Featured Case Studies 2004, Volume 1, Number 4

Stereotactic Radiotherapy for Spine Metastasis

by > John Breneman, MD and Ron Warnick, MD

Clinical problem

This 72-year-old man underwent a T1 corpectomy for metastatic renal cell carcinoma in January 2003, followed by external beam radiotherapy to 50 Gy. Follow-up imaging in March 2004 showed a recurrence at the level of T1-T2, impinging the spinal cord within the previous field of radiation. His surgeon in St. Petersburg, Florida evaluated him and advised no further surgery. He was referred for consideration of re-irradiation of his recurrent tumor.


Treatment options

The patient had already received maximal radiation doses to his spinal cord, making further conventional radiotherapy impossible. Stereotactic body radiotherapy using intensity modulation was recommended to allow retreatment of the metastasis with sparing of the adjacent spinal cord. A treatment plan was devised using multiple conformed beams with daily stereotactic localization using the Novalis Exactrac positioning system. Using real-time stereoscopic x-ray positioning, daily treatment reproducibility of +/- 1-2 mm was achieved. This allowed delivery of an additional 4000 cGy of radiation to the tumor with less than 1000 cGy reaching the adjacent spinal cord. The patient completed treatment without side-effects and is currently pain-free.



Figure 1. Stereotactic intensity modulated body radiotherapy can deliver ablative doses of radiation to spinal metastases while limiting spinal cord doses to tolerable levels.

 

Comments

Current technology allows retreatment of recurrent spinal lesions that have received “maximal” radiation. This permits palliation and extended improvement of quality of life for previously untreatable patients with recurrent spinal metastasis and cord compression. Additionally, use of this technology in previously untreated patients may allow escalation of radiation doses, resulting in more effective and durable palliation of pain.


References
  • Ryu S, Fang Yin F, Rock J, Zhu J, Chu A, Kagan E, Rogers L, Ajlouni M, Rosenblum M, Kim JH. Image-guided and intensity-modulated radiosurgery for patients with spinal metastasis. Cancer 97(8):2013-8, 2003
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Because of the specific nature and complexity of the services we provide, patients must have a consultation with one of our physicians prior to being referred to the center. To schedule an appointment with one of our physicians, please contact Precision Radiotherapy at 513-475-7777.