Researchers from Memorial Sloan-Kettering Cancer Center (New York, NY) have found that tumor "separation surgery" followed by high-dose hypofractionated stereotactic radiosurgery (SRS) or high-dose single-fraction SRS is safe and effective in controlling spinal metastases regardless of the radiosensitivity of the particular tumor type that has invaded the spine. This finding is fleshed out in the article "Local disease control for spinal metastases following 'separation surgery' and adjuvant hypofractionated or high-dose single-fraction stereotactic radiosurgery: outcome analysis in 186 patients. Clinical article," by Ilya Laufer, M.D., and colleagues, published today online in the Journal of Neurosurgery: Spine (http://thejns.org/doi/full/10.3171/2012.11.SPINE12111).
The authors reviewed and analyzed data in the charts of 186 patients who presented with epidural spinal cord compression due to spinal metastases. All of these patients underwent tumor separation surgery to decompress the spinal cord and stabilize the spine sometime between 2002 and 2011. During this procedure the tumor was dissected away from the spinal cord-or separated-providing a space between the spinal dura and any remaining tumor. Unlike in traditional spinal tumor surgery, extensive tumor resection was not pursued to reduce surgical morbidity. The spine was also stabilized with screws and rods.
Within 2 to 4 weeks after surgery, stereotactic radiosurgery (SRS) was performed to deliver radiation to the remaining metastatic tumor without damaging the spinal cord. In 40 patients (21.5%) radiation was delivered in a single 24-Gray (Gy) dose to the tumor (high-dose single-fraction SRS). In 37 patients (19.9%) a median total dose of 27 Gy (range 24 to 30 Gy) was delivered in three fractions (high-dose hypofractionated SRS), and in 109 patients (58.6%) a median total dose of 30 Gy (range 18 to 36 Gy) was delivered in five or six fractions (low-dose hypofractionated SRS).
In their review and analysis, the authors identified the following: