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Spine Stereotactic Body Radiotherapy: Indications, Outcomes, and Points of Caution
STUDY DESIGN: A broad narrative review. OBJECTIVES: The objective of this article is to provide a technical review of spine stereotactic body radiotherapy (SBRT) planning and delivery, indications for treatment, outcomes, complications, and the challenges of response assessment. The surgical approac...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5415159/ https://www.ncbi.nlm.nih.gov/pubmed/28507888 http://dx.doi.org/10.1177/2192568217694016 |
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author | Tseng, Chia-Lin Eppinga, Wietse Charest-Morin, Raphaele Soliman, Hany Myrehaug, Sten Maralani, Pejman Jabehdar Campbell, Mikki Lee, Young K. Fisher, Charles Fehlings, Michael G. Chang, Eric L. Lo, Simon S. Sahgal, Arjun |
author_facet | Tseng, Chia-Lin Eppinga, Wietse Charest-Morin, Raphaele Soliman, Hany Myrehaug, Sten Maralani, Pejman Jabehdar Campbell, Mikki Lee, Young K. Fisher, Charles Fehlings, Michael G. Chang, Eric L. Lo, Simon S. Sahgal, Arjun |
author_sort | Tseng, Chia-Lin |
collection | PubMed |
description | STUDY DESIGN: A broad narrative review. OBJECTIVES: The objective of this article is to provide a technical review of spine stereotactic body radiotherapy (SBRT) planning and delivery, indications for treatment, outcomes, complications, and the challenges of response assessment. The surgical approach to spinal metastases is discussed with an overview of emerging minimally invasive techniques. METHODS: A comprehensive review of the literature was conducted on the techniques, outcomes, and developments in SBRT and surgery for spinal metastases. RESULTS: The optimal management of patients with spinal metastases is complex and requires multidisciplinary assessment from an oncologic team that is familiar with the shifting paradigm as a consequence of evolving techniques in surgery and stereotactic radiation, as well as new developments in systemic agents. The Spinal Instability Neoplastic Score and the epidural spinal cord compression (Bilsky) grading system are useful tools that facilitate communication among oncologic team members and can direct management by providing a baseline assessment of risks prior to therapy. The combined multimodality approach with “separation surgery” followed by postoperative spine SBRT achieves thecal sac decompression, improves tumor control, and avoids complications that may be associated with more extensive surgery. CONCLUSION: Spine SBRT is a highly effective treatment that is capable of delivering ablative doses to the target while sparing the critical organs-at-risk, chiefly the critical neural tissues, within a short and manageable schedule. At the same time, surgery occupies an important role in select patients, particularly with the expanding availability and expertise in minimally invasive techniques. With rapid adoption of spine SBRT in centers outside of the academic setting, it is imperative for the practicing oncologist to understand the relevance and application of these evolving concepts. |
format | Online Article Text |
id | pubmed-5415159 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-54151592017-05-15 Spine Stereotactic Body Radiotherapy: Indications, Outcomes, and Points of Caution Tseng, Chia-Lin Eppinga, Wietse Charest-Morin, Raphaele Soliman, Hany Myrehaug, Sten Maralani, Pejman Jabehdar Campbell, Mikki Lee, Young K. Fisher, Charles Fehlings, Michael G. Chang, Eric L. Lo, Simon S. Sahgal, Arjun Global Spine J Review Articles STUDY DESIGN: A broad narrative review. OBJECTIVES: The objective of this article is to provide a technical review of spine stereotactic body radiotherapy (SBRT) planning and delivery, indications for treatment, outcomes, complications, and the challenges of response assessment. The surgical approach to spinal metastases is discussed with an overview of emerging minimally invasive techniques. METHODS: A comprehensive review of the literature was conducted on the techniques, outcomes, and developments in SBRT and surgery for spinal metastases. RESULTS: The optimal management of patients with spinal metastases is complex and requires multidisciplinary assessment from an oncologic team that is familiar with the shifting paradigm as a consequence of evolving techniques in surgery and stereotactic radiation, as well as new developments in systemic agents. The Spinal Instability Neoplastic Score and the epidural spinal cord compression (Bilsky) grading system are useful tools that facilitate communication among oncologic team members and can direct management by providing a baseline assessment of risks prior to therapy. The combined multimodality approach with “separation surgery” followed by postoperative spine SBRT achieves thecal sac decompression, improves tumor control, and avoids complications that may be associated with more extensive surgery. CONCLUSION: Spine SBRT is a highly effective treatment that is capable of delivering ablative doses to the target while sparing the critical organs-at-risk, chiefly the critical neural tissues, within a short and manageable schedule. At the same time, surgery occupies an important role in select patients, particularly with the expanding availability and expertise in minimally invasive techniques. With rapid adoption of spine SBRT in centers outside of the academic setting, it is imperative for the practicing oncologist to understand the relevance and application of these evolving concepts. SAGE Publications 2017-04-06 2017-04 /pmc/articles/PMC5415159/ /pubmed/28507888 http://dx.doi.org/10.1177/2192568217694016 Text en © The Author(s) 2017 http://creativecommons.org/licenses/by-nc-nd/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (http://www.creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Review Articles Tseng, Chia-Lin Eppinga, Wietse Charest-Morin, Raphaele Soliman, Hany Myrehaug, Sten Maralani, Pejman Jabehdar Campbell, Mikki Lee, Young K. Fisher, Charles Fehlings, Michael G. Chang, Eric L. Lo, Simon S. Sahgal, Arjun Spine Stereotactic Body Radiotherapy: Indications, Outcomes, and Points of Caution |
title | Spine Stereotactic Body Radiotherapy: Indications, Outcomes, and Points of Caution |
title_full | Spine Stereotactic Body Radiotherapy: Indications, Outcomes, and Points of Caution |
title_fullStr | Spine Stereotactic Body Radiotherapy: Indications, Outcomes, and Points of Caution |
title_full_unstemmed | Spine Stereotactic Body Radiotherapy: Indications, Outcomes, and Points of Caution |
title_short | Spine Stereotactic Body Radiotherapy: Indications, Outcomes, and Points of Caution |
title_sort | spine stereotactic body radiotherapy: indications, outcomes, and points of caution |
topic | Review Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5415159/ https://www.ncbi.nlm.nih.gov/pubmed/28507888 http://dx.doi.org/10.1177/2192568217694016 |
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