title: Peripheral nervous system injury after high-dose single-fraction image-guided stereotactic radiosurgery for spine tumors.
abstract: OBJECTIVE The object of this study was to determine the percentage of high-dose (1800-2600 cGy) single-fraction stereotactic radiosurgery (SF-SRS) treatments to the spine that result in peripheral nervous system (PNS) injury. METHODS All patients treated with SF-SRS for primary or metastatic spine tumors between January 2004 and May 2013 and referred to the Rehabilitation Medicine Service for evaluation and treatment of neuromuscular, musculoskeletal, or functional impairments or pain were retrospectively identified. RESULTS Five hundred fifty-seven SF-SRS treatments in 447 patients resulted in 14 PNS injuries in 13 patients. All injures resulted from SF-SRS delivered to the cervical or lumbosacral spine at 2400 cGy. The overall percentage of SF-SRS treatments resulting in PNS injury was 2.5%, increasing to 4.5% when the thoracic spine was excluded from analysis. The median time to symptom onset following SF-SRS was 10 months (range 4-32 months). The plexus (cervical, brachial, and/or lumbosacral) was affected clinically and/or electrophysiologically in 12 (86%) of 14 cases, the nerve root in 2 (14%) of 14, and both in 6 (43%) of 14 cases. All patients experienced pain and most (93%) developed weakness. Peripheral nervous system injuries were CTCAE Grade 1 in 14% of cases, 2 in 64%, and 3 in 21%. No dose relationship between SF-SRS dose and PNS injury was detected. CONCLUSIONS Single-fraction SRS to the spine can result in PNS injury with major implications for function and quality of life.
authors.affiliation: Kessler Institute for Rehabilitation Select Medical, West Orange, New Jersey.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Stubblefield
authors.affiliation: Department of Neurology, Rehabilitation Medicine Service.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Ibanez
authors.affiliation: Departments of 3 Epidemiology and Biostatistics.
authors.forename: Elyn R
authors.initials: ER
authors.lastname: Riedel
authors.affiliation: Neurosurgery.
authors.forename: Ori
authors.initials: O
authors.lastname: Barzilai
authors.affiliation: Neurosurgery.|Department of Neurological Surgery, Weill Cornell Medical College, New York, New York.
authors.forename: Ilya
authors.initials: I
authors.lastname: Laufer
authors.affiliation: Radiology, and.
authors.forename: Eric
authors.initials: E
authors.lastname: Lis
authors.affiliation: Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York; and.
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Yamada
authors.affiliation: Neurosurgery.|Department of Neurological Surgery, Weill Cornell Medical College, New York, New York.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Bilsky
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000000981:diagnostic imaging* / Q000209:etiology; D017933:Peripheral Nervous System / Q000293:injuries*; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology; D016634:Radiosurgery / Q000009:adverse effects*; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D055815:Young Adult
keywords: CTCAE = Common Terminology Criteria for Adverse Events; DRG = dorsal root ganglion; EGFR = epidermal growth factor; EMG = electromyography; GTV = gross tumor volume; PNS = peripheral nervous system; PTV = planning treatment volume; SF-SRS = single-fraction stereotactic radiosurgery; VEGF = vascular endothelial growth factor; complications; peripheral nerve; radiosurgery; spine