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Purpose: The purpose of this study was to evaluate the role of stereotactic radiosurgery in the treatment of primary tumors of the spine and spinal cord. Methods: An Institutional Review Board approved retrospective analysis of 30 patients with primary spine tumors treated at a single institution was performed. Post-treatment pain, neurological, and radiographic responses were the endpoints. Results: Nine patients were treated for benign tumors, and 21 patients were treated for malignant tumors. The median dose delivered was 16 Gy in one fraction. Median follow up was 13.13 months (range, 1 month-84 months). Pain relief was 88% initially. Pain recurred in five patients with a median time to recurrence of 5 months (range, 3.6 months - 80 months). Neurological improvement was achieved in 65% of patients. Three patients experienced a recurrence in their neurological deficit (at 3.6 months, 1.6 years, and 3.7 years after SRS). Radiographic control was achieved in 77% of sites treated with SRS. Thirteen of the treated sites recurred with a median time of 9.9 months. Two long-term toxicities were observed (asymptomatic radio-necrosis of the erector spinae muscle and foot drop). Conclusions: Our results suggest that SRS is a safe and effective treatment option for primary tumors of the spine and spinal cord. [ABSTRACT FROM AUTHOR]

Purpose: The standard of care of patients with high-grademetastatic epidural compression is open decompression with or without stabilization. However, many patients are unwilling or unable to undergo open surgical decompression. This study investigated the outcomes of treating patients with high-grade (Ryu/ Rock radiographic grade IV and V, Spine Oncology Study Group Grade II and III) metastatic epidural spinal cord compression with spinal radiosurgery as first-line therapy in lieu of surgical decompression. Methods: Utilizing the Henry Ford Spinal Tumor Database, patients with metastatic lesions causing advanced radiographical grade (IV or V) epidural spinal cord compression who received stereotactic radiosurgery (SRS)with adequate clinical and radiological follow-up were identified from 2007-2011. These patients were retrospectively reviewed for clinical and radiological response to radiosurgery. Results: 33 patients with 35 metastatic lesions causing Ryu/Rock radiographical grade IV or V compression were identified with a median follow-up of 435 days. Of the 34 lesions in 32 patients who were ambulatory pre- SRS, 23 (67%) were ambulatory at last follow-up. 6/33 progressed early (less than 2 months) neurologically and an additional 5 patients developed late progressive neurologic deficit. The one patient who was initially non-ambulatory was able to regain ambulatory status. Radiologically, there was a significant epidural tumor response rate of 74%. Ultimately, 9 patients (27%) eventually required surgery for neurologic compromise or mechanical instability. There was one patient who received EBRT previously who experienced radiation myelopathy as a complication of SRS. Conclusion: Radiosurgery as an initial therapy for high-grade metastatic epidural compression appears to be a viable treatment paradigm for selected patients with close clinical and radiological follow-up. However, a significant minority will progress necessitating the need for rigorous monitoring. Further study is needed prospectively analyze the effectiveness of SRS with or without open surgical decompression. [ABSTRACT FROM AUTHOR]

Purpose Spine radiosurgery requires accurate image-guided stereotactic targeting and intensity-modulated radiation delivery. It can deliver a high radiation dose to spine and spinal cord tumors. The purpose of this study is to demonstrate the clinical effectiveness of radiosurgery for primary spine and cord tumors. Methods and Materials A total of 26 patients with 36 primary spine and cord tumors were treated with radiosurgery. There were 7 patients with spinal cord tumors, and 19 patients with primary spine tumors. Radiosurgery doses were single session of 12-18 Gy in 29 lesions, and fractionated in 6 lesions. Ten lesions were recurrent tumors after the initial therapy of combined surgery and radiation. Median follow-up was 12 months (range 2-42 months) with imaging studies and clinical examinations. Results The patients' symptoms and neurological status improved in 56%, and was stable in 28% after radiosurgery. One-year local tumor control rate was 94 %; complete response in 26%, partial response in 26%, and stable in 42%. There were no acute or long-term complications. Conclusion This study demonstrates that spine radiosurgery is an effective treatment for symptom improvement and tumor control of primary spine and spinal cord tumors. Spine radiosurgery can be a viable and non-invasive treatment option for primary spine tumors. [ABSTRACT FROM AUTHOR]

Purpose: To determine our institutional vertebral compression fracture (VCF) rate after spine stereotactic radiosurgery (SRS) and determine contributory factors.Methods and Materials: Retrospective analysis from 2001 to 2013 at a single institution was performed. With institutional review board approval, electronic medical records of 1905 vertebral bodies from 791 patients who were treated with SRS for the management of primary or metastatic spinal lesions were reviewed. A total of 448 patients (1070 vertebral bodies) with adequate follow-up imaging studies available were analyzed. Doses ranging from 10 Gy in 1 fraction to 60 Gy in 5 fractions were delivered. Computed tomography and magnetic resonance imaging were used to evaluate the primary endpoints of this study: development of a new VCF, progression of an existing VCF, and requirement of stabilization surgery after SRS.Results: A total of 127 VCFs (11.9%; 95% confidence interval [CI] 9.5%-14.2%) in 97 patients were potentially SRS induced: 46 (36%) were de novo, 44 (35%) VCFs progressed, and 37 (29%) required stabilization surgery after SRS. Our rate for radiologic VCF development/progression (excluding patients who underwent surgery) was 8.4%. Upon further exclusion of patients with hematologic malignancies the VCF rate was 7.6%. In the univariate analyses, females (hazard ratio [HR] 1.54, 95% CI 1.01-2.33, P=.04), prior VCF (HR 1.99, 95% CI 1.30-3.06, P=.001), primary hematologic malignancies (HR 2.68, 95% CI 1.68-4.28, P<.001), thoracic spine lesions (HR 1.46, 95% CI 1.02-2.10, P=.02), and lytic lesions had a significantly increased risk for VCF after SRS. On multivariate analyses, prior VCF and lesion type remained contributory.Conclusions: Single-fraction SRS doses of 16 to 18 Gy to the spine seem to be associated with a low rate of VCFs. To the best of our knowledge, this is the largest reported experience analyzing SRS-induced VCFs, with one of the lowest event rates reported. [ABSTRACT FROM AUTHOR]

Abstract: Precision and accuracy of image-guided spinal radiosurgery has been previously demonstrated. This study was carried out to determine the clinical efficacy of spine radiosurgery for the treatment of solitary spinal metastases with or without cord compression. A total of 49 patients with 61 separate spinal metastases were treated with radiosurgery. All patients had pathologically proven primary cancers and had either synchronous or metachronous metastasis to the spine. The majority of the patients presented with back pain. All patients received single-dose radiosurgery to the involved spine only. The radiosurgery dose ranged from 10 to 16Gy. The primary endpoint was pain control, but outcomes in neurological status and radiological tumor control also were assessed. The median time to pain relief was 14 days and the earliest time of pain relief was within 24hours. Complete pain relief was achieved in 46%, partial relief in 18.9%, and stable symptoms in 16.2%. Relapse of pain at the treated spinal segment was 6.9%. Median duration of pain relief at the treated spine was 13.3 months. Overall pain control rate for one year was 84%. This experience demonstrates that spinal radiosurgery can achieve rapid and durable pain relief. Single-dose radiosurgery has a potential to be a viable treatment option for single spinal metastasis. [Copyright &y& Elsevier]