Lee Ian, Omodon Melvin, Rock Jack, Shultz Lonni, Ryu Samuel
Departments of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202 USA.
Public Health Sciences, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202 USA.
J Radiosurg SBRT. 2014;3(1):51-58.
The standard of care of patients with high-grademetastatic epidural compression is open decompression with or without stabilization. However, many patients are unwilling or unable to undergo open surgical decompression. This study investigated the outcomes of treating patients with high-grade (Ryu/Rock radiographic grade IV and V, Spine Oncology Study Group Grade II and III) metastatic epidural spinal cord compression with spinal radiosurgery as first-line therapy in lieu of surgical decompression.
Utilizing the Henry Ford Spinal Tumor Database, patients with metastatic lesions causing advanced radiographical grade (IV or V) epidural spinal cord compression who received stereotactic radiosurgery (SRS)with adequate clinical and radiological follow-up were identified from 2007-2011. These patients were retrospectively reviewed for clinical and radiological response to radiosurgery.
33 patients with 35 metastatic lesions causing Ryu/Rock radiographical grade IV or V compression were identified with a median follow-up of 435 days. Of the 34 lesions in 32 patients who were ambulatory pre-SRS, 23 (67%) were ambulatory at last follow-up. 6/33 progressed early (less than 2 months) neurologically and an additional 5 patients developed late progressive neurologic deficit. The one patient who was initially non-ambulatory was able to regain ambulatory status. Radiologically, there was a significant epidural tumor response rate of 74%. Ultimately, 9 patients (27%) eventually required surgery for neurologic compromise or mechanical instability. There was one patient who received EBRT previously who experienced radiation myelopathy as a complication of SRS.
Radiosurgery as an initial therapy for high-grade metastatic epidural compression appears to be a viable treatment paradigm for selected patients with close clinical and radiological follow-up. However, a significant minority will progress necessitating the need for rigorous monitoring. Further study is needed prospectively analyze the effectiveness of SRS with or without open surgical decompression.
高分级转移性硬膜外压迫患者的标准治疗方法是进行开放减压，可选择是否进行稳定手术。然而，许多患者不愿意或无法接受开放手术减压。本研究调查了采用脊柱立体定向放射外科作为一线治疗方法代替手术减压来治疗高分级（Ryu/Rock影像学分级IV级和V级，脊柱肿瘤学研究组分级II级和III级）转移性硬膜外脊髓压迫患者的疗效。
利用亨利·福特脊柱肿瘤数据库，从2007年至2011年期间识别出因转移性病变导致高级别（IV级或V级）硬膜外脊髓压迫且接受了立体定向放射外科（SRS）治疗并进行了充分临床和影像学随访的患者。对这些患者进行回顾性分析，以评估放射外科治疗的临床和影像学反应。
共识别出33例患者，其35处转移性病变导致Ryu/Rock影像学分级IV级或V级压迫，中位随访时间为435天。在SRS治疗前能够行走的32例患者的34处病变中，23处（67%）在最后一次随访时仍能行走。33例患者中有6例早期（不到2个月）出现神经功能进展，另有5例患者出现晚期进行性神经功能缺损。最初不能行走的1例患者恢复了行走能力。影像学上，硬膜外肿瘤的显著反应率为74%。最终，9例患者（27%）最终因神经功能损害或机械性不稳定而需要手术治疗。有1例患者之前接受过外照射放疗，在SRS治疗后出现放射性脊髓病并发症。
对于经过密切临床和影像学随访的特定患者，放射外科作为高分级转移性硬膜外压迫的初始治疗方法似乎是一种可行的治疗模式。然而，相当一部分患者会出现病情进展，因此需要进行严格监测。需要进一步开展前瞻性研究，分析SRS联合或不联合开放手术减压的有效性。
