Radiosurgical decompression of metastatic epidural compression

Samuel Ryu, Jack Rock, Rajan Jain, Mei Lu, Joseph Anderson, JianYue Jin, Mark Rosenblum, Benjamin Movsas, Jae Ho Kim

Research output: Contribution to journalArticle

75 Citations (Scopus)

Abstract

BACKGROUND: Surgical decompression of metastatic epidural compression (MEC) improved ambulatory function. Spine radiosurgery can accurately target the epidural tumor and deliver high radiation doses for tumor control. Therefore, a clinical trial was performed to quantitatively determine the degree of epidural decompression by radiosurgery of metastatic epidural compression. METHODS: Sixty-two patients with a total of 85 lesions of metastatic epidural compression were treated. Epidural compression was diagnosed by magnetic resonance imaging (MRI) scans. Main criteria of inclusion were neurological status with muscle power 4 of 5 or better. Radiosurgery was performed to the involved spine segment, including the epidural mass with median dose of 16 Gy (range 12-20 Gy) in a single session. All patients had prospective clinical follow-up, ranging from 1-48 months (median 11.5 months), and 36 patients had pretreatment and post-treatment imaging, ranging from 2-33 months (median 9.3 months). Primary endpoints were epidural tumor control and thecal sac decompression. RESULTS: The mean epidural tumor volume reduction was 65 ± 14% at 2 months after radiosurgery. The epidural tumor area at the level of the most severe spinal cord compression was 0.82 ± 0.08 cm2 before radiosurgery and 0.41 ± 0.06 cm2 after radiosurgery (P < .001). Thecal sac patency improved from 55 ± 4% to 76 ± 3% (P < .001). Overall, neurological function improved in 81%. CONCLUSIONS: This study demonstrated a radiosurgical decompression of epidural tumor. Although neurosurgical decompression and radiotherapy is the standard treatment in patients with good performance, radiosurgical decompression can be a viable noninvasive treatment option for malignant epidural compression.

Original languageEnglish (US)
Pages (from-to)2250-2257
Number of pages8
JournalCancer
Volume116
Issue number9
DOIs
StatePublished - May 1 2010

Fingerprint

Epidural Neoplasms
Radiosurgery
Decompression
Spine
Surgical Decompression
Spinal Cord Compression
Tumor Burden
Radiotherapy
Therapeutics
Magnetic Resonance Imaging
Clinical Trials
Radiation
Muscles
Neoplasms

Keywords

  • Decompressive radiosurgery
  • Metastatic epidural compression
  • Spinal cord compression
  • Spine radiosurgery

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Ryu, S., Rock, J., Jain, R., Lu, M., Anderson, J., Jin, J., ... Kim, J. H. (2010). Radiosurgical decompression of metastatic epidural compression. Cancer, 116(9), 2250-2257. https://doi.org/10.1002/cncr.24993

Radiosurgical decompression of metastatic epidural compression. / Ryu, Samuel; Rock, Jack; Jain, Rajan; Lu, Mei; Anderson, Joseph; Jin, JianYue; Rosenblum, Mark; Movsas, Benjamin; Kim, Jae Ho.

In: Cancer, Vol. 116, No. 9, 01.05.2010, p. 2250-2257.

Research output: Contribution to journalArticle

Ryu, S, Rock, J, Jain, R, Lu, M, Anderson, J, Jin, J, Rosenblum, M, Movsas, B & Kim, JH 2010, 'Radiosurgical decompression of metastatic epidural compression', Cancer, vol. 116, no. 9, pp. 2250-2257. https://doi.org/10.1002/cncr.24993
Ryu S, Rock J, Jain R, Lu M, Anderson J, Jin J et al. Radiosurgical decompression of metastatic epidural compression. Cancer. 2010 May 1;116(9):2250-2257. https://doi.org/10.1002/cncr.24993
Ryu, Samuel ; Rock, Jack ; Jain, Rajan ; Lu, Mei ; Anderson, Joseph ; Jin, JianYue ; Rosenblum, Mark ; Movsas, Benjamin ; Kim, Jae Ho. / Radiosurgical decompression of metastatic epidural compression. In: Cancer. 2010 ; Vol. 116, No. 9. pp. 2250-2257.
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abstract = "BACKGROUND: Surgical decompression of metastatic epidural compression (MEC) improved ambulatory function. Spine radiosurgery can accurately target the epidural tumor and deliver high radiation doses for tumor control. Therefore, a clinical trial was performed to quantitatively determine the degree of epidural decompression by radiosurgery of metastatic epidural compression. METHODS: Sixty-two patients with a total of 85 lesions of metastatic epidural compression were treated. Epidural compression was diagnosed by magnetic resonance imaging (MRI) scans. Main criteria of inclusion were neurological status with muscle power 4 of 5 or better. Radiosurgery was performed to the involved spine segment, including the epidural mass with median dose of 16 Gy (range 12-20 Gy) in a single session. All patients had prospective clinical follow-up, ranging from 1-48 months (median 11.5 months), and 36 patients had pretreatment and post-treatment imaging, ranging from 2-33 months (median 9.3 months). Primary endpoints were epidural tumor control and thecal sac decompression. RESULTS: The mean epidural tumor volume reduction was 65 ± 14{\%} at 2 months after radiosurgery. The epidural tumor area at the level of the most severe spinal cord compression was 0.82 ± 0.08 cm2 before radiosurgery and 0.41 ± 0.06 cm2 after radiosurgery (P < .001). Thecal sac patency improved from 55 ± 4{\%} to 76 ± 3{\%} (P < .001). Overall, neurological function improved in 81{\%}. CONCLUSIONS: This study demonstrated a radiosurgical decompression of epidural tumor. Although neurosurgical decompression and radiotherapy is the standard treatment in patients with good performance, radiosurgical decompression can be a viable noninvasive treatment option for malignant epidural compression.",
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