title: Utilization of laser interstitial thermotherapy guided by real-time thermal MRI as an alternative to separation surgery in the management of spinal metastasis.
abstract: OBJECTIVE
  High-grade malignant spinal cord compression is commonly managed with a combination of surgery aimed at removing the epidural tumor, followed by spinal stereotactic radiosurgery (SSRS) aimed at local tumor control. The authors here introduce the use of spinal laser interstitial thermotherapy (SLITT) as an alternative to surgery prior to SSRS.
  
  
  METHODS
  Patients with a high degree of epidural malignant compression due to radioresistant tumors were selected for study. Visual analog scale (VAS) scores for pain and quality of life were obtained before and within 30 and 60 days after treatment. A laser probe was percutaneously placed in the epidural space. Real-time thermal MRI was used to monitor tissue damage in the region of interest. All patients received postoperative SSRS. The maximum thickness of the epidural tumor was measured, and the degree of epidural spinal cord compression (ESCC) was scored in pre- and postprocedure MRI.
  
  
  RESULTS
  In the 11 patients eligible for study, the mean VAS score for pain decreased from 6.18 in the preoperative period to 4.27 within 30 days and 2.8 within 60 days after the procedure. A similar VAS interrogating the percentage of quality of life demonstrated improvement from 60% preoperatively to 70% within both 30 and 60 days after treatment. Imaging follow-up 2 months after the procedure demonstrated a significant reduction in the mean thickness of the epidural tumor from 8.82 mm (95% CI 7.38-10.25) before treatment to 6.36 mm (95% CI 4.65-8.07) after SLITT and SSRS (p = 0.0001). The median preoperative ESCC Grade 2 was scored as 4, which was significantly higher than the score of 2 for Grade 1b (p = 0.04) on imaging follow-up 2 months after the procedure.
  
  
  CONCLUSIONS
  The authors present the first report on an innovative minimally invasive alternative to surgery in the management of spinal metastasis. In their early experience, SLITT has provided local control with low morbidity and improvement in both pain and the quality of life of patients.
authors.affiliation: Departments of 1 Neurosurgery.
authors.forename: Claudio E
authors.initials: CE
authors.lastname: Tatsui
authors.affiliation: Imaging Physics.
authors.forename: R Jason
authors.initials: RJ
authors.lastname: Stafford
authors.affiliation: Radiation Oncology.
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.affiliation: Departments of 1 Neurosurgery.
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Sellin
authors.affiliation: Diagnostic Radiology, and.
authors.forename: Behrang
authors.initials: B
authors.lastname: Amini
authors.affiliation: Departments of 1 Neurosurgery.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Rao
authors.affiliation: Departments of 1 Neurosurgery.
authors.forename: Dima
authors.initials: D
authors.lastname: Suki
authors.affiliation: Radiation Oncology.
authors.forename: Amol J
authors.initials: AJ
authors.lastname: Ghia
authors.affiliation: Radiation Oncology.
authors.forename: Paul
authors.initials: P
authors.lastname: Brown
authors.affiliation: Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Sun-Ho
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Anesthesiology, The University of Texas MD Anderson Cancer Center, Houston, Texas; and.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Cowles
authors.affiliation: Departments of 1 Neurosurgery.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Weinberg
authors.affiliation: Departments of 1 Neurosurgery.
authors.forename: Laurence D
authors.initials: LD
authors.lastname: Rhines
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000295:instrumentation*; D053685:Laser Therapy / Q000379:methods*; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011788:Quality of Life; D016634:Radiosurgery; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000209:etiology / Q000628:therapy*; D013125:Spinal Neoplasms / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome
keywords: ESCC = epidural spinal cord compression; HASTE = half Fourier acquisition single-shot turbo spin-echo; K-wire = Kirschner wire; NOMS = neurologic, oncologic, mechanical, systemic; SINS = Spine Instability Neoplastic Score; SLITT = spinal laser interstitial thermotherapy; SSRS = spinal stereotactic radiosurgery; SpO2 = blood oxygen saturation; VAS = visual analog scale; cEBRT = conventional external beam radiation therapy; laser interstitial thermotherapy; separation surgery; spinal metastasis; technique