Stereotactic Radiosurgery a Viable Treatment Option for Select Patients with Painful Metastatic Spinal Tumors

Newswise — An estimated 1.4 million new cases of all types of cancer will be diagnosed in 2007, and more than 559,000 estimated deaths will occur. Conservative estimates indicate that at least 30 percent of patients with cancer will experience spread of the cancer to their spine, and without treatment, the tumor will continue to grow. This can lead to compression of the spinal cord, chronic pain, loss of leg function, and ultimately " paraplegia and incontinence. Currently, the "best" management strategy for spinal cord compression secondary to metastatic cancer consists of surgery to decompress the spinal cord followed by radiation therapy.

While few would argue with this approach, the overall health condition of many cancer patients is too compromised, or they are simply unwilling to undergo surgery. Recently, stereotactic radiosurgery has been extensively investigated at basic science and clinical levels. Stereotactic radiosurgery is the technique of delivering very high doses of radiation in a very precise manner while minimizing radiation injury to surrounding normal tissues. Patients with spinal tumors have been treated with this form of radiation and encouraging results have been published.

Based on these promising results, researchers at Henry Ford Hospital determined it would be worthwhile investigating whether similar high and focused doses of radiation could be used to treat the more urgent condition of spinal cord compression. About three years ago, they began offering radiosurgery as a treatment alternative to patients with spinal cord compression who were ambulatory prior to treatment or had otherwise refused surgery.

The results of this study, Spinal Canal Compromise; Is Radiosurgery a Reasonable Treatment Alternative?, will be presented by Ian Lee, MD, 4:40 to 4:50 p.m. on Tuesday, April 17, 2007, during the 75th Annual Meeting of the American Association of Neurological Surgeons in Washington, D.C. Co-authors are Samuel Ryu, MD, Marilyn Gates, MD, Rajan Jain, MD, Kelly James, BS, David Nerenz, PhD, and Jack Rock, MD.

All patients in this study were followed for at least three months after treatment with both clinical evaluations and radiological investigations. Preliminary results in the 38 patients were encouraging, but not without failures. Of these 38 patients, 16 had neurological deficits prior to undergoing radiosurgery. Ten of these patients had neurological deficits clearly secondary to spinal cord compression and there was little doubt that most neurosurgeons would have recommended surgery. The following outcomes were noted:

"¢Twelve (75 percent) of 16 patients with a neurological deficit prior to radiosurgery were clinically stable or improved and four of 16 (25 percent) clinically worsened."¢Twenty-two patients (84.6 percent) without a neurological deficit prior to radiosurgery were clinically stable or improved and four of 26 (15.4 percent) clinically worsened."¢In the 10 patients with spinal cord compression, seven (70 percent) ultimately remained neurologically stable or improved."¢Three (30 percent) of the 10 patients deteriorated neurologically and lost their ability to walk."¢Two patients, who could not walk prior to radiosurgery, regained their ability to walk.

"Based on these preliminary results, we feel that radiosurgery may be considered as an alternative to surgery when patients with malignant spinal cord compression are ambulatory and especially when the tumor is radiosensitive," said Dr. Lee. "However, in patients who are not able to walk, based on deteriorating strength in their legs, and especially if their tumors are not radiosensitive, surgery remains the best option," stated Dr. Lee.

Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 6,800 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system, including the spinal column, spinal cord, brain and peripheral nerves.