|
Frameless
stereotactic radiosurgery in the treatment of cervical spine metastases
Steven
A Burton, Peter Gerszten, Ron Lalonde, Alex Chen, John Flickinger, William
Welch, Shalom Kalnicki
UPMC-Shadyside,
Pittsburgh, PA; UPMC-Presbyterian, Pittsburgh, PA
Purpose.
The goal of this study was to examine the feasibility of the CyberKnife
Stereotactic Radiosurgery system in the palliative treatment of patients with
metastases to the cervical spine.
Methods.
Ten patients with metastatic disease to the cervical spine were treated with
single fraction radiosurgery with the CyberKnife (Accuray, Inc.,Sunnyvale, CA)
to a dose of 12 Gy to the 80% isodose line.
Patients were immobilized with an aquaplast mask.
CT scans were obtained for treatment planning using 3 mm slices.
The target volume ranged from 1.8 to 28.5 cc with a mean of 10.7 cc.
Each plan was tested with a phantom to assure 1 mm accuracy.
The maximum spinal cord dose was 6.3 to 10.1 Gy with a mean of 8.2 Gy.
The primary tumor was breast (4 patients); lung (3 patients); pancreas (1
patient); and osteosarcoma (1 patient).
Four patients had received prior radiation therapy, and one patient received a
boost with radiosurgery.
Results.
Patients were treated in the outpatient setting with an average treatment time
of 30-40 minutes.
There was no acute radiation toxicity or neurologic deficits.
Three patients had transient flare of neck pain.
Pain was significantly improved in the 8 of the 9 patients who were symptomatic
prior to treatment.
Conclusions.
Frameless stereotactic radiosurgery was found to be feasible and safe.
It provided rapid palliation of pain from metastases to the cervial spine in a
single outpatient treatment.
The advantages of stereotactic radiosurgery for cervical spine metastases as
compared to external beam radiation therapy include decreased toxicity (mucositis,
marrow suppression), ability to treat patients who had previously received
radiation therapy, and shorter treatment duration with improved patient
cenvenience and more rapid systemic therapy.
Longer follow-up is needed to determine potential late complications and
duration of response.
© Copyright 2002
American Society of Clinical Oncology
Source:
http://www.asco.org/ac/1,1003,_12-002324-00_18-002002-00_19-00319-00_29-00A-00_42-00ONeill-00_43-00-00_44-00-00_45-00
Author-00_46-00Title-00_47-00Title-00_48-00and-00_49-00and,00.asp?cat=CNS+Tumors&parent=CENTRAL+NERVOUS+SYSTEM+TUMORS
&returnpid=2323
|
