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- Title
Cyber knife radiosurgery (CKRS) treatment for benign spinal and paraspinal lesions.
- Authors
Martínez Moreno, N.; Kusak Lambea, M. E.; Gutiérrez Sárraga, J.; Portoles, G. Rey; Martínez Álvarez, R.
- Abstract
Introduction: In patients with spinal and/or paraspinal lesions, especially if benign, the first treatment option is generally surgery. In certain cases local recurrences occur or residual tumor growth follows subtotal resections. In these cases CKRS may be an alternative to repeat surgery. On the other hand, when high-risk surgery is expected, CKRS can be used as a first line treatment. We here analyze our five year experience with this radiosurgical treatment. Methods: Between 2006 and 2012, 31 patients were treated at our Unit for spinal or paraspinal lesions. In 21 cases the lesions were purely spinal, mainly cervical. Most were schwannomas (8), paragangliomas (7) and meningiomas (6). The mean age was 48 years and the mean lesion volume was 21.8 cc (0.21-160). In seven cases multiple lesions were treated, and the clinical presentation was predominantly pain (55%). Nineteen patients had been operated on, three had received previous radiotherapy and in two embolization of the lesion had been performed. Radiosurgery was delivered using Cyber Knife with an X-sight tracking system. The marginal dose varied according to the fractionation schedule used (1-5 fractions) and the nature of the tumor. In most cases three 7Gy fractions (total delivered dose 21 Gy) were used. Results: Ninety per cent of patients were followed, with a mean follow-up of 43.8 months (4-72.5). Local control was obtained in 96% (stabilization in 65% and decrease in size in 31%), and only one case of tumor progression. Thirty-six% of patients reported a clinical benefit, with a good response in 100% of patients complaining of pain, with its disappearance in 55% of them. One patient with multiple paragangliomas had progression of the systemic disease and pain relapsed in one patient with an ependymoma after 13 months of good response. The rest remained stable. To date there has been no toxicity or new neurological symptoms. The two patients treated for arteriovenous malformations have not experienced new bleeding. Conclusions: CKRS appears to be an adequate therapeutic alternative for spinal and other extracranial sites lesions when incomplete surgery was performed or resection was not possible. CKRS is a simple and fast procedure, with good results in terms of local control and toxicity. Our preliminary results are supported by the wider experience of other centers using this technology. Disclosure: No significant relationships.
- Subjects
SPINAL tumors; RADIOSURGERY; TUMOR surgery; DOSE fractionation; RADIOTHERAPY
- Publication
Journal of Radiosurgery & SBRT, 2013, Vol 2, p163
- ISSN
2156-4639
- Publication type
Article