LINAC-based spinal stereotactic radiosurgery

Allan J Hamilton, Bruce A. Lulu, Helen Fosmire, Lynne Gossett

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

The authors' report on the use of a prototype spinal stereotactic radiosurgery frame which was employed for the treatment of 9 patients who presented with recurrent neoplastic involvement of the spinal column. All patients had failed standard therapy consisting of surgery, external fractionated radiation therapy, and/or chemotherapy. Eight of the lesions represented metastatic tumors in the vertebral column, one of the lesions was a primary osteosarcoma involving multiple vertebral bodies. The lesions were found at multiple levels, from the cervical through the sacral region. Six out of the 9 patients presented with epidural compression; 4 of the 9 patients with evidence of myelopathy; 2 of the 9 patients with radicular symptoms secondary to compression from the tumor, and 1 patient was free of any compressive symptoms. All patients had pain requiring narcotics. Patients were treated with a median radiosurgical dose of 800 cGy (range 800-1,000) with a median of 1 isocenter (range 1-7 isocenters) and median normalization of 80% to the isodose contour (range 80-160). Median dose delivered to the already prior irradiated spinal cord was 179 cGy (range 52-320 cGy) with a median spinal cord dose of 34 (range 4-68). To date, there have been three minor complications: one radiation-induced esophagitis which was treated medically; one wound infection, and 1 patient requiring an additional 24 h of hospitalization stay. There have been no major complications. To date, 5 of the 9 patients have died, all from causes unrelated to the spinal radiosurgery. Three out of the 9 patients have been followed for more than 1 year. In all 3, there was radiographic regression of the tumor and epidural compression. In 2 patients, there was histologic confirmation of absence of tumor in the treated site; in 1 patient, no tumor was found at postmortem, 12 months after treatment, when the patient died of unrelated causes. Although the number of patients followed is limited, the phase I study clearly shows the technical feasibility of spinal radiosurgery for the control of metastatic involvement of the vertebral column even in the face of epidural compression.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalStereotactic and Functional Neurosurgery
Volume66
Issue number1-3
DOIs
StatePublished - Oct 1996

Fingerprint

Radiosurgery
Spine
Neoplasms
Spinal Cord
Epidural Neoplasms
Sacrococcygeal Region
Esophagitis
Spinal Cord Diseases
Narcotics
Wound Infection
Osteosarcoma

Keywords

  • Extracranial stereotactic radiosurgery
  • LINAC
  • Radiosurgery
  • Spinal metastases
  • Stereotaxis

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

LINAC-based spinal stereotactic radiosurgery. / Hamilton, Allan J; Lulu, Bruce A.; Fosmire, Helen; Gossett, Lynne.

In: Stereotactic and Functional Neurosurgery, Vol. 66, No. 1-3, 10.1996, p. 1-9.

Research output: Contribution to journalArticle

Hamilton, Allan J ; Lulu, Bruce A. ; Fosmire, Helen ; Gossett, Lynne. / LINAC-based spinal stereotactic radiosurgery. In: Stereotactic and Functional Neurosurgery. 1996 ; Vol. 66, No. 1-3. pp. 1-9.
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