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Dara Bakar, Joseph E. Tanenbaum, Kevin Phan, Vincent J. Alentado, Michael P. Steinmetz, Edward C. Benzel and Thomas E. Mroz

T he spine is the most common site of bony metastases, with 50% of all skeletal metastases occurring in the spine. 9 , 14 Among patients whose cause of death is malignant neoplasm, an estimated 30.6% have spinal metastases based on microscopic examination. 27 Certain primary tumors, such as lung, breast, and prostate, have a higher frequency of metastases to the spinal column. 44 Spinal cord compression is a common complication among patients with spinal metastases. Metastatic epidural spinal cord compression (MESCC) has been reported in 5%–10% of all

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Stereotactic body radiotherapy for de novo spinal metastases: systematic review

International Stereotactic Radiosurgery Society practice guidelines

Zain A. Husain, Arjun Sahgal, Antonio De Salles, Melissa Funaro, Janis Glover, Motohiro Hayashi, Masahiro Hiraoka, Marc Levivier, Lijun Ma, Roberto Martínez-Alvarez, J. Ian Paddick, Jean Régis, Ben J. Slotman and Samuel Ryu

S pinal metastases are a common cause of morbidity in patients with cancer. Nearly 100,000 cases of bone metastases are diagnosed each year, and their most common location is the spine. 12 Spinal metastases have traditionally been treated with conventional palliative irradiation. This approach is associated with several limitations, particularly relatively low rates of complete response to pain and local control. 7 , 12 , 17 , 30 Furthermore, efficacy has been limited to the short term, and as patients are living longer with metastatic disease, more durable

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Kristin J. Redmond, Simon S. Lo, Scott G. Soltys, Yoshiya Yamada, Igor J. Barani, Paul D. Brown, Eric L. Chang, Peter C. Gerszten, Samuel T. Chao, Robert J. Amdur, Antonio A. F. De Salles, Matthias Guckenberger, Bin S. Teh, Jason Sheehan, Charles R. Kersh, Michael G. Fehlings, Moon-Jun Sohn, Ung-Kyu Chang, Samuel Ryu, Iris C. Gibbs and Arjun Sahgal

E vidence of spinal metastases may be found in as many as 90% of cancer patients 20 , 36 upon autopsy, and 40% of patients with metastatic disease will present with clinically evident spinal metastases. 18 Treatment options for patients with spinal metastases are dependent on individual patient circumstances, but include systemic therapy, radiation therapy (RT), surgery, and surgery plus RT. The role of surgery for patients with malignant epidural spinal cord compression (MESCC) was clarified by a randomized controlled study comparing the efficacy of

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Frédéric Clarençon, Federico Di Maria, Evelyne Cormier, Nader-Antoine Sourour, Eric Enkaoua, Frédéric Sailhan, Christina Iosif, Lise Le Jean and Jacques Chiras

embolizing several skull base and head and neck tumors. 3 , 5 , 10 We report our early experience in using Onyx-18, injected by direct puncture, to embolize hypervascular spinal metastases of the posterior arch that were in proximity to the ASA. Case Reports Case 1 This 36-year-old woman was referred to our department for presurgical embolization of a recurrent C-4 metastasis from a thyroid cancer. Four years earlier, the patient had already undergone percutaneous vertebroplasty treatment of the C-4 vertebral body, and laminectomy and posterior fixation were

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Yoshiya Yamada, Evangelia Katsoulakis, Ilya Laufer, Michael Lovelock, Ori Barzilai, Lily A. McLaughlin, Zhigang Zhang, Adam M. Schmitt, Daniel S. Higginson, Eric Lis, Michael J. Zelefsky, James Mechalakos and Mark H. Bilsky

interpretation of the literature difficult. Tumor histological type is recognized as an important factor in expected outcomes for conventional palliative radiotherapy for spinal metastases, but is thought to be less important in the case of high-dose SRS. This histology-independent response may be due to unique radiobiological mechanisms of action. 9 The NOMS (neurological, oncological, mechanical, and systemic) framework 14 and similar paradigms have been put forward to define the role of spine radiosurgery in the management of spinal metastases, using tumor histological

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Ahmed Hashmi, Matthias Guckenberger, Ron Kersh, Peter C. Gerszten, Frederick Mantel, Inga S. Grills, John C. Flickinger, John H. Shin, Daniel K. Fahim, Brian Winey, Kevin Oh, B. C. John Cho, Daniel Létourneau, Jason Sheehan and Arjun Sahgal

S pinal metastases will develop in 40% of patients diagnosed with cancer. Most of these patients will be offered short-course palliative conventional external beam radiation therapy (cEBRT), which has been associated with short-term pain control and low rates of complete response to pain. 24 Furthermore, approximately 10%–20% of patients will suffer pain progression following cEBRT, requiring retreatment. 18 Therefore, the burden of patients needing re-irradiation to spinal metastases is significant, considering the prevalence of the disease

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Godard C. W. de Ruiter, Claudine O. Nogarede, Jasper F. C. Wolfs and Mark P. Arts

D eciding which surgery to perform in patients with spinal metastases is often based on several factors such as indication (for example, pain, spinal cord compression, instability, tumor control), primary tumor type, presence of metastases, and condition of the patient. Several models have been developed to guide the surgeon in this selection process. 3 , 23 , 24 , 26 Most of these models are based on the patient's life expectancy. Little is known about the effect of various surgical procedures on patient quality of life (QOL), 18 but this factor is

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Ilya Laufer, J. Bryan Iorgulescu, Talia Chapman, Eric Lis, Weiji Shi, Zhigang Zhang, Brett W. Cox, Yoshiya Yamada and Mark H. Bilsky

were escalated from low-dose (20–30 Gy in 5 fractions) prior to 2008 to high-dose (24–30 Gy in 3 fractions). This study reports the local tumor control and toxicity for patients who underwent “separation surgery” followed by 24-Gy single-fraction SRS, high-dose hypofractionated SRS, or low-dose hypofractionated SRS. Methods Study Design A retrospective analysis was undertaken of all patients treated at MSKCC between 2002 and 2011 who harbored spinal metastases and underwent surgery followed by SRS. This study was approved by MSKCC's institutional review

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Satoru Demura, Norio Kawahara, Hideki Murakami, Mohamed E. Abdel-Wanis, Satoshi Kato, Katsuhito Yoshioka, Katsuro Tomita and Hiroyuki Tsuchiya

T hyroid carcinoma is generally not aggressive and thus is associated with a favorable prognosis. When distant metastases do occur, they commonly appear in the bone, lymph nodes, or lung. Bone metastases develop in approximately 2%–13% of patients with thyroid carcinoma, and the spine is a common site of occurrence. 10 Authors of several studies have evaluated the effectiveness of resection for spinal metastases of thyroid carcinoma, and the survival rate has been reported. 4 , 6 , 14 However, few studies have analyzed the impact of local curative surgery

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Berkeley G. Bate, Nickalus R. Khan, Brent Y. Kimball, Kyle Gabrick and Jason Weaver

M ore than 1.6 million new cases of cancer are diagnosed annually in the United States. 2 , 24 Symptomatic spinal metastases are estimated to occur in up to 10% of all cancer patients. 28 The majority occur in the extradural compartment, most frequently presenting within the vertebral bodies. 12 Most of the metastatic burden (70%) is within the thoracic spine, followed by the lumbar spine (20%), cervical spine, and sacrum. 20 As survival rates for primary tumors improve, it is expected that the prevalence of spinal metastases will continue to increase