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MO_5_2564 - Single Fraction Spine Stereotactic Radiosurgery for Epidural Tumors

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Single Fraction Spine Stereotactic Radiosurgery for Epidural Tumors
E. Elibe, D. Boyce-Fappiano, M. S. U. Siddiqui, I. Lee, and F. Siddiqui; Henry Ford Health System, Detroit, MI

Purpose/Objective(s): Stereotactic radiosurgery (SRS) is increasingly being utilized as a safe and effective treatment for primary and metastatic tumors of the spine and spinal cord. However, the current literature suggests that spine tumors with an epidural component have relatively poor responses to SRS, and durable local control is challenging to achieve. We reviewed our institutional experience to better understand the efficacy of SRS in achieving local control for spine tumors with an epidural component.

Materials/Methods: Electronic medical records of computed tomography/magnetic resonance imaging from patients treated with spine SRS at a single institution between 06/2001 and 15/2015 were evaluated with institutional review board approval. Radiographic tumor control was the primary endpoint of this analysis. Tumor control was defined using the updated Response Evaluation Criteria in Solid Tumors (RECIST), and an adaptation of this criterion was used when evaluating tumor control in tumors caused by hematological malignancies.

Results: A total of 302 SRS treatments (administered to 231 patients) for tumors with an epidural component were identified. 160 patients were deceased, and of those deceased, the median survival was 4.7 months (range, 2 days –7.6 years). Fifty-nine percent were males and 41% females with a median age of 64 years (25-91 years). Fifty-five percent, 37%, and 8% of patients were Caucasian, African American, and of other ethnicities respectively. Primary tumor locations included the following: lung (22%), prostate (21%), breast (13.6%), hematological (9%), head and neck (6.8%), kidney (6%), colon (3.6%), liver (3%), and other (15%). Eleven percent of the tumors were at the cervical level, 67% thoracic, 21% lumbar, and 1% sacral. Median dose of SRS was 18 Gy (range, 10–20 Gy). Median target volume was 50.79 cc (range, 1.03– 505.5 cc). Radiographic follow-up for treatment response was available after 189 (63%) of the treatments, with a median follow-up time of 8.4 m (range, 9 days – 10.6 years). Local failure (within the PTV) occurred after 22% of treatments. Local control based on radiographic imaging was achieved after 78% (stable- 1.6%, partial response -36.5%, complete response 1.6%) of treatments. Recurrence occurred after 37 treatments with a median time to recurrence of 9.6 months (range, 1.9 months – 7.2 years).

Conclusion: Though larger and prospective studies will be needed, our results suggest SRS is a relatively effective method of achieving local control in spinal tumors with an epidural component. To the best of our knowledge, this is the largest study evaluating the efficacy of spine SRS in achieving local control in patients with an epidural component.

Author Disclosure: E. Elibe: None. D. Boyce-Fappiano: None. M.U. Siddiqui: Research Grant; Philips Medical. Honoraria; Varian Medical Systems Inc. Director, Brain and Spine Radiation Oncology; Henry Ford Hospital. I. Lee: Consultant; Medtronic, Monteris. F. Siddiqui: Employee; Children's Hospital of Michigan. Research Grant; Varian Medical Systems, Inc. Honoraria; Varian Medical Systems, Inc, American College of Radiology, Wayne State University. Travel Expenses; Varian Medical Systems, Inc. Vice-Chairman or Operations; Department of Radiation Oncology, Henry Ford Hosp. Chair; ASTRO. Board Member; Henry Ford Health System Board of Governors. Committee Member; HFHS Bylaws and Governance Committee.

Erinma Elibe, BS

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