title: Image-guided robotic radiosurgery for spinal metastases.
abstract: OBJECTIVE
  To determine the effectiveness and safety of image-guided robotic radiosurgery for spinal metastases.
  
  
  METHODS
  From 1996 to 2005, 74 patients with 102 spinal metastases were treated using the CyberKnife at Stanford University. Sixty-two (84%) patients were symptomatic. Seventy-four percent (50/68) of previously treated patients had prior radiation. Using the CyberKnife, 16-25 Gy in 1-5 fractions was delivered. Patients were followed clinically and radiographically for at least 3 months or until death.
  
  
  RESULTS
  With mean follow-up of 9 months (range 0-33 months), 36 patients were alive and 38 were dead at last follow-up. No death was treatment related. Eighty-four (84%) percent of symptomatic patients experienced improvement or resolution of symptoms after treatment. Three patients developed treatment-related spinal injury. Analysis of dose-volume parameters and clinical parameters failed to identify predictors of spinal cord injury.
  
  
  CONCLUSIONS
  Robotic radiosurgery is effective and generally safe for spinal metastases even in previously irradiated patients.
authors.affiliation: Department of Radiation Oncology, Stanford University, Stanford, CA 94305-5847, USA. iris.gibbs@stanford.edu
authors.forename: Iris C
authors.initials: IC
authors.lastname: Gibbs
authors.forename: Pimkhuan
authors.initials: P
authors.lastname: Kamnerdsupaphon
authors.forename: Mi-Ryeong
authors.initials: MR
authors.lastname: Ryu
authors.forename: Robert
authors.initials: R
authors.lastname: Dodd
authors.forename: Michaela
authors.initials: M
authors.lastname: Kiernan
authors.forename: Steven D
authors.initials: SD
authors.lastname: Chang
authors.forename: John R
authors.initials: JR
authors.lastname: Adler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011446:Prospective Studies; D016634:Radiosurgery / Q000379:methods*; D012371:Robotics; D013125:Spinal Neoplasms / Q000556:secondary* / Q000601:surgery*; D025321:Surgery, Computer-Assisted; D016896:Treatment Outcome