title: Quantitative Evaluation of Local Control and Wound Healing Following Surgery and Stereotactic Spine Radiosurgery for Spine Tumors.
abstract: OBJECTIVE
  The present study evaluated the optimal measuring criteria to assess spinal tumor response to surgery followed by stereotactic spine radiosurgery (SRS) and reports the local control and wound complication rates following combined multimodality treatment.
  
  
  METHODS
  Prospectively collected patient information was retrospectively reviewed to identify patients treated with spine surgery followed by SRS. Tumor sizes and volumetric assessment were formally measured. Local control status was defined according to World Health Organization (WHO, bidimensional), RECIST (unidimensional), or volumetric size change. Statistical comparative assessments of tumor measurements were performed.
  
  
  RESULTS
  Twenty-two patients were eligible for evaluation after having undergone surgery followed by single-fraction SRS within a 2-month period. Seventeen had follow-up magnetic resonance imaging (MRI) with a mean patient follow-up of 12.59 months (range 3-36 months). None developed wound complication after radiation therapy (95% lower confidence bound 13%). Two patients had clinical recurrence while 15 of 17 achieved local control (88.3%). A test of marginal homogeneity for RECIST versus WHO was not statistically significant, P = 1.0 suggesting similar response classifications with both systems. Spearman correlations among 1) volumetric assessment, 2) bidimensional size, and 3) unidimensional size were significant for all groups (P < 0.05).
  
  
  CONCLUSIONS
  High local control rates can be achieved with surgery followed by SRS. Further, adjuvant SRS following spine tumor surgery delivers less radiation to the wound than conventional radiation and thus potentially reduces wound complications. Unidimensional, bidimensional, and volumetric tumor assessments demonstrate similar results. Hence the use of the simpler RECIST criteria is suitable and appropriate for evaluating the response to treatment after spine radiosurgery.
authors.affiliation: Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio; Spine Unit, Neurosurgery Department, Talpiot Medical Leadership Program, Sheba Medical Center, Israel.
authors.forename: Ran
authors.initials: R
authors.lastname: Harel
authors.affiliation: Imaging Institute, Section of Neuroradiology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Todd
authors.initials: T
authors.lastname: Emch
authors.affiliation: Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio; Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio; Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Samuel
authors.initials: S
authors.lastname: Chao
authors.affiliation: Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Paul
authors.initials: P
authors.lastname: Elson
authors.affiliation: Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Ajit
authors.initials: A
authors.lastname: Krishnaney
authors.affiliation: Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio; Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Toufik
authors.initials: T
authors.lastname: Djemil
authors.affiliation: Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio; Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: John
authors.initials: J
authors.lastname: Suh
authors.affiliation: Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio; Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio; Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: angelol@ccf.org.
authors.forename: Lilyana
authors.initials: L
authors.lastname: Angelov
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003131:Combined Modality Therapy; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects; D016634:Radiosurgery / Q000009:adverse effects; D011879:Radiotherapy Dosage; D066066:Response Evaluation Criteria in Solid Tumors; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods; D013125:Spinal Neoplasms / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome; D047368:Tumor Burden; D014944:World Health Organization; D014945:Wound Healing
keywords: Local control; Spine radiosurgery; Spine surgery; Tumor; Wound infection