Postoperative radiosurgery for malignant spinal tumors.
OBJECTIVE
Although, as a primary therapy, radiosurgery for spinal tumors is becoming more common in clinical practice and is associated with encouraging clinical results, we wanted to evaluate outcomes after radiosurgery in a series of postoperative patients.


METHODS
We examined the medical records of 18 postoperative patients who received radiosurgical treatment to their residual spinal tumors: metastatic carcinoma (10), sarcoma (3), multiple myeloma/plasmacytoma (4), and giant cell tumor (1). Marginal radiosurgical doses ranged from 6 to 16 Gy (mean, 11.4 Gy) prescribed to the 90% isodose line. All regions of the spine received treatment: 2 cervical, 15 thoracic, and 1 lumbosacral. The volume of irradiated spinal elements receiving 30, 50, and 80% of the total dose ranged from 0.51 to 11.05, 0.19 to 6.34, and 0.06 to 1.73 cm, respectively. Treatment sessions (i.e., patient in to patient out of the room) varied between 20 and 40 minutes. Follow-up ranged from 4 to 36 months (median, 7 mo).


RESULTS
Even though significant doses of radiation were delivered to all regions of the spinal cord and nerve roots coincidentally involved in the treatments, only one patient in this series developed progressive symptoms possibly attributable to a toxic effect of the radiosurgery. Of those patients initially presenting with neurological deficits, 92% either remained neurologically stable or improved.


CONCLUSIONS
Our observations suggest that radiosurgery as prescribed in this series of postoperative patients with residual spinal tumor is well-tolerated and associated with little to no significant morbidity.
Rock
Jack P
JP
Department of Neurological Surgery, Hermelin Brain Tumor Center, Henry Ford Hospital, Detroit, Michigan 48202, USA. nsjar@neuro.hfh.edu
Ryu
Samuel
S
Shukairy
Mohammad S
MS
Yin
Fang-Fang
FF
Sharif
Aktham
A
Schreiber
Faye
F
Abdulhak
Muwaffak
M
Kim
Jae Ho
JH
Rosenblum
Mark L
ML
D000328:Adult; D000368:Aged; D006801:Humans; D008875:Middle Aged; D011184:Postoperative Period; D016634:Radiosurgery / Q000379:methods; D012189:Retrospective Studies; D013120:Spinal Cord Neoplasms / Q000175:diagnosis / Q000601:surgery*; D013125:Spinal Neoplasms / Q000175:diagnosis / Q000601:surgery*