Felix Ehret1,2, Carolin Senger1,3, Markus Kufeld2, Christoph Fürweger2,4, Melina Kord1, Alfred Haidenberger2, Paul Windisch2,5, Daniel Rueß4, David Kaul1, Maximilian Ruge4, Christian Schichor6, Jörg-Christian Tonn6, Alexander Muacevic2. 1. Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany. 2. European Cyberknife Center, 81377 Munich, Germany. 3. Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité CyberKnife Center, 13353 Berlin, Germany. 4. Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, 50937 Cologne, Germany. 5. Department of Radiation Oncology, Kantonsspital Winterthur, 8400 Winterthur, Switzerland. 6. Department of Neurosurgery, Ludwig-Maximilians-University Munich, 81377 Munich, Germany.
Abstract
BACKGROUND: Intramedullary metastases are rare and bear a dismal prognosis. Limited data are available on the treatment of such lesions. As surgery may be the mainstay of treatment for patients with resectable and localized metastatic spread, previous case reports and case series suggest radiosurgery to be another viable treatment modality. This multicenter study analyzes the efficacy and safety of robotic radiosurgery (RRS) for intramedullary metastases. METHODS: Patients who received RRS for the treatment of at least one intramedullary metastasis were included. RESULTS: Thirty-three patients with 46 intramedullary metastases were treated with a median dose of 16 Gy prescribed to a median isodose of 70%. The local control was 79% after a median follow-up of 8.5 months. The median overall survival (OS) was 11.7 months, with a 12- and 24-month OS of 47 and 31%. The 12-month progression-free survival was 42% and at 24 months 25%. In addition, 57% of patients showed either an improved or stable neurological function after treatment delivery. Systemic disease progression was the main cause of death. No significant treatment-related toxicities were observed. CONCLUSIONS: RRS appears to be a safe, time-saving and effective treatment modality for intramedullary metastases, especially for patients with unresectable lesions and high burden of disease.
BACKGROUND: Intramedullary metastases are rare and bear a dismal prognosis. Limited data are available on the treatment of such lesions. As surgery may be the mainstay of treatment for patients with resectable and localized metastatic spread, previous case reports and case series suggest radiosurgery to be another viable treatment modality. This multicenter study analyzes the efficacy and safety of robotic radiosurgery (RRS) for intramedullary metastases. METHODS:Patients who received RRS for the treatment of at least one intramedullary metastasis were included. RESULTS: Thirty-three patients with 46 intramedullary metastases were treated with a median dose of 16 Gy prescribed to a median isodose of 70%. The local control was 79% after a median follow-up of 8.5 months. The median overall survival (OS) was 11.7 months, with a 12- and 24-month OS of 47 and 31%. The 12-month progression-free survival was 42% and at 24 months 25%. In addition, 57% of patients showed either an improved or stable neurological function after treatment delivery. Systemic disease progression was the main cause of death. No significant treatment-related toxicities were observed. CONCLUSIONS: RRS appears to be a safe, time-saving and effective treatment modality for intramedullary metastases, especially for patients with unresectable lesions and high burden of disease.
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