title: Radiosurgery for the treatment of spinal lung metastases.
abstract: BACKGROUND
  Spinal metastases are a common source of pain as well as neurologic deficit in patients with lung cancer. Metastases from lung cancer traditionally have been believed to be relatively responsive to radiation therapy. However, conventional external beam radiotherapy lacks the precision to allow delivery of large single-fraction doses of radiation and simultaneously limit the dose to radiosensitive structures such as the spinal cord. The current study evaluated the efficacy of single-fraction radiosurgery for the treatment of spinal lung cancer metastases.
  
  
  METHODS
  In the current prospective cohort evaluation, 87 lung cancer metastases to the spine in 77 patients were treated with a single-fraction radiosurgery technique with a follow-up period of 6 to 40 months (median, 12 months). The indication for radiosurgery treatment was pain in 73 cases, as a primary treatment modality in 7 cases, for radiographic tumor progression in 4 cases, and for progressive neurologic deficit in 3 cases.
  
  
  RESULTS
  Tumor volume ranged from 0.2 to 264 cm(3) (mean, 25.7 cm(3)). The maximum tumor dose was maintained at 15 to 25 grays (Gy) (mean, 20 Gy; median, 20 Gy). No radiation-induced toxicity occurred during the follow-up period. Long-term axial and radicular pain improvement occurred in 65 of 73 patients (89%) who were treated primarily for pain. Long-term radiographic tumor control was observed in all patients who underwent radiosurgery as their primary treatment modality or for radiographic tumor progression.
  
  
  CONCLUSIONS
  Spinal radiosurgery was found to be feasible, safe, and clinically effective for the treatment of spinal metastases from lung cancer. The results of the current study indicate the potential of radiosurgery in the treatment of patients with spinal lung metastases, especially those with solitary sites of spine involvement, to improve long-term palliation.
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. gersztenpc@upmc.edu
authors.forename: Peter C
authors.initials: PC
authors.lastname: Gerszten
authors.forename: Steven A
authors.initials: SA
authors.lastname: Burton
authors.forename: Chandra P
authors.initials: CP
authors.lastname: Belani
authors.forename: Suresh
authors.initials: S
authors.lastname: Ramalingam
authors.forename: David M
authors.initials: DM
authors.lastname: Friedland
authors.forename: Cihat
authors.initials: C
authors.lastname: Ozhasoglu
authors.forename: Annette E
authors.initials: AE
authors.lastname: Quinn
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: McCue
authors.forename: William C
authors.initials: WC
authors.lastname: Welch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016634:Radiosurgery / Q000379:methods; D013125:Spinal Neoplasms / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery*