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The Feasibility of Spinal Stereotactic Radiosurgery for Spinal Metastasis with Epidural Cord Compression

Cancer Research and Treatment 2019년 51권 4호 p.1324 ~ 1335
 ( Kim Yi-Jun ) - Seoul National University College of Medicine Department of Radiation Oncology

 ( Kim Jin-Ho ) - Seoul National University College of Medicine Department of Radiation Oncology
 ( Kim Kyu-Bo ) - Ewha Womans University School of Medicine Department of Radiation Oncology
 ( Kim Hak-Jae ) - Seoul National University College of Medicine Department of Radiation Oncology
 ( Chie Eui-Kyu ) - Seoul National University College of Medicine Department of Radiation Oncology
 ( Shin Kyung-Hwan ) - Seoul National University College of Medicine Department of Radiation Oncology
 ( Wu Hong-Gyun ) - Seoul National University College of Medicine Department of Radiation Oncology
 ( Kim Il-Han ) - Seoul National University College of Medicine Department of Radiation Oncology

Abstract


Purpose: The purpose of this study was to investigate the effectiveness and safety of spinal stereotactic radiosurgery (SRS) in treating spinal metastasis with epidural spinal cord compression (ESCC).

Materials and Methods: During 2013-2016, 149 regions of spinal metastasis in 105 patients treated with singlefraction (12-24 Gy) spinal SRS were reviewed. Cord compression of Bilsky grade 2 (with visible cerebrospinal fluid [CSF]) or 3 (no visible CSF) was defined as ESCC. Local progression (LP) and vertebral compression fracture (VCF) rates after SRS were evaluated using multivariate competing-risk regression analysis.

Results: The 1-year cumulative incidences of LP for Bilsky grades 0 (n=80), 1 (n=39), 2 (n=21), and 3 (n=9) were 3.0%, 8.4%, 0%, and 24.9%, respectively. Bilsky grade 2 ESCC did not significantly increase the LP rate (no LP for grade 2). The 1-year cumulative incidences of VCF for Bilsky grades 0, 1, 2, and 3 were 6.6%, 5.2%, 17.1%, and 12.1%, respectively. ESCC may increase VCF risk (subhazard ratio [SHR] for grade 2, 5.368; p=0.035; SHR for grade 3, 2.215; p=0.460). Complete or partial pain response rates after SRS were 79%, 78%, 53%, and 63% for Bilsky grades 0, 1, 2, and 3, respectively (p=0.008). No neurotoxicity of grade ≥ 3 was observed.

Conclusion: Spinal SRS for spinal metastasis with Bilsky grade 2 ESCC did not increase the LP rate, was not associated with severe neurotoxicity, and showed moderate VCF and pain response rates. Bilsky grade 3 had a high LP rate.

키워드

Spine; Neoplasm metastasis; Spinal cord compression; Fractures; Compression; Radiosurgery; Disease progression
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