Resident University of Illinois Peoria Peoria, Illinois, United States
Introduction: Separation surgery followed by stereotactic body radiotherapy (SBRT) for the treatment of radioresistant, spinal metastatic disease with high grade epidural spinal cord compression is a well-accepted treatment paradigm. Here we describe SBRT as a preoperative modality prior to separation surgery. Potential benefits include improved radiation targeting, less scatter radiation, avoidance of CT myelogram, and social logistical factors.
Methods: A retrospective review identified 11 patients with extradural spinal metastatic disease who underwent preoperative SBRT before separation surgery. Patient demographics, tumor morphology, tumor type, neurologic symptoms, surgery details, complications, recurrence, and systemic treatments were collected
Results: Cervical, thoracic, and lumbar radioresistant tumors were included. Patients underwent hypofractionated SBRT (1-3 fractions, 1800-3000 cGy) prior to surgery (range 0-5 days). All surgeries included open posterior approach, epidural decompression and tumor resection with partial corpectomy, and posterior screw-rod instrumentation. One patient with intra-operative durotomy required revision surgery for wound dehiscence. No other major complications were recorded. None had local recurrence.
Conclusion : SBRT for high grade epidural metastatic disease traditionally follows separation surgery. Here we present 11 patients who received these treatment modalities in reverse order. In this small series, SBRT immediately prior to separation surgery appears to be safe. Further research is needed to determine if preoperative SBRT results in similar recurrence, survival, and complication rates compared to postoperative SBRT.
