different biological behavior, most spinal sarcomas are best treated with resection. The combination of chemotherapy and radiotherapy is often used as a neoadjuvant or adjuvant modality. 10 The Enneking classification system was developed as a surgical staging tool for primary nonspinal musculoskeletal tumors, 9 but studies have proven its validity in primary spinal neoplasms. 12 Based on tumor histological findings, anatomical extent, and the presence of metastases, the Enneking system recommends resection with negative margins for malignant tumors such as sarcoma. 9
Daniel M. Sciubba, Rafael De la Garza Ramos, C. Rory Goodwin, Nancy Abu-Bonsrah, Ali Bydon, Timothy F. Witham, Chetan Bettegowda, Ziya L. Gokaslan and Jean-Paul Wolinsky
Jonathan E. Leeman, Mark Bilsky, Ilya Laufer, Michael R. Folkert, Neil K. Taunk, Joseph R. Osborne, Julio Arevalo-Perez, Joan Zatcky, Kaled M. Alektiar, Yoshiya Yamada and Daniel E. Spratt
The aim of this study was to report the first detailed analysis of patterns of failure within the spinal axis of patients treated with stereotactic body radiotherapy (SBRT) for sarcoma spine metastases.
Between 2005 and 2012, 88 consecutive patients with metastatic sarcoma were treated with SBRT for 120 spinal lesions. Seventy-one percent of patients were enrolled on prospective institutional protocols. For patients who underwent routine posttreatment total-spine MRI (64 patients, 88 lesions), each site of progression within the entire spinal axis was mapped in relation to the treated lesion. Actuarial rates of local-, adjacent-, and distant-segment failure-free survival (FFS) were calculated using the Kaplan-Meier method.
The median follow-up for the cohort was 14.4 months, with 81.7% of patients followed up until death. The 12-month actuarial rate of local FFS was 85.9%; however, 83.3% of local failures occurred in conjunction with distant-segment failures. The 12-month actuarial rates of isolated local-, adjacent-, and distant-segment FFS were 98.0%, 97.8%, and 74.7%, respectively. Of patients with any spinal progression (n = 55), only 25.5% (n = 14) had progression at a single vertebral level, with 60.0% (n = 33) having progression at ≥ 3 sites within the spine simultaneously. Linear regression analysis revealed a relationship of decreasing risk of failure with increasing distance from the treated index lesion (R2 = 0.87), and 54.1% of failures occurred ≥ 5 vertebral levels away. Treatment of the index lesion with a lower biological effective dose (OR 3.2, 95% CI 1.1–9.2) and presence of local failure (OR 18.0, 95% CI 2.1–152.9) independently predicted for distant spine failure.
Isolated local- and adjacent-segment failures are exceptionally rare for patients with metastatic sarcoma to the spine treated with SBRT, thereby affirming the treatment of the involved level only. The majority of progression within the spinal axis occurs ≥ 5 vertebral levels away. Thus, total-spine imaging is necessary for surveillance posttreatment.
Report of 3 cases
Paul Klimo Jr., Patrick J. Codd, Holcombe Grier and Liliana C. Goumnerova
S arcomas are a family of tumors that arise from connective or mesenchymal tissue. Primary spinal sarcomas arise from the spine itself, usually from a structural component such as bone or cartilage. When these lesions arise within the epidural or intradural space they are called primary intraspinal sarcomas. In general, these tumors are highly aggressive malignant lesions that pose significant challenges with regard to the extent of resection, risk of neurological impairment, and prevention of local recurrence and metastatic spread. Primary spinal
Abstracts of the 2013 Annual Meeting of the AANS/CNS Section on Disorders of the Spine and Peripheral Nerves
Phoenix, Arizona • March 6–9, 2013
underscores the importance of maintaining meticulous wound management and vigilance in patients who have received preoperative chemo/hormonal therapy. Neurosurg Focus Neurosurgical Focus FOC 1092-0684 American Association of Neurological Surgeons 2013.3.FOC-DSPNABSTRACTS Oral Poster Abstract Mayfield Basic Science Award 241. Survival Following Surgical Resection of Spinal Sarcoma: A Report of Twenty-five Consecutive Cases Mari L. Groves , MD , Patricia L. Zadnik , BA , Jackson Sui , Derek Ju
John B. Runnels and John W. Hanbery
: 37 – 40 , 1949 Roger H, Paillas JE, Duplay J: Hémorragie méningée spino-cérébrale révélatrice d'une tumeur de la queue de cheval chez deux jeunes sujets. Bull Mem Soc Med Hop Paris 65: 37–40, 1949 21. Tarlov IM , Keener EB : Subarachnoid hemorrhage and tumor implants from spinal sarcoma in an infant. Neurology 3 : 384 – 390 , 1953 Tarlov IM, Keener EB: Subarachnoid hemorrhage and tumor implants from spinal sarcoma in an infant. Neurology 3: 384–390, 1953 22. Thomas JJ
Robert A. Mendelsohn and Federico Mora
'une tumeur de la queue de cheval chez deux jeunes sujets. Bull. Soc. méd. Hôp. Paris. , 1949 , 65 : 37 – 40 . Roger , H., Paillas , J.-E., and Duplay , J. Hémorragie méningée spino-cérébrale révélatrice d'une tumeur de la queue de cheval chez deux jeunes sujets. Bull. Soc. méd. Hôp. Paris. , 1949, 65: 37–40. 5. Tarlov , I. M. , and Keener , E. B. Subarachnoid hemorrhage and tumor implants from spinal sarcoma in an infant. Neurology , 1953 , 3 : 384 – 390 . Tarlov , I. M., and Keener , E. B
Doniel Drazin, Ziya L. Gokaslan and J. Patrick Johnson
. reviewed the clinical, surgical, and molecular prognostic factors for survival after spinal sarcoma resection. We began the metastatic disease section with an article that reviewed the 100 most influential articles in metastatic spine disease. The authors, Cohen et al., followed a similar methodology that has been used in the literature to define an article's influence by the number of citations. Molina et al. investigated the role of posterior surgical procedures (posterior laminectomy with and without instrumentation, transpedicular corpectomy, and
Report of two cases
John S. Yu, M. Priscilla Short, James Schumacher, Paul H. Chapman and Griffith R. Harsh IV
-Lindau syndrome. J Neurosurg 70 : 24 – 30 , 1989 Neumann HPH, Eggert HR, Weigel K, et al: Hemangioblastomas of the central nervous system. A 10-year study with special reference to von Hippel-Lindau syndrome. J Neurosurg 70: 24–30, 1989 9. Tarlov IM , Keener EB : Subarachnoid hemorrhage and tumor implants from spinal sarcoma in an infant. Neurology 3 : 384 – 390 , 1953 Tarlov IM, Keener EB: Subarachnoid hemorrhage and tumor implants from spinal sarcoma in an infant. Neurology 3: 384–390, 1953 10. Van
Linda M. Luxon and Michael J. G. Harrison
and tumor implants from spinal sarcoma in an infant. Neurology 3 : 384 – 390 , 1953 Tarlov IM, Keener EB: Subarachnoid hemorrhage and tumor implants from spinal sarcoma in an infant. Neurology 3: 384–390, 1953 20. Trupp M , Sachs E : Vascular tumors of the brain and spinal cord and their treatment. J Neurosurg 5 : 354 – 371 , 1948 Trupp M, Sachs E: Vascular tumors of the brain and spinal cord and their treatment. J Neurosurg 5: 354–371, 1948 21. Walton JN : Subarachnoid hemorrhage of
Ganesh Rao, Dima Suki, Indro Chakrabarti, Iman Feiz-Erfan, Milan G. Mody, Ian E. McCutcheon, Ziya Gokaslan, Shreyaskumar Patel and Laurence D. Rhines
survival benefit and minimize local recurrence. Outcomes of surgery for spinal sarcomas are drawn from a few large patient series and several case reports, most of which describe the results of various surgical techniques and heterogeneous pathologies. 2 , 5 , 7 , 8 , 15 , 16 , 19 , 20 , 23 , 25 , 31 , 33–35 , 38 , 41–43 , 45 , 49 , 50 , 52 , 57–60 , 62 , 63 , 66 , 71 , 72 , 76 , 77 , 81 Taken together, the existing literature from large patient populations supports a paradigm of aggressive resection of spinal sarcomas for providing neurological and functional