Cancer Res Treat.  2019 Oct;51(4):1324-1335. 10.4143/crt.2018.653.

The Feasibility of Spinal Stereotactic Radiosurgery for Spinal Metastasis with Epidural Cord Compression

• Kim YJ
• Kim JH
• Kim K
• Kim HJ
• Chie EK
• Shin KH
• Wu HG
• Kim IH

• KMID: 2460582
• DOI: http://doi.org/10.4143/crt.2018.653

Abstract

PURPOSE
The purpose of this study was to investigate the effectiveness and safety of spinal stereotactic radiosurgery (SRS) in treating spinal metastasis with epidural spinal cord compression (ESCC).
MATERIALS AND METHODS
During 2013-2016, 149 regions of spinal metastasis in 105 patients treated with single-fraction (12-24 Gy) spinal SRS were reviewed. Cord compression of Bilsky grade 2 (with visible cerebrospinal fluid [CSF]) or 3 (no visible CSF) was defined as ESCC. Local progression (LP) and vertebral compression fracture (VCF) rates after SRS were evaluated using multivariate competing-risk regression analysis.
RESULTS
The 1-year cumulative incidences of LP for Bilsky grades 0 (n=80), 1 (n=39), 2 (n=21), and 3 (n=9) were 3.0%, 8.4%, 0%, and 24.9%, respectively. Bilsky grade 2 ESCC did not significantly increase the LP rate (no LP for grade 2). The 1-year cumulative incidences of VCF for Bilsky grades 0, 1, 2, and 3 were 6.6%, 5.2%, 17.1%, and 12.1%, respectively. ESCC may increase VCF risk (subhazard ratio [SHR] for grade 2, 5.368; p=0.035; SHR for grade 3, 2.215; p=0.460). Complete or partial pain response rates after SRS were 79%, 78%, 53%, and 63% for Bilsky grades 0, 1, 2, and 3, respectively (p=0.008). No neurotoxicity of grade ≥ 3 was observed.
CONCLUSION
Spinal SRS for spinal metastasis with Bilsky grade 2 ESCC did not increase the LP rate, was not associated with severe neurotoxicity, and showed moderate VCF and pain response rates. Bilsky grade 3 had a high LP rate.

Keyword

Spine; Neoplasm metastasis; Spinal cord compression; Fractures; Compression; Radiosurgery; Disease progression

MeSH Terms

Cerebrospinal Fluid
Disease Progression
Fractures, Compression
Humans
Incidence
Neoplasm Metastasis*
Radiosurgery*
Spinal Cord Compression
Spine

Figure

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  Fig. 1. Cumulative incidence function of local progression following univariate competing risk regression analysis in spinal metastasis treated with stereotactic radiosurgery.

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  Fig. 2. Cumulative incidence function of vertebral compression fracture following univariate competing risk regression analysis in spinal metastasis treated with stereotactic radiosurgery.

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  Fig. 3. An example of region (T12 spine) of progressed epidural spinal cord compression (ESCC) induced by vertebral compression fracture (VCF) after stereotactic radiosurgery (SRS) (20 Gy/1 fraction to T11-L1 spines). (A) Before SRS (T12 spine, Bilsky grade 2). (B) Progressed VCF and ESCC at T12 spine 7 months after SRS. (C) Posterior fixation (T9- L2) after diagnosis of progressed ESCC (motor function, from 4 to 4+).

Reference

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