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Neurosurgery. 2018 Nov 16. doi: 10.1093/neuros/nyy442. [Epub ahead of print]

Long-Term Update of Stereotactic Radiosurgery for Benign Spinal Tumors.

Author information

1
Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California.
2
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California.
3
Department of Neurosurgery, Kaiser Permanente, Redwood City, California.
4
Department of Radiation Oncology, Northwestern University, Chicago, Illinois.

Abstract

BACKGROUND:

Stereotactic radiosurgery (SRS) for benign intracranial tumors is an established standard of care. The widespread implementation of SRS for benign spinal tumors has been limited by lack of long-term data.

OBJECTIVE:

To update our institutional experience of safety and efficacy outcomes after SRS for benign spinal tumors.

METHODS:

We performed a retrospective cohort study of 120 patients with 149 benign spinal tumors (39 meningiomas, 26 neurofibromas, and 84 schwannomas) treated with SRS between 1999 and 2016, with follow-up magnetic resonance imaging available for review. The primary endpoint was the cumulative incidence of local failure (LF), with death as a competing risk. Secondary endpoints included tumor shrinkage, symptom response, toxicity, and secondary malignancy.

RESULTS:

Median follow-up was 49 mo (interquartile range: 25-103 mo, range: 3-216 mo), including 61 courses with >5 yr and 24 courses with >10 yr of follow-up. We observed 9 LF for a cumulative incidence of LF of 2%, 5%, and 12% at 3, 5, and 10 yr, respectively. Excluding 10 tumors that were previously irradiated or that arose within a previously irradiated field, the 3-, 5-, and 10-yr cumulative incidence rates of LF were 1%, 2%, and 8%, respectively. At last follow-up, 35% of all lesions had decreased in size. With a total of 776 patient-years of follow-up, no SRS-related secondary malignancies were observed.

CONCLUSION:

Comparable to SRS for benign intracranial tumors, SRS provides longer term local control of benign spinal tumors and is a standard-of-care alternative to surgical resection.

PMID:
30445557
DOI:
10.1093/neuros/nyy442

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