title: Radiosurgery for metastatic disease at the craniocervical junction.
abstract: OBJECTIVE
  Metastatic disease of the craniovertebral junction (CVJ) can cause pain, cranial nerve deficits, occipitocervical instability, or brainstem/spinal cord compression if left untreated. Many patients with metastasis in this region have a high burden of systemic disease and short life expectancy, making them poor candidates for aggressive surgical resections and fusion procedures. Traditionally, symptom palliation and local disease control in these patients has been achieved through conventional radiation therapy. Stereotactic radiosurgery (SRS) has the advantage of precisely delivering radiation to a target in fewer fractions. To our knowledge, we report the results of the largest series of patients with CVJ metastasis treated with stereotactic radiosurgery.
  
  
  METHODS
  We performed a retrospective review of 9 consecutive patients with 10 tumors of the CVJ treated with SRS at the Keck Medical Center of the University of Southern California. Two tumors were treated with Gamma Knife, whereas the other 8 received CyberKnife.
  
  
  RESULTS
  The median marginal dose was 20 Gy (16-24 Gy) over 1-5 fractions. Point maximal dose to the brainstem or spinal cord ranged between 8 and 18.9 Gy. Median survival was 4 months (1-51 months). Five of six patients presenting with pain had at least partial symptom resolution. No patient went on to require surgical decompression or fusion, and there were no complications directly related to SRS.
  
  
  CONCLUSIONS
  In well-selected patients, SRS for metastatic lesions of the CVJ has a low risk for complications or treatment failure, while achieving a high rate of palliation of pain symptoms.
authors.affiliation: Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA. Electronic address: alexandertuchman@gmail.com.
authors.forename: Alexander
authors.initials: A
authors.lastname: Tuchman
authors.affiliation: Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
authors.forename: Cheng
authors.initials: C
authors.lastname: Yu
authors.affiliation: Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Chang
authors.affiliation: Department of Neuroradiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Kim
authors.affiliation: Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
authors.forename: Mairead C
authors.initials: MC
authors.lastname: Rusch
authors.affiliation: Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
authors.forename: Michael L J
authors.initials: ML
authors.lastname: Apuzzo
mesh_terms: D000328:Adult; D000368:Aged; D001268:Atlanto-Axial Joint / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010148:Intractable Pain / Q000601:surgery; D010166:Palliative Care; D061214:Patient Safety; D011829:Radiation Dosage; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000556:secondary* / Q000601:surgery*; D016019:Survival Analysis; D055815:Young Adult
keywords: Craniovertebral junction; CyberKnife; Gamma Knife; Metastasis; Stereotactic Radiosurgery; Tumor