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Knöll P, Lenschow M, Lenz M, Neuschmelting V, von Spreckelsen N, Telentschak S, Olbrück S, Weber M, Rosenbrock J, Eysel P, Walter SG. Local Recurrence and Development of Spinal Cord Syndrome during Follow-Up after Surgical Treatment of Metastatic Spine Disease. Cancers (Basel) 2023; 15:4749. [PMID: 37835444 PMCID: PMC10571549 DOI: 10.3390/cancers15194749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Surgical decompression (SD), with or without posterior stabilization followed by radiotherapy, is an established treatment for patients with metastatic spinal disease with epidural spinal cord compression (ESCC). This study aims to identify risk factors for occurrence of neurological compromise resulting from local recurrence. METHODS All patients who received surgical treatment for metastatic spinal disease at our center between 2011 and 2022 were included in this study. Cases were evaluated for tumor entity, surgical technique for decompression (decompression, hemilaminectomy, laminectomy, corpectomy) neurological deficits, grade of ESCC, time interval to radiotherapy, and perioperative complications. RESULTS A total of 747 patients were included in the final analysis, with a follow-up of 296.8 days (95% CI (263.5, 330.1)). During the follow-up period, 7.5% of the patients developed spinal cord/cauda syndrome (SCS). Multivariate analysis revealed prolonged time (>35 d) to radiation therapy as a solitary risk factor (p < 0.001) for occurrence of SCS during follow-up. CONCLUSION Surgical treatment of spinal metastatic disease improves patients' quality of life and Frankel grade, but radiation therapy needs to be scheduled within a time frame of a few weeks in order to reduce the risk of tumor-induced neurological compromise.
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Affiliation(s)
- Peter Knöll
- Department of Orthopedics, Trauma Surgery and Plastic Surgery, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (P.K.)
| | - Moritz Lenschow
- Department of General Neurosurgery, Center for Neurosurgery, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (M.L.); (V.N.); (N.v.S.); (S.T.)
| | - Maximilian Lenz
- Department of Orthopedics, Trauma Surgery and Plastic Surgery, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (P.K.)
| | - Volker Neuschmelting
- Department of General Neurosurgery, Center for Neurosurgery, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (M.L.); (V.N.); (N.v.S.); (S.T.)
| | - Niklas von Spreckelsen
- Department of General Neurosurgery, Center for Neurosurgery, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (M.L.); (V.N.); (N.v.S.); (S.T.)
| | - Sergej Telentschak
- Department of General Neurosurgery, Center for Neurosurgery, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (M.L.); (V.N.); (N.v.S.); (S.T.)
| | - Sebastian Olbrück
- Department of Orthopedics, Trauma Surgery and Plastic Surgery, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (P.K.)
- Faculty of Medicine, University of Cologne, 50937 Cologne, Germany
| | - Maximilian Weber
- Department of Orthopedics, Trauma Surgery and Plastic Surgery, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (P.K.)
| | - Johannes Rosenbrock
- Department of Radiation Oncology, CyberKnife and Radiation Therapy, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany;
| | - Peer Eysel
- Department of Orthopedics, Trauma Surgery and Plastic Surgery, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (P.K.)
| | - Sebastian G. Walter
- Department of Orthopedics, Trauma Surgery and Plastic Surgery, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (P.K.)
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Janopaul-Naylor JR, Cao Y, McCall NS, Switchenko JM, Tian S, Chen H, Stokes WA, Kesarwala AH, McDonald MW, Shelton JW, Bradley JD, Higgins KA. Definitive intensity modulated proton re-irradiation for lung cancer in the immunotherapy era. Front Oncol 2023; 12:1074675. [PMID: 36733369 PMCID: PMC9888533 DOI: 10.3389/fonc.2022.1074675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/29/2022] [Indexed: 01/18/2023] Open
Abstract
Introduction As immunotherapy has improved distant metastasis-free survival (DMFS) in Non-Small Cell Lung Cancer (NSCLC), isolated locoregional recurrences have increased. However, management of locoregional recurrences can be challenging. We report our institutional experience with definitive intent re-irradiation using Intensity Modulated Proton Therapy (IMPT). Method Retrospective cohort study of recurrent or second primary NSCLC or LS-SCLC treated with IMPT. Kaplan-Meier method and log-rank test were used for time-to-event analyses. Results 22 patients were treated from 2019 to 2021. After first course of radiation (median 60 Gy, range 45-70 Gy), 45% received adjuvant immunotherapy. IMPT re-irradiation began a median of 28.2 months (8.8-172.9 months) after initial radiotherapy. The median IMPT dose was 60 GyE (44-60 GyE). 36% received concurrent chemotherapy with IMPT and 18% received immunotherapy after IMPT. The median patient's IMPT lung mean dose was 5.3 GyE (0.9-13.9 GyE) and 5 patients had cumulative esophagus max dose >100 GyE with 1-year overall survival (OS) 68%, 1-year local control 80%, 1-year progression free survival 45%, and 1-year DMFS 60%. Higher IMPT (HR 1.4; 95% CI 1.1-1.7, p=0.01) and initial radiotherapy mean lung doses (HR 1.3; 95% CI 1.0-1.6, p=0.04) were associated with worse OS. Two patients developed Grade 3 pneumonitis or dermatitis, one patient developed Grade 2 pneumonitis, and seven patients developed Grade 1 toxicity. There were no Grade 4 or 5 toxicities. Discussion Definitive IMPT re-irradiation for lung cancer can prolong disease control with limited toxicity, particularly in the immunotherapy era.
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Affiliation(s)
- James R. Janopaul-Naylor
- Winship Cancer Institute, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Yichun Cao
- Biostatistics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, United States
| | - Neal S. McCall
- Winship Cancer Institute, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Jeffrey M. Switchenko
- Biostatistics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, United States
- Rollins School of Public Health, Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, United States
| | - Sibo Tian
- Winship Cancer Institute, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Haijian Chen
- Winship Cancer Institute, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - William A. Stokes
- Winship Cancer Institute, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Aparna H. Kesarwala
- Winship Cancer Institute, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Mark W. McDonald
- Winship Cancer Institute, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Joseph W. Shelton
- Winship Cancer Institute, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Jeffrey D. Bradley
- Winship Cancer Institute, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Kristin A. Higgins
- Winship Cancer Institute, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United States
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Liu Y, Yuan H, Milan S, Zhang C, Han X, Jiao D. PVP with or without microwave ablation for the treatment of painful spinal metastases from NSCLC: a retrospective case-control study. Int J Hyperthermia 2023; 40:2241687. [PMID: 37536672 DOI: 10.1080/02656736.2023.2241687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/16/2023] [Accepted: 07/24/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVE To compare the clinical efficacy of percutaneous vertebroplasty (PVP) alone and microwave ablation (MWA) combined with PVP for the treatment of painful spinal metastases from non-small cell lung cancer (NSCLC). METHODS From October 2014 to October 2021, the data of 58 NSCLC patients with refractory painful spinal metastases (visual analog scale score ≥ 5) were retrospectively collected and analyzed. Patients in Group A (n = 30) and Group B (n = 28) received PVP alone and MWA combined with PVP, respectively. The primary endpoint was pain relief. The secondary endpoints were quality of life (QoL), local tumor progression (LTP), and complications. RESULTS The technical success rate was 100% in both groups. Patients in both groups showed similar pain relief at 1-12 weeks, but patients in Group B still showed sustained pain relief at 24 weeks compared to those in Group A (p = 0.03). The assessment of QoL showed similar changes. LTP (33.00% vs. 7.14%, p = 0.02) and cement leakage rates (40.00% vs. 7.14%, p = 0.03) were lower in Group B. The multivariate analysis demonstrated spinal metastases with a maximum diameter ≤ 3.0 cm (p = 0.027) and MWA combined with PVP (p = 0.028) were two independent protective factors for LTP. For cement leakage, spinal metastases with vertebral body compression (p = 0.019) was an independent risk factor, while MWA combined with PVP (p = 0.042) was an independent protective factor. CONCLUSION MWA combined with PVP for painful spinal metastases from NSCLC performed more sustained pain relief (>6 months) and ultimately improved QoL with lower LTP and cement leakage rates, compared to PVP alone.
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Affiliation(s)
- Yiming Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Haoyue Yuan
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Sigdel Milan
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chengzhi Zhang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dechao Jiao
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Chen L, Hou G, Zhang K, Li Z, Yang S, Qiu Y, Yuan Q, Hou D, Ye X. Percutaneous CT-Guided Microwave Ablation Combined with Vertebral Augmentation for Treatment of Painful Spinal Metastases. AJNR Am J Neuroradiol 2022; 43:501-506. [PMID: 35115308 PMCID: PMC8910789 DOI: 10.3174/ajnr.a7415] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 09/09/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Percutaneous thermal ablation followed by vertebral augmentation is an emerging minimally invasive therapeutic alternative for the management of spinal metastases. This study aimed to retrospectively evaluate the effectiveness and safety of microwave ablation combined with vertebral augmentation for the treatment of painful vertebral metastases. MATERIALS AND METHODS Overall, 91 patients with 140 metastatic vertebrae who experienced refractory moderate-to-severe pain were treated with CT-guided microwave ablation and vertebral augmentation. Procedural effectiveness was determined using the visual analog scale, daily morphine consumption, and the Oswestry Disability Index preprocedurally and during follow-up. Local tumor control was assessed at follow-up imaging. RESULTS The procedure was technically successful in all patients. The median visual analog scale score and mean morphine dose were 6 (range, 4-10) and 77.8 (SD, 31.5) mg (range, 15-143 mg), preprocedurally; 5 (range 3-8) and 34.5 (SD, 23.8) mg (range, 0-88 mg) at 3 days; 4 (range, 2-7) and 28.7 (SD, 16.4) mg (range, 0-73 mg) at 1 week; 3 (range, 1-6) and 24.6 (SD, 13.2) mg (range, 0-70 mg) at 1 month; 3 (range, 1-6) and 21.70 (SD, 10.0) mg (range, 0-42 mg) at 3 months; and 3 (range, 1-8) and 21.0 (SD, 9.9) mg (range, 0-46 mg) at 6 months postprocedurally (all P < .05). A decrease in the Oswestry Disability Index score was also observed (P < .01). Local control was achieved in 94.8% of the treated metastatic vertebrae during the 6-month follow-up period. Asymptomatic cement leakage occurred in 42 (30%) treated vertebrae. A grade 3 neural injury was observed in 1 patient (1.1%). The patient's neurologic function returned to normal following treatment with mannitol, glucocorticoids, and radiation therapy. CONCLUSIONS This study demonstrates that percutaneous CT-guided microwave ablation combined with vertebral augmentation is a safe and effective minimally invasive intervention for the treatment of painful spinal metastases.
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Affiliation(s)
- L. Chen
- From the Departments of Oncology (L.C., K.Z., S.Y., Y.Q., Q.Y.)
| | | | - K. Zhang
- From the Departments of Oncology (L.C., K.Z., S.Y., Y.Q., Q.Y.)
| | - Z. Li
- Orthopedics (Z.L.), Tengzhou Central People’s Hospital Affiliated with Jining Medical University, Tengzhou, Shandong Province, China
| | - S. Yang
- From the Departments of Oncology (L.C., K.Z., S.Y., Y.Q., Q.Y.)
| | - Y. Qiu
- From the Departments of Oncology (L.C., K.Z., S.Y., Y.Q., Q.Y.)
| | - Q. Yuan
- From the Departments of Oncology (L.C., K.Z., S.Y., Y.Q., Q.Y.)
| | - D. Hou
- Department of Radiation Oncology (D.H.), Beijing Shijitan Hospital Affiliated with Capital Medical University, Haidian District, Beijing, China
| | - X. Ye
- Department of Minimally invasive Oncology (X.Y.), Shandong Provincial Qianfoshan Hospital, Jinan, Shandong Province, China
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