title: Spinal Laser Interstitial Thermal Therapy: A Novel Alternative to Surgery for Metastatic Epidural Spinal Cord Compression.
abstract: BACKGROUND
  Although surgery followed by radiation effectively treats metastatic epidural compression, the ideal surgical approach should enable fast recovery and rapid institution of radiation and systemic therapy directed at the primary tumor.
  
  
  OBJECTIVE
  To assess spinal laser interstitial thermotherapy (SLITT) as an alternative to surgery monitored in real time by thermal magnetic resonance (MR) images.
  
  
  METHODS
  Patients referred for spinal metastasis without motor deficits underwent MR-guided SLITT, followed by stereotactic radiosurgery. Clinical and radiological data were gathered prospectively, according to routine practice.
  
  
  RESULTS
  MR imaging-guided SLITT was performed on 19 patients with metastatic epidural compression. No procedures were discontinued because of technical difficulties, and no permanent neurological injuries occurred. The median follow-up duration was 28 weeks (range 10-64 weeks). Systemic therapy was not interrupted to perform the procedures. The mean preoperative visual analog scale scores of 4.72 (SD ± 0.67) decreased to 2.56 (SD ± 0.71, P = .043) at 1 month and remained improved from baseline at 3.25 (SD ± 0.75, P = .021) 3 months after the procedure. The preoperative mean EQ-5D index for quality of life was 0.67 (SD ± 0.07) and remained without significant change at 1 month 0.79 (SD ± 0.06, P = .317) and improved at 3 months 0.83 (SD ± 0.06, P = .04) after SLITT. Follow-up MR imaging after 2 months revealed significant decompression of the neural component in 16 patients. However, 3 patients showed progression at follow-up, 1 was treated with surgical decompression and stabilization and 2 were treated with repeated SLITT.
  
  
  CONCLUSIONS
  MR-guided SLITT can be both a feasible and safe alternative to separation surgery in carefully selected cases of spinal metastatic tumor epidural compression.
  
  
  BACKGROUND
  cEBRT, conventional external beam radiation therapyESCC, epidural spinal cord compressionSLITT, spinal laser interstitial thermotherapySSRS, stereotactic spinal radiosurgeryVAS, visual analog scale.
authors.affiliation: ‡Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas; §Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; ¶Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas; ‖Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; #Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas; **Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Claudio E
authors.initials: CE
authors.lastname: Tatsui
authors.forename: Sun-Ho
authors.initials: SH
authors.lastname: Lee
authors.forename: Behrang
authors.initials: B
authors.lastname: Amini
authors.forename: Ganesh
authors.initials: G
authors.lastname: Rao
authors.forename: Dima
authors.initials: D
authors.lastname: Suki
authors.forename: Marilou
authors.initials: M
authors.lastname: Oro
authors.forename: Paul D
authors.initials: PD
authors.lastname: Brown
authors.forename: Amol J
authors.initials: AJ
authors.lastname: Ghia
authors.forename: Shreyas
authors.initials: S
authors.lastname: Bhavsar
authors.forename: Keyuri
authors.initials: K
authors.lastname: Popat
authors.forename: Laurence D
authors.initials: LD
authors.lastname: Rhines
authors.forename: R Jason
authors.initials: RJ
authors.lastname: Stafford
authors.forename: Jing
authors.initials: J
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D053685:Laser Therapy / Q000379:methods*; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery*; D013125:Spinal Neoplasms / Q000556:secondary / Q000601:surgery*; D013238:Stereotaxic Techniques