor area at the level of the most severe spinal cord compression was 0.82 +/- 0.08 cm(2) before radiosurgery and 0.41 +/- 0.06 cm(2) after radiosurgery (P < .001). Thecal sac patency improved from 55 +/- 4% to 76 +/- 3% (P < .001). Overall, neurological function improved in 81%. CONCLUSIONS: This study demonstrated a radiosurgical decompression of epidural tumor. Although neurosurgical decompression and radiotherapy is the standard treatment in patients with good performance, radiosurgical decompression can be a viable noninvasive treatment option for malignant epidural compression. (c) 2010 American Cancer Society.
BACKGROUND: Surgical decompression of metastatic epidural compression (MEC) improved ambulatory function. Spine radiosurgery can accurately target the epidural tumor and deliver high radiation doses for tumor control. Therefore, a clinical trial was performed to quantitatively determine the degree of epidural decompression by radiosurgery of metastatic epidural compression. METHODS: Sixty-two patients with a total of 85 lesions of metastatic epidural compression were treated. Epidural compression was diagnosed by magnetic resonance imaging (MRI) scans. Main criteria of inclusion were neurological status with muscle power 4 of 5 or better. Radiosurgery was performed to the involved spine segment, including the epidural mass with median dose of 16 Gy (range 12-20 Gy) in a single session. All patients had prospective clinical follow-up, ranging from 1-48 months (median 11.5 months), and 36 patients had pretreatment and post-treatment imaging, ranging from 2-33 months (median 9.3 months). Primary endpoints were epidural tumor control and thecal sac decompression. RESULTS: The mean epidural tumor volume reduction was 65 +/- 14% at 2 months after radiosurgery. The epidural tumor area at the level of the most severe spinal cord compression was 0.82 +/- 0.08 cm(2) before radiosurgery and 0.41 +/- 0.06 cm(2) after radiosurgery (P < .001). Thecal sac patency improved from 55 +/- 4% to 76 +/- 3% (P < .001). Overall, neurological function improved in 81%. CONCLUSIONS: This study demonstrated a radiosurgical decompression of epidural tumor. Although neurosurgical decompression and radiotherapy is the standard treatment in patients with good performance, radiosurgical decompression can be a viable noninvasive treatment option for malignant epidural compression. (c) 2010 American Cancer Society.
Authors: Zain A Husain; Arjun Sahgal; Eric L Chang; Pejman Jabehdar Maralani; Charlotte D Kubicky; Kristin J Redmond; Charles Fisher; Ilya Laufer; Simon S Lo Journal: CNS Oncol Date: 2017-07-18
Authors: Ilya Laufer; Simon S Lo; Eric L Chang; Jason Sheehan; Matthias Guckenberger; Moon-Jun Sohn; Samuel Ryu; Matthew Foote; Alexander Muacevic; Scott G Soltys; Samuel Chao; Sten Myrehaug; Peter C Gerszten; Eric Lis; Pejman Maralani; Mark Bilsky; Charles Fisher; Laurence Rhines; Jorrit-Jan Verlaan; David Schiff; Michael G Fehlings; Lijun Ma; Susan Chang; Wendy R Parulekar; Michael A Vogelbaum; Arjun Sahgal Journal: Neuro Oncol Date: 2018-08-02 Impact factor: 12.300
Authors: Morten H Suppli; Per Munck Af Rosenschold; Helle Pappot; Benny Dahl; Søren S Morgen; Ivan R Vogelius; Svend A Engelholm Journal: J Radiosurg SBRT Date: 2016
Authors: Mark H Bilsky; Lilyana Angelov; Jack Rock; Jason Weaver; Jason Sheehan; Laurence Rhines; Syed Azeem; Peter Gerszten Journal: J Radiosurg SBRT Date: 2011