title: Radiosurgical decompression of metastatic epidural compression.
abstract: BACKGROUND
  Surgical decompression of metastatic epidural compression (MEC) improved ambulatory function. Spine radiosurgery can accurately target the epidural tumor and deliver high radiation doses for tumor control. Therefore, a clinical trial was performed to quantitatively determine the degree of epidural decompression by radiosurgery of metastatic epidural compression.
  
  
  METHODS
  Sixty-two patients with a total of 85 lesions of metastatic epidural compression were treated. Epidural compression was diagnosed by magnetic resonance imaging (MRI) scans. Main criteria of inclusion were neurological status with muscle power 4 of 5 or better. Radiosurgery was performed to the involved spine segment, including the epidural mass with median dose of 16 Gy (range 12-20 Gy) in a single session. All patients had prospective clinical follow-up, ranging from 1-48 months (median 11.5 months), and 36 patients had pretreatment and post-treatment imaging, ranging from 2-33 months (median 9.3 months). Primary endpoints were epidural tumor control and thecal sac decompression.
  
  
  RESULTS
  The mean epidural tumor volume reduction was 65 +/- 14% at 2 months after radiosurgery. The epidural tumor area at the level of the most severe spinal cord compression was 0.82 +/- 0.08 cm(2) before radiosurgery and 0.41 +/- 0.06 cm(2) after radiosurgery (P < .001). Thecal sac patency improved from 55 +/- 4% to 76 +/- 3% (P < .001). Overall, neurological function improved in 81%.
  
  
  CONCLUSIONS
  This study demonstrated a radiosurgical decompression of epidural tumor. Although neurosurgical decompression and radiotherapy is the standard treatment in patients with good performance, radiosurgical decompression can be a viable noninvasive treatment option for malignant epidural compression.
authors.affiliation: Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan 48202, USA. sryu1@hfhs.org
authors.forename: Samuel
authors.initials: S
authors.lastname: Ryu
authors.forename: Jack
authors.initials: J
authors.lastname: Rock
authors.forename: Rajan
authors.initials: R
authors.lastname: Jain
authors.forename: Mei
authors.initials: M
authors.lastname: Lu
authors.forename: Joseph
authors.initials: J
authors.lastname: Anderson
authors.forename: Jian-Yue
authors.initials: JY
authors.lastname: Jin
authors.forename: Mark
authors.initials: M
authors.lastname: Rosenblum
authors.forename: Benjamin
authors.initials: B
authors.lastname: Movsas
authors.forename: Jae Ho
authors.initials: JH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015174:Epidural Neoplasms / Q000150:complications / Q000556:secondary* / Q000601:surgery; D005260:Female; D020233:Gait Disorders, Neurologic / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009420:Nervous System / Q000503:physiopathology; D016634:Radiosurgery; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery*