Michael R Folkert1, Mark H Bilsky2, Gil'ad N Cohen3, Laszlo Voros3, Jung Hun Oh3, Marco Zaider3, Ilya Laufer2, Yoshiya Yamada4. 1. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY. 2. Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, NY. 3. Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY. 4. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY. Electronic address: yamadaj@mskcc.org.
Abstract
PURPOSE: Sterilization of surgical margins for lesions involving the dura is complicated by the tolerance of the spinal cord and/or cauda equina, especially in the setting of prior radiation therapy (RT); use of intraoperative brachytherapy may allow local delivery of therapeutic dose without damaging sensitive structures. METHODS AND MATERIALS: Patients with malignant lesions involving the dura received intraoperative brachytherapy with a (32)P plaque after maximal resection of the tumor. Local recurrence (LR) was analyzed using competing risks analysis; overall survival was analyzed using Kaplan-Meier statistics. RESULTS: Between September 2009 and April 2013, 68 patients with 69 lesions in the spine were treated with the (32)P plaque. Median followup was 10 months. Most patients (n=59, 85.5%) had previously been treated with at least one course of prior RT to the treated site. About 38 (55%) lesions received postoperative RT (median dose, 30 Gy; range, 18-30 Gy). The LR and overall survival at 12 months were 25.5% (95% confidence interval [CI]=15.5-37%) and 59.5% (95% CI=46-73%), respectively. For patients who received postoperative RT, LR at 12 months was 18.5% (95% CI=7.5-33%) compared with 34% (95% CI=18-51%) for those who were treated with the plaque alone (p=0.08 and 0.04 on univariate and multivariable analysis, respectively). There were no acute or long-term complications from treatment observed in this cohort. CONCLUSIONS: The (32)P intraoperative brachytherapy plaque is a useful adjunct to surgical intervention for primary recurrent and metastatic lesions of the spine involving the dura, and is not associated with additional toxicity.
PURPOSE: Sterilization of surgical margins for lesions involving the dura is complicated by the tolerance of the spinal cord and/or cauda equina, especially in the setting of prior radiation therapy (RT); use of intraoperative brachytherapy may allow local delivery of therapeutic dose without damaging sensitive structures. METHODS AND MATERIALS: Patients with malignant lesions involving the dura received intraoperative brachytherapy with a (32)P plaque after maximal resection of the tumor. Local recurrence (LR) was analyzed using competing risks analysis; overall survival was analyzed using Kaplan-Meier statistics. RESULTS: Between September 2009 and April 2013, 68 patients with 69 lesions in the spine were treated with the (32)P plaque. Median followup was 10 months. Most patients (n=59, 85.5%) had previously been treated with at least one course of prior RT to the treated site. About 38 (55%) lesions received postoperative RT (median dose, 30 Gy; range, 18-30 Gy). The LR and overall survival at 12 months were 25.5% (95% confidence interval [CI]=15.5-37%) and 59.5% (95% CI=46-73%), respectively. For patients who received postoperative RT, LR at 12 months was 18.5% (95% CI=7.5-33%) compared with 34% (95% CI=18-51%) for those who were treated with the plaque alone (p=0.08 and 0.04 on univariate and multivariable analysis, respectively). There were no acute or long-term complications from treatment observed in this cohort. CONCLUSIONS: The (32)P intraoperative brachytherapy plaque is a useful adjunct to surgical intervention for primary recurrent and metastatic lesions of the spine involving the dura, and is not associated with additional toxicity.
Authors: Ori Barzilai; Ilya Laufer; Adam Robin; Ran Xu; Yoshiya Yamada; Mark H Bilsky Journal: Oper Neurosurg (Hagerstown) Date: 2019-03-01 Impact factor: 2.703
Authors: Patrick D Kelly; Scott L Zuckerman; Yoshiya Yamada; Eric Lis; Mark H Bilsky; Ilya Laufer; Ori Barzilai Journal: Neurosurg Rev Date: 2019-06-01 Impact factor: 3.042
Authors: Gil'ad N Cohen; Karen Episcopia; Seng-Boh Lim; Thomas J LoSasso; Mark J Rivard; Amandeep S Taggar; Neil K Taunk; Abraham J Wu; Antonio L Damato Journal: Brachytherapy Date: 2017-08-18 Impact factor: 2.362
Authors: Liana Mulet; Izabella Barreto; Gil'ad N Cohen; Antonio L Damato; Thomas Mauceri; Jennifer Pursley; Christopher L Deufel Journal: Brachytherapy Date: 2021-10-24 Impact factor: 2.362