Long-Term Update of Stereotactic Radiosurgery for Benign Spinal Tumors

Alexander L. Chin, Dylann Fujimoto, Kiran A. Kumar, Laurie Tupper, Salma Mansour, Steven D. Chang, John R. Adler, Iris C. Gibbs, Steven L. Hancock, Robert Dodd, Gordon Li, Melanie Hayden Gephart, John K. Ratliff, Victor Tse, Melissa Usoz, Sean Sachdev, Scott G. Soltys*

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)708-716
Number of pages9
JournalClinical Neurosurgery
Volume85
Issue number5
DOIs
StatePublished - Nov 1 2019

Fingerprint

Radiosurgery
Neoplasms
Standard of Care
Incidence
Neurofibroma
Neurilemmoma
Meningioma
Cohort Studies
Retrospective Studies
Magnetic Resonance Imaging
Safety

Keywords

  • Meningioma
  • Neurofibroma
  • Radiosurgery
  • Schwannoma
  • Spinal tumors

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Chin, A. L., Fujimoto, D., Kumar, K. A., Tupper, L., Mansour, S., Chang, S. D., ... Soltys, S. G. (2019). Long-Term Update of Stereotactic Radiosurgery for Benign Spinal Tumors. Clinical Neurosurgery, 85(5), 708-716. https://doi.org/10.1093/neuros/nyy442
Chin, Alexander L. ; Fujimoto, Dylann ; Kumar, Kiran A. ; Tupper, Laurie ; Mansour, Salma ; Chang, Steven D. ; Adler, John R. ; Gibbs, Iris C. ; Hancock, Steven L. ; Dodd, Robert ; Li, Gordon ; Gephart, Melanie Hayden ; Ratliff, John K. ; Tse, Victor ; Usoz, Melissa ; Sachdev, Sean ; Soltys, Scott G. / Long-Term Update of Stereotactic Radiosurgery for Benign Spinal Tumors. In: Clinical Neurosurgery. 2019 ; Vol. 85, No. 5. pp. 708-716.
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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.",
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author = "Chin, {Alexander L.} and Dylann Fujimoto and Kumar, {Kiran A.} and Laurie Tupper and Salma Mansour and Chang, {Steven D.} and Adler, {John R.} and Gibbs, {Iris C.} and Hancock, {Steven L.} and Robert Dodd and Gordon Li and Gephart, {Melanie Hayden} and Ratliff, {John K.} and Victor Tse and Melissa Usoz and Sean Sachdev and Soltys, {Scott G.}",
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Chin, AL, Fujimoto, D, Kumar, KA, Tupper, L, Mansour, S, Chang, SD, Adler, JR, Gibbs, IC, Hancock, SL, Dodd, R, Li, G, Gephart, MH, Ratliff, JK, Tse, V, Usoz, M, Sachdev, S & Soltys, SG 2019, 'Long-Term Update of Stereotactic Radiosurgery for Benign Spinal Tumors', Clinical Neurosurgery, vol. 85, no. 5, pp. 708-716. https://doi.org/10.1093/neuros/nyy442

Long-Term Update of Stereotactic Radiosurgery for Benign Spinal Tumors. / Chin, Alexander L.; Fujimoto, Dylann; Kumar, Kiran A.; Tupper, Laurie; Mansour, Salma; Chang, Steven D.; Adler, John R.; Gibbs, Iris C.; Hancock, Steven L.; Dodd, Robert; Li, Gordon; Gephart, Melanie Hayden; Ratliff, John K.; Tse, Victor; Usoz, Melissa; Sachdev, Sean; Soltys, Scott G.

In: Clinical Neurosurgery, Vol. 85, No. 5, 01.11.2019, p. 708-716.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Long-Term Update of Stereotactic Radiosurgery for Benign Spinal Tumors

AU - Chin, Alexander L.

AU - Fujimoto, Dylann

AU - Kumar, Kiran A.

AU - Tupper, Laurie

AU - Mansour, Salma

AU - Chang, Steven D.

AU - Adler, John R.

AU - Gibbs, Iris C.

AU - Hancock, Steven L.

AU - Dodd, Robert

AU - Li, Gordon

AU - Gephart, Melanie Hayden

AU - Ratliff, John K.

AU - Tse, Victor

AU - Usoz, Melissa

AU - Sachdev, Sean

AU - Soltys, Scott G.

PY - 2019/11/1

Y1 - 2019/11/1

N2 - 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.

AB - 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.

KW - Meningioma

KW - Neurofibroma

KW - Radiosurgery

KW - Schwannoma

KW - Spinal tumors

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Chin AL, Fujimoto D, Kumar KA, Tupper L, Mansour S, Chang SD et al. Long-Term Update of Stereotactic Radiosurgery for Benign Spinal Tumors. Clinical Neurosurgery. 2019 Nov 1;85(5):708-716. https://doi.org/10.1093/neuros/nyy442