| Strategy of Spinal Radiosurgery for Metastatic Spine Tumors?? Curative vs. Palliative Treatment |
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Moon-Jun Sohn, Dong Joon Lee, Hye Ran Lee, C Jin Whang |
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Department of Neurosurgery, Internal Medicine, Clinical Research Center, Inje University Ilsan Paik Hospital, College of Medicine, Ilsan, Korea |
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| Abstract |
Objective
The objective of this study is to assess the effects of spinal radiosurgery as either curative or palliative intent for improvement in quality of life and local tumor controls in advanced cancer patients with spinal metastases.
Methods
Total twenty patients with metastatic spine tumors were treated with Novalis shaped beam radiosurgery unit. Ten patients were treated to palliate medically intractable cancer pain caused by spinal metastasis and the rest ten patients underwent spinal radiosurgery to achieve local tumor control. We analyzed clinical prognostic factors using two surgical scoring systems developed to provide an optimal guideline for patient selection and to determine the aim of radiosurgery.
Results
There was a significant difference of median survival times between two groups (2months vs. 19months, palliative vs. curative, respectively, p<0.0001, log rank test). Mean Karnofski's performance score was improved from 69 to 85 in the curative group (p<0.0001, paired t-test). Overall average VAS of cancer pain was significantly improved from 8.4 to 2.0 in both groups (p<0.0001). Although no patient was indicated for the curative surgical procedures by the established scoring systems, 90% local tumor control was achieved in the curative group. Comparing Kaplan-Meier survival according to the type of tumor extent and KPS, single metastasis and less than three multiple metastasis (type 7a) showed better outcome than over 3 multiple lesions (type 7b) in the curative group. There were statistically significant differences in median survival length (6 vs. 12.8 vs. 19.9 months; type 7b vs. type 7a vs. type 4-6, respectively, p<0.0065) among those groups.
Conclusion
Image guided stereotactic spinal radiosurgery offers a safe and effective palliative or curative treatment for metastatic spine tumors. For the palliative group, intractable cancer pain was significantly resolved with radiosurgery in a short course. Number of metastases and type of tumor extent also provide important prognostic determinants to improve survival and local tumor control was successfully achieved during follow-up period in the curative group. |
| Key Words:
Spinal radiosurgery, Stereotactic radiosurgery, Metastasis, Quality of life, Clinical outcome, Prognostic factors. |
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