title: Local recurrence outcomes using the ³²P intraoperative brachytherapy plaque in the management of malignant lesions of the spine involving the dura.
abstract: OBJECTIVE
  Sterilization of surgical margins for lesions involving the dura is complicated by the tolerance of the spinal cord and/or cauda equina, especially in the setting of prior radiation therapy (RT); use of intraoperative brachytherapy may allow local delivery of therapeutic dose without damaging sensitive structures.
  
  
  METHODS
  Patients with malignant lesions involving the dura received intraoperative brachytherapy with a (32)P plaque after maximal resection of the tumor. Local recurrence (LR) was analyzed using competing risks analysis; overall survival was analyzed using Kaplan-Meier statistics.
  
  
  RESULTS
  Between September 2009 and April 2013, 68 patients with 69 lesions in the spine were treated with the (32)P plaque. Median followup was 10 months. Most patients (n=59, 85.5%) had previously been treated with at least one course of prior RT to the treated site. About 38 (55%) lesions received postoperative RT (median dose, 30 Gy; range, 18-30 Gy). The LR and overall survival at 12 months were 25.5% (95% confidence interval [CI]=15.5-37%) and 59.5% (95% CI=46-73%), respectively. For patients who received postoperative RT, LR at 12 months was 18.5% (95% CI=7.5-33%) compared with 34% (95% CI=18-51%) for those who were treated with the plaque alone (p=0.08 and 0.04 on univariate and multivariable analysis, respectively). There were no acute or long-term complications from treatment observed in this cohort.
  
  
  CONCLUSIONS
  The (32)P intraoperative brachytherapy plaque is a useful adjunct to surgical intervention for primary recurrent and metastatic lesions of the spine involving the dura, and is not associated with additional toxicity.
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Folkert
authors.affiliation: Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Bilsky
authors.affiliation: Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Gil'ad N
authors.initials: GN
authors.lastname: Cohen
authors.affiliation: Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Laszlo
authors.initials: L
authors.lastname: Voros
authors.affiliation: Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Jung Hun
authors.initials: JH
authors.lastname: Oh
authors.affiliation: Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Marco
authors.initials: M
authors.lastname: Zaider
authors.affiliation: Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Ilya
authors.initials: I
authors.lastname: Laufer
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY. Electronic address: yamadaj@mskcc.org.
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Yamada
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D002648:Child; D004388:Dura Mater; D005260:Female; D006801:Humans; D015994:Incidence; D007432:Intraoperative Period; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009518:New York; D010761:Phosphorus Radioisotopes / Q000627:therapeutic use*; D012189:Retrospective Studies; D013120:Spinal Cord Neoplasms / Q000175:diagnosis / Q000532:radiotherapy* / Q000601:surgery; D015996:Survival Rate / Q000639:trends; D055815:Young Adult
chemical_list: D010761:Phosphorus Radioisotopes
keywords: Brachytherapy; Dura; Intraoperative radiation therapy; Metastatic; Recurrent; Salvage; Spine