Spinal Laser Interstitial Thermal Therapy: A Novel Alternative to Surgery for Metastatic Epidural Spinal Cord Compression
BACKGROUND:Although surgery followed by radiation effectively treats metastatic epidural compression, the ideal surgical approach should enable fast recovery and rapid institution of radiation and systemic therapy directed at the primary tumor. OBJECTIVE:To assess spinal laser interstitial thermothe...
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| Veröffentlicht in: | Neurosurgery 2016-12, Vol.79 Suppl 1 (Supplement 1), p.S73-S82 |
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| creator | Tatsui, Claudio E Lee, Sun-Ho Amini, Behrang Rao, Ganesh Suki, Dima Oro, Marilou Brown, Paul D Ghia, Amol J Bhavsar, Shreyas Popat, Keyuri Rhines, Laurence D Stafford, R Jason Li, Jing |
| description | BACKGROUND:Although surgery followed by radiation effectively treats metastatic epidural compression, the ideal surgical approach should enable fast recovery and rapid institution of radiation and systemic therapy directed at the primary tumor.
OBJECTIVE:To assess spinal laser interstitial thermotherapy (SLITT) as an alternative to surgery monitored in real time by thermal magnetic resonance (MR) images.
METHODS:Patients referred for spinal metastasis without motor deficits underwent MR-guided SLITT, followed by stereotactic radiosurgery. Clinical and radiological data were gathered prospectively, according to routine practice.
RESULTS:MR imaging-guided SLITT was performed on 19 patients with metastatic epidural compression. No procedures were discontinued because of technical difficulties, and no permanent neurological injuries occurred. The median follow-up duration was 28 weeks (range 10-64 weeks). Systemic therapy was not interrupted to perform the procedures. The mean preoperative visual analog scale scores of 4.72 (SD ± 0.67) decreased to 2.56 (SD ± 0.71, P = .043) at 1 month and remained improved from baseline at 3.25 (SD ± 0.75, P = .021) 3 months after the procedure. The preoperative mean EQ-5D index for quality of life was 0.67 (SD ± 0.07) and remained without significant change at 1 month 0.79 (SD ± 0.06, P = .317) and improved at 3 months 0.83 (SD ± 0.06, P = .04) after SLITT. Follow-up MR imaging after 2 months revealed significant decompression of the neural component in 16 patients. However, 3 patients showed progression at follow-up, 1 was treated with surgical decompression and stabilization and 2 were treated with repeated SLITT.
CONCLUSION:MR-guided SLITT can be both a feasible and safe alternative to separation surgery in carefully selected cases of spinal metastatic tumor epidural compression.
ABBREVIATIONS:cEBRT, conventional external beam radiation therapyESCC, epidural spinal cord compressionSLITT, spinal laser interstitial thermotherapySSRS, stereotactic spinal radiosurgeryVAS, visual analog scale |
| doi_str_mv | 10.1227/NEU.0000000000001444 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1841801294</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1841801294</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3299-2e475f4761eb2691d744387342a74d39320e916d72be10d779f4db874700f4133</originalsourceid><addsrcrecordid>eNpdkc1OGzEUha0KVALtG1SVJTZsBvxzY4-7i6JQkFK6AKTuRk7mTjPUM57aHlDevg6EtsILX-n4O8eyDyGfODvnQuiLm8X9OftvcQB4RyZ8KqAABuyATLJWFtKoH0fkOMaHzCjQ5XtyJHSpuBR6Qra3Q9tbR5c2YqDXfcIQU5vaLN1tMHT7aYftFzqjN_4RHZ25TPU2tY9Ik6e3Y_iJYUsbH-g3TDamfLSmi6Gtx5D9-xvmPtR564aAMba-_0AOG-siftzPE3J_ubibXxXL71-v57NlsZbCmEIg6GkDWnFcCWV4rQFkqSUIq6GWRgqGhqtaixVyVmttGqhXpQbNWANcyhNy9pI7BP97xJiqro1rdM726MdY8RJ4ybgwkNHTN-iDH_NLXaaMMkZpLaeZghdqHXyMAZtqCG1nw7birNpVU-VqqrfVZNvnffi46rD-a3rt4l_uk999cPzlxicM1QatS5vnPMWFLERukYscWuwkI_8AHaWXqA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1969967735</pqid></control><display><type>article</type><title>Spinal Laser Interstitial Thermal Therapy: A Novel Alternative to Surgery for Metastatic Epidural Spinal Cord Compression</title><source>MEDLINE</source><source>Journals@Ovid Complete</source><creator>Tatsui, Claudio E ; Lee, Sun-Ho ; Amini, Behrang ; Rao, Ganesh ; Suki, Dima ; Oro, Marilou ; Brown, Paul D ; Ghia, Amol J ; Bhavsar, Shreyas ; Popat, Keyuri ; Rhines, Laurence D ; Stafford, R Jason ; Li, Jing</creator><creatorcontrib>Tatsui, Claudio E ; Lee, Sun-Ho ; Amini, Behrang ; Rao, Ganesh ; Suki, Dima ; Oro, Marilou ; Brown, Paul D ; Ghia, Amol J ; Bhavsar, Shreyas ; Popat, Keyuri ; Rhines, Laurence D ; Stafford, R Jason ; Li, Jing</creatorcontrib><description>BACKGROUND:Although surgery followed by radiation effectively treats metastatic epidural compression, the ideal surgical approach should enable fast recovery and rapid institution of radiation and systemic therapy directed at the primary tumor.
OBJECTIVE:To assess spinal laser interstitial thermotherapy (SLITT) as an alternative to surgery monitored in real time by thermal magnetic resonance (MR) images.
METHODS:Patients referred for spinal metastasis without motor deficits underwent MR-guided SLITT, followed by stereotactic radiosurgery. Clinical and radiological data were gathered prospectively, according to routine practice.
RESULTS:MR imaging-guided SLITT was performed on 19 patients with metastatic epidural compression. No procedures were discontinued because of technical difficulties, and no permanent neurological injuries occurred. The median follow-up duration was 28 weeks (range 10-64 weeks). Systemic therapy was not interrupted to perform the procedures. The mean preoperative visual analog scale scores of 4.72 (SD ± 0.67) decreased to 2.56 (SD ± 0.71, P = .043) at 1 month and remained improved from baseline at 3.25 (SD ± 0.75, P = .021) 3 months after the procedure. The preoperative mean EQ-5D index for quality of life was 0.67 (SD ± 0.07) and remained without significant change at 1 month 0.79 (SD ± 0.06, P = .317) and improved at 3 months 0.83 (SD ± 0.06, P = .04) after SLITT. Follow-up MR imaging after 2 months revealed significant decompression of the neural component in 16 patients. However, 3 patients showed progression at follow-up, 1 was treated with surgical decompression and stabilization and 2 were treated with repeated SLITT.
CONCLUSION:MR-guided SLITT can be both a feasible and safe alternative to separation surgery in carefully selected cases of spinal metastatic tumor epidural compression.
ABBREVIATIONS:cEBRT, conventional external beam radiation therapyESCC, epidural spinal cord compressionSLITT, spinal laser interstitial thermotherapySSRS, stereotactic spinal radiosurgeryVAS, visual analog scale</description><identifier>ISSN: 0148-396X</identifier><identifier>EISSN: 1524-4040</identifier><identifier>DOI: 10.1227/NEU.0000000000001444</identifier><identifier>PMID: 27861327</identifier><language>eng</language><publisher>United States: Copyright by the Congress of Neurological Surgeons</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Decompression, Surgical - methods ; Female ; Humans ; Hyperthermia, Induced - methods ; Imaging, Three-Dimensional - methods ; Laser Therapy - methods ; Magnetic Resonance Imaging, Interventional ; Male ; Metastasis ; Middle Aged ; Quality of Life ; Retrospective Studies ; Spinal Cord Compression - etiology ; Spinal Cord Compression - surgery ; Spinal Neoplasms - secondary ; Spinal Neoplasms - surgery ; Stereotaxic Techniques ; Surgery</subject><ispartof>Neurosurgery, 2016-12, Vol.79 Suppl 1 (Supplement 1), p.S73-S82</ispartof><rights>Copyright © by the Congress of Neurological Surgeons</rights><rights>Copyright © 2016 Congress of Neurological Surgeons</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3299-2e475f4761eb2691d744387342a74d39320e916d72be10d779f4db874700f4133</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,782,786,27933,27934</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27861327$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tatsui, Claudio E</creatorcontrib><creatorcontrib>Lee, Sun-Ho</creatorcontrib><creatorcontrib>Amini, Behrang</creatorcontrib><creatorcontrib>Rao, Ganesh</creatorcontrib><creatorcontrib>Suki, Dima</creatorcontrib><creatorcontrib>Oro, Marilou</creatorcontrib><creatorcontrib>Brown, Paul D</creatorcontrib><creatorcontrib>Ghia, Amol J</creatorcontrib><creatorcontrib>Bhavsar, Shreyas</creatorcontrib><creatorcontrib>Popat, Keyuri</creatorcontrib><creatorcontrib>Rhines, Laurence D</creatorcontrib><creatorcontrib>Stafford, R Jason</creatorcontrib><creatorcontrib>Li, Jing</creatorcontrib><title>Spinal Laser Interstitial Thermal Therapy: A Novel Alternative to Surgery for Metastatic Epidural Spinal Cord Compression</title><title>Neurosurgery</title><addtitle>Neurosurgery</addtitle><description>BACKGROUND:Although surgery followed by radiation effectively treats metastatic epidural compression, the ideal surgical approach should enable fast recovery and rapid institution of radiation and systemic therapy directed at the primary tumor.
OBJECTIVE:To assess spinal laser interstitial thermotherapy (SLITT) as an alternative to surgery monitored in real time by thermal magnetic resonance (MR) images.
METHODS:Patients referred for spinal metastasis without motor deficits underwent MR-guided SLITT, followed by stereotactic radiosurgery. Clinical and radiological data were gathered prospectively, according to routine practice.
RESULTS:MR imaging-guided SLITT was performed on 19 patients with metastatic epidural compression. No procedures were discontinued because of technical difficulties, and no permanent neurological injuries occurred. The median follow-up duration was 28 weeks (range 10-64 weeks). Systemic therapy was not interrupted to perform the procedures. The mean preoperative visual analog scale scores of 4.72 (SD ± 0.67) decreased to 2.56 (SD ± 0.71, P = .043) at 1 month and remained improved from baseline at 3.25 (SD ± 0.75, P = .021) 3 months after the procedure. The preoperative mean EQ-5D index for quality of life was 0.67 (SD ± 0.07) and remained without significant change at 1 month 0.79 (SD ± 0.06, P = .317) and improved at 3 months 0.83 (SD ± 0.06, P = .04) after SLITT. Follow-up MR imaging after 2 months revealed significant decompression of the neural component in 16 patients. However, 3 patients showed progression at follow-up, 1 was treated with surgical decompression and stabilization and 2 were treated with repeated SLITT.
CONCLUSION:MR-guided SLITT can be both a feasible and safe alternative to separation surgery in carefully selected cases of spinal metastatic tumor epidural compression.
ABBREVIATIONS:cEBRT, conventional external beam radiation therapyESCC, epidural spinal cord compressionSLITT, spinal laser interstitial thermotherapySSRS, stereotactic spinal radiosurgeryVAS, visual analog scale</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Decompression, Surgical - methods</subject><subject>Female</subject><subject>Humans</subject><subject>Hyperthermia, Induced - methods</subject><subject>Imaging, Three-Dimensional - methods</subject><subject>Laser Therapy - methods</subject><subject>Magnetic Resonance Imaging, Interventional</subject><subject>Male</subject><subject>Metastasis</subject><subject>Middle Aged</subject><subject>Quality of Life</subject><subject>Retrospective Studies</subject><subject>Spinal Cord Compression - etiology</subject><subject>Spinal Cord Compression - surgery</subject><subject>Spinal Neoplasms - secondary</subject><subject>Spinal Neoplasms - surgery</subject><subject>Stereotaxic Techniques</subject><subject>Surgery</subject><issn>0148-396X</issn><issn>1524-4040</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNpdkc1OGzEUha0KVALtG1SVJTZsBvxzY4-7i6JQkFK6AKTuRk7mTjPUM57aHlDevg6EtsILX-n4O8eyDyGfODvnQuiLm8X9OftvcQB4RyZ8KqAABuyATLJWFtKoH0fkOMaHzCjQ5XtyJHSpuBR6Qra3Q9tbR5c2YqDXfcIQU5vaLN1tMHT7aYftFzqjN_4RHZ25TPU2tY9Ik6e3Y_iJYUsbH-g3TDamfLSmi6Gtx5D9-xvmPtR564aAMba-_0AOG-siftzPE3J_ubibXxXL71-v57NlsZbCmEIg6GkDWnFcCWV4rQFkqSUIq6GWRgqGhqtaixVyVmttGqhXpQbNWANcyhNy9pI7BP97xJiqro1rdM726MdY8RJ4ybgwkNHTN-iDH_NLXaaMMkZpLaeZghdqHXyMAZtqCG1nw7birNpVU-VqqrfVZNvnffi46rD-a3rt4l_uk999cPzlxicM1QatS5vnPMWFLERukYscWuwkI_8AHaWXqA</recordid><startdate>201612</startdate><enddate>201612</enddate><creator>Tatsui, Claudio E</creator><creator>Lee, Sun-Ho</creator><creator>Amini, Behrang</creator><creator>Rao, Ganesh</creator><creator>Suki, Dima</creator><creator>Oro, Marilou</creator><creator>Brown, Paul D</creator><creator>Ghia, Amol J</creator><creator>Bhavsar, Shreyas</creator><creator>Popat, Keyuri</creator><creator>Rhines, Laurence D</creator><creator>Stafford, R Jason</creator><creator>Li, Jing</creator><general>Copyright by the Congress of Neurological Surgeons</general><general>Wolters Kluwer Health, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>201612</creationdate><title>Spinal Laser Interstitial Thermal Therapy: A Novel Alternative to Surgery for Metastatic Epidural Spinal Cord Compression</title><author>Tatsui, Claudio E ; Lee, Sun-Ho ; Amini, Behrang ; Rao, Ganesh ; Suki, Dima ; Oro, Marilou ; Brown, Paul D ; Ghia, Amol J ; Bhavsar, Shreyas ; Popat, Keyuri ; Rhines, Laurence D ; Stafford, R Jason ; Li, Jing</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3299-2e475f4761eb2691d744387342a74d39320e916d72be10d779f4db874700f4133</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Decompression, Surgical - methods</topic><topic>Female</topic><topic>Humans</topic><topic>Hyperthermia, Induced - methods</topic><topic>Imaging, Three-Dimensional - methods</topic><topic>Laser Therapy - methods</topic><topic>Magnetic Resonance Imaging, Interventional</topic><topic>Male</topic><topic>Metastasis</topic><topic>Middle Aged</topic><topic>Quality of Life</topic><topic>Retrospective Studies</topic><topic>Spinal Cord Compression - etiology</topic><topic>Spinal Cord Compression - surgery</topic><topic>Spinal Neoplasms - secondary</topic><topic>Spinal Neoplasms - surgery</topic><topic>Stereotaxic Techniques</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tatsui, Claudio E</creatorcontrib><creatorcontrib>Lee, Sun-Ho</creatorcontrib><creatorcontrib>Amini, Behrang</creatorcontrib><creatorcontrib>Rao, Ganesh</creatorcontrib><creatorcontrib>Suki, Dima</creatorcontrib><creatorcontrib>Oro, Marilou</creatorcontrib><creatorcontrib>Brown, Paul D</creatorcontrib><creatorcontrib>Ghia, Amol J</creatorcontrib><creatorcontrib>Bhavsar, Shreyas</creatorcontrib><creatorcontrib>Popat, Keyuri</creatorcontrib><creatorcontrib>Rhines, Laurence D</creatorcontrib><creatorcontrib>Stafford, R Jason</creatorcontrib><creatorcontrib>Li, Jing</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tatsui, Claudio E</au><au>Lee, Sun-Ho</au><au>Amini, Behrang</au><au>Rao, Ganesh</au><au>Suki, Dima</au><au>Oro, Marilou</au><au>Brown, Paul D</au><au>Ghia, Amol J</au><au>Bhavsar, Shreyas</au><au>Popat, Keyuri</au><au>Rhines, Laurence D</au><au>Stafford, R Jason</au><au>Li, Jing</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Spinal Laser Interstitial Thermal Therapy: A Novel Alternative to Surgery for Metastatic Epidural Spinal Cord Compression</atitle><jtitle>Neurosurgery</jtitle><addtitle>Neurosurgery</addtitle><date>2016-12</date><risdate>2016</risdate><volume>79 Suppl 1</volume><issue>Supplement 1</issue><spage>S73</spage><epage>S82</epage><pages>S73-S82</pages><issn>0148-396X</issn><eissn>1524-4040</eissn><abstract>BACKGROUND:Although surgery followed by radiation effectively treats metastatic epidural compression, the ideal surgical approach should enable fast recovery and rapid institution of radiation and systemic therapy directed at the primary tumor.
OBJECTIVE:To assess spinal laser interstitial thermotherapy (SLITT) as an alternative to surgery monitored in real time by thermal magnetic resonance (MR) images.
METHODS:Patients referred for spinal metastasis without motor deficits underwent MR-guided SLITT, followed by stereotactic radiosurgery. Clinical and radiological data were gathered prospectively, according to routine practice.
RESULTS:MR imaging-guided SLITT was performed on 19 patients with metastatic epidural compression. No procedures were discontinued because of technical difficulties, and no permanent neurological injuries occurred. The median follow-up duration was 28 weeks (range 10-64 weeks). Systemic therapy was not interrupted to perform the procedures. The mean preoperative visual analog scale scores of 4.72 (SD ± 0.67) decreased to 2.56 (SD ± 0.71, P = .043) at 1 month and remained improved from baseline at 3.25 (SD ± 0.75, P = .021) 3 months after the procedure. The preoperative mean EQ-5D index for quality of life was 0.67 (SD ± 0.07) and remained without significant change at 1 month 0.79 (SD ± 0.06, P = .317) and improved at 3 months 0.83 (SD ± 0.06, P = .04) after SLITT. Follow-up MR imaging after 2 months revealed significant decompression of the neural component in 16 patients. However, 3 patients showed progression at follow-up, 1 was treated with surgical decompression and stabilization and 2 were treated with repeated SLITT.
CONCLUSION:MR-guided SLITT can be both a feasible and safe alternative to separation surgery in carefully selected cases of spinal metastatic tumor epidural compression.
ABBREVIATIONS:cEBRT, conventional external beam radiation therapyESCC, epidural spinal cord compressionSLITT, spinal laser interstitial thermotherapySSRS, stereotactic spinal radiosurgeryVAS, visual analog scale</abstract><cop>United States</cop><pub>Copyright by the Congress of Neurological Surgeons</pub><pmid>27861327</pmid><doi>10.1227/NEU.0000000000001444</doi></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Decompression, Surgical - methods Female Humans Hyperthermia, Induced - methods Imaging, Three-Dimensional - methods Laser Therapy - methods Magnetic Resonance Imaging, Interventional Male Metastasis Middle Aged Quality of Life Retrospective Studies Spinal Cord Compression - etiology Spinal Cord Compression - surgery Spinal Neoplasms - secondary Spinal Neoplasms - surgery Stereotaxic Techniques Surgery |
| title | Spinal Laser Interstitial Thermal Therapy: A Novel Alternative to Surgery for Metastatic Epidural Spinal Cord Compression |
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