Threat for surgical problems after earlier stereotactic physique radiotherapy of the backbone.
Radiat Oncol. 2017 Sep 11;12(1):153
Authors: Roesch J, Cho JBC, Fahim DK, Gerszten PC, Flickinger JC, Grills IS, Jawad M, Kersh R, Letourneau D, Mantel F, Sahgal A, Shin JH, Winey B, Guckenberger M
OBJECT: Stereotactic physique radiotherapy (SBRT) for vertebral metastases has emerged as a promising approach, providing excessive charges of symptom aid and native management mixed with low threat of toxicity. Nonetheless, native failure or vertebral instability could happen after backbone SBRT, producing the necessity for subsequent surgical procedure within the irradiated area. This research evaluated whether or not there may be an elevated incidence of surgical problems in sufferers beforehand handled with SBRT on the index degree.
METHODS: Primarily based upon a retrospective worldwide database of 704 instances handled with SBRT for vertebral metastases, 30 sufferers handled at 6 completely different establishments have been recognized who underwent surgical procedure in a area beforehand handled with SBRT.
RESULTS: Thirty sufferers, median age 59 years (vary 27-84 years) underwent SBRT for 32 vertebral metastases adopted by surgical procedure on the similar vertebra. Median follow-up time from SBRT was 17 months. In 17 instances, standard radiotherapy had been delivered previous to SBRT at a median dose of 30 Gy in median 10 fractions. SBRT was administered with a median prescription dose of 19.three Gy (vary 15-65 Gy) delivered in median 1 fraction (vary 1-17) (median EQD2/10 = 44 Gy). The median time interval between SBRT and surgical salvage remedy was 6 months (vary 1-39 months). Causes for subsequent surgical procedure have been ache (n = 28), neurological deterioration (n = 15) or fracture of the vertebral physique (n = 13). Open surgical decompression (n = 24) and/or stabilization (n = 18) have been most steadily carried out; 5 sufferers (6 vertebrae) have been handled with out problems with vertebroplasty solely. Elevated fibrosis complicating the surgical process was explicitly acknowledged in a single surgical report. Two durotomies occurred which have been closed in the course of the operation, related to a neurological deficit in a single affected person. Median blood loss was 500 ml, however 5 sufferers had a blood lack of greater than 1 l in the course of the process. Delayed wound therapeutic was reported in two instances. One affected person died inside 30 days of the operation.
CONCLUSION: On this collection of surgical interventions following backbone SBRT, the general complication price was 19%, which seems similar to main surgical procedure with out earlier SBRT. Prior backbone SBRT doesn’t seem to considerably improve the danger of intra- and post-surgical problems.
PMID: 28893299 [PubMed – indexed for MEDLINE]