title: Radiosurgery in the treatment of spinal metastases: tumor control, survival, and quality of life after helical tomotherapy.
abstract: OBJECTIVE
  The effectiveness and limitations of spinal radiosurgery using a helical TomoTherapy system for the treatment of spinal metastases are reviewed in this article.
  
  
  METHODS
  This is a retrospective review of patients who underwent stereotactic radiosurgery for spinal metastases between July 2004 and December 2007. Radiographic follow-up consisted of magnetic resonance imaging to assess tumor growth control as well as pre- and posttreatment x-rays, which were used to measure changes in segmental angulation and deformity. Clinical performance was assessed using the Karnofsky Performance Scale, Oswestry Disability Index, and visual analog scale.
  
  
  RESULTS
  Forty patients were treated for 110 metastatic tumors (range, 1-6 tumors per patient). The mean age at the time of radiosurgical treatment was 67 years (age range, 35-81 years). Twenty-three patients (57.5%) had undergone previous surgical resection. Pain was the most common presenting symptom, seen in 32 patients (80%). The mean Oswestry Disability Index score at presentation was 43 (range, 20-90), and the mean visual analog scale score was 6.2 (range, 0-10). The mean radiosurgical dose to the tumor was 17.3 Gy (range, 10-24 Gy). At a mean follow-up duration of 12.7 months (range, 4-32 months), decreased or stable tumor volume was seen in 90 (82%) of the tumors treated. There was improvement in pain in 34 patients (85%). The mean postradiosurgical Oswestry Disability Index score was 25 (range, 10-90), whereas the postradiosurgical visual analog scale score was 3.2 (range, 0-9). Progression of kyphosis was the most common radiographic sequela, experienced by 73% of patients alive at 12 months, with a mean change in angulation of 7.3 +/- 4.5 degrees.
  
  
  CONCLUSIONS
  Radiosurgery is effective as either primary or adjunctive treatment of metastatic tumors of the spine.
authors.affiliation: Departments of Neurological Surgery and Radiation Oncology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA. jps2f@hscmail.mcc.virginia.edu
authors.forename: Jason P
authors.initials: JP
authors.lastname: Sheehan
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
authors.forename: David
authors.initials: D
authors.lastname: Schlesinger
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Williams
authors.forename: Vincent
authors.initials: V
authors.lastname: Arlet
authors.forename: James
authors.initials: J
authors.lastname: Larner
mesh_terms: D006801:Humans; D008279:Magnetic Resonance Imaging; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D011788:Quality of Life; D016634:Radiosurgery / Q000379:methods* / Q000401:mortality; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000401:mortality / Q000523:psychology / Q000601:surgery; D016896:Treatment Outcome