Spinal laser interstitial thermal therapy: single-center experience and outcomes in the first 120 cases

View More View Less
  • 1 Departments of Neurosurgery,
  • 2 Radiation Oncology, and
  • 3 Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
  • 4 Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

The objective of this study was to present the results of a consecutive series of 120 cases treated with spinal laser interstitial thermal therapy (sLITT) to manage epidural spinal cord compression (ESCC) from metastatic tumors.

METHODS

The electronic records of patients treated from 2013 to 2019 were analyzed retrospectively. Data collected included demographic, pathology, clinical, operative, and imaging findings; degree of epidural compression before and after sLITT; length of hospital stay; complications; and duration before subsequent oncological treatment. Independent-sample t-tests were used to compare means between pre- and post-sLITT treatments. Survival was estimated by the Kaplan-Meier method. Multivariate logistic regression was used to analyze predictive factors for local recurrence and neurological complications.

RESULTS

There were 110 patients who underwent 120 sLITT procedures. Spinal levels treated included 5 cervical, 8 lumbar, and 107 thoracic. The pre-sLITT Frankel grades were E (91.7%), D (6.7%), and C (1.7%). The preoperative ESCC grade was 1c or higher in 92% of cases. Metastases were most common from renal cell carcinoma (39%), followed by non–small cell lung carcinoma (10.8%) and other tumors (35%). The most common location of ESCC was in the vertebral body (88.3%), followed by paraspinal/foraminal (7.5%) and posterior elements (4.2%). Adjuvant radiotherapy (spinal stereotactic radiosurgery or conventional external beam radiation therapy) was performed in 87 cases (72.5%), whereas 33 procedures (27.5%) were performed as salvage after radiotherapy options were exhausted. sLITT was performed without need for spinal stabilization in 87 cases (72.5%). Post-sLITT Frankel grades were E (85%), D (10%), C (4.2%), and B (0.8%); treatment was associated with a median decrease of 2 ESCC grades. The local control rate at 1 year was 81.7%. Local control failure occurred in 25 cases (20.8%). The median progression-free survival was not reached, and overall survival was 14 months. Tumor location in the paraspinal region and salvage treatment were independent predictors of local recurrence, with hazard ratios of 6.3 and 3.3, respectively (p = 0.01). Complications were observed in 22 cases (18.3%). sLITT procedures performed in the lumbar and cervical spine had hazard ratios for neurological complications of 15.4 and 17.1 (p < 0.01), respectively, relative to the thoracic spine.

CONCLUSIONS

sLITT is safe and provides effective local control for high-grade ESCC from vertebral metastases in the thoracic spine, particularly when combined with adjuvant radiotherapy. The authors propose considering sLITT as an alternative to open surgery in selected patients with spinal metastases.

ABBREVIATIONS cEBRT = conventional external beam radiation therapy; ESCC = epidural spinal cord compression; HR = hazard ratio; KPS = Karnofsky Performance Scale; NOMS = neurological, oncological, mechanical instability, and systemic disease; NSCLC = non–small cell lung cancer; OS = overall survival; PFS = progression-free survival; PLL = posterior longitudinal ligament; RCC = renal cell carcinoma; sLITT = spinal laser interstitial thermal therapy; SSRS = spinal stereotactic radiosurgery.

Supplementary Materials

    • Supplemental Tables 1 and 2 (PDF 589 KB)

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Claudio E. Tatsui: The University of Texas MD Anderson Cancer Center, Houston, TX. cetatsui@mdanderson.org.

ACCOMPANYING EDITORIAL DOI: 10.3171/2020.7.SPINE201214.

INCLUDE WHEN CITING Published online December 11, 2020; DOI: 10.3171/2020.7.SPINE20661.

D.C.A.B. and R.A.V. contributed equally to this work.

Disclosures Drs. Tatsui and Li report clinical or research support for this study from Medtronic (educational grant).

  • 1

    Bakar D, Tanenbaum JE, Phan K, Decompression surgery for spinal metastases: a systematic review. Neurosurg Focus. 2016;41(2):E2.

  • 2

    Patchell RA, Tibbs PA, Regine WF, Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet. 2005;366(9486):643648.

    • Search Google Scholar
    • Export Citation
  • 3

    Gerszten PC, Mendel E, Yamada Y. Radiotherapy and radiosurgery for metastatic spine disease: what are the options, indications, and outcomes? Spine (Phila Pa 1976). 2009;34(22)(suppl):S78S92.

    • Search Google Scholar
    • Export Citation
  • 4

    Yamada Y, Bilsky MH, Lovelock DM, High-dose, single-fraction image-guided intensity-modulated radiotherapy for metastatic spinal lesions. Int J Radiat Oncol Biol Phys. 2008;71(2):484490.

    • Search Google Scholar
    • Export Citation
  • 5

    Bishop AJ, Tao R, Rebueno NC, Outcomes for spine stereotactic body radiation therapy and an analysis of predictors of local recurrence. Int J Radiat Oncol Biol Phys. 2015;92(5):10161026.

    • Search Google Scholar
    • Export Citation
  • 6

    Chang EL, Shiu AS, Mendel E, Phase I/II study of stereotactic body radiotherapy for spinal metastasis and its pattern of failure. J Neurosurg Spine. 2007;7(2):151160.

    • Search Google Scholar
    • Export Citation
  • 7

    Moussazadeh N, Laufer I, Yamada Y, Bilsky MH. Separation surgery for spinal metastases: effect of spinal radiosurgery on surgical treatment goals. Cancer Contr. 2014;21(2):168174.

    • Search Google Scholar
    • Export Citation
  • 8

    Bilsky M, Smith M. Surgical approach to epidural spinal cord compression. Hematol Oncol Clin North Am. 2006;20(6):13071317.

  • 9

    Bate BG, Khan NR, Kimball BY, Stereotactic radiosurgery for spinal metastases with or without separation surgery. J Neurosurg Spine. 2015;22(4):409415.

    • Search Google Scholar
    • Export Citation
  • 10

    Laufer I, Iorgulescu JB, Chapman T, Local disease control for spinal metastases following “separation surgery” and adjuvant hypofractionated or high-dose single-fraction stereotactic radiosurgery: outcome analysis in 186 patients. J Neurosurg Spine. 2013;18(3):207214.

    • Search Google Scholar
    • Export Citation
  • 11

    Tao R, Bishop AJ, Brownlee Z, Stereotactic body radiation therapy for spinal metastases in the postoperative setting: a secondary analysis of mature phase 1-2 trials. Int J Radiat Oncol Biol Phys. 2016;95(5):14051413.

    • Search Google Scholar
    • Export Citation
  • 12

    Pennington Z, Ahmed AK, Molina CA, Minimally invasive versus conventional spine surgery for vertebral metastases: a systematic review of the evidence. Ann Transl Med. 2018;6(6):103.

    • Search Google Scholar
    • Export Citation
  • 13

    Tatsui CE, Stafford RJ, Li J, Utilization of laser interstitial thermotherapy guided by real-time thermal MRI as an alternative to separation surgery in the management of spinal metastasis. J Neurosurg Spine. 2015;23(4):400411.

    • Search Google Scholar
    • Export Citation
  • 14

    Missios S, Bekelis K, Barnett GH. Renaissance of laser interstitial thermal ablation. Neurosurg Focus. 2015;38(3):E13.

  • 15

    Tatsui CE, Lee SH, Amini B, Spinal laser interstitial thermal therapy: a novel alternative to surgery for metastatic epidural spinal cord compression. Neurosurgery. 2016;79(suppl 1):S73S82.

    • Search Google Scholar
    • Export Citation
  • 16

    Moussazadeh N, Evans LT, Grasu R, Laser interstitial thermal therapy of the spine: technical aspects. Neurosurg Focus. 2018;44(VideoSuppl2):V3.

    • Search Google Scholar
    • Export Citation
  • 17

    Bilsky MH, Laufer I, Fourney DR, Reliability analysis of the epidural spinal cord compression scale. J Neurosurg Spine. 2010;13(3):324328.

    • Search Google Scholar
    • Export Citation
  • 18

    Frankel HL, Hancock DO, Hyslop G, The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I. Paraplegia. 1969;7(3):179192.

    • Search Google Scholar
    • Export Citation
  • 19

    Tatsui CE, Nascimento CNG, Suki D, Image guidance based on MRI for spinal interstitial laser thermotherapy: technical aspects and accuracy. J Neurosurg Spine. 2017;26(5):605612.

    • Search Google Scholar
    • Export Citation
  • 20

    Vega RA, Ghia AJ, Tatsui CE. Percutaneous hybrid therapy for spinal metastatic disease: laser interstitial thermal therapy and spinal stereotactic radiosurgery. Neurosurg Clin N Am. 2020;31(2):211219.

    • Search Google Scholar
    • Export Citation
  • 21

    Thomas JG, Al-Holou WN, de Almeida Bastos DC, A novel use of the intraoperative MRI for metastatic spine tumors: laser interstitial thermal therapy for percutaneous treatment of epidural metastatic spine disease. Neurosurg Clin N Am. 2017;28(4):513524.

    • Search Google Scholar
    • Export Citation
  • 22

    Ghia AJ, Rebueno NC, Li J, The use of image guided laser interstitial thermotherapy to supplement spine stereotactic radiosurgery to manage metastatic epidural spinal cord compression: proof of concept and dosimetric analysis. Pract Radiat Oncol. 2016;6(2):e35e38.

    • Search Google Scholar
    • Export Citation
  • 23

    Bilsky MH, Laufer I, Burch S. Shifting paradigms in the treatment of metastatic spine disease. Spine (Phila Pa 1976). 2009;34(22)(suppl):S101S107.

    • Search Google Scholar
    • Export Citation
  • 24

    Laufer I, Rubin DG, Lis E, The NOMS framework: approach to the treatment of spinal metastatic tumors. Oncologist. 2013;18(6):744751.

  • 25

    Wang JC, Boland P, Mitra N, Single-stage posterolateral transpedicular approach for resection of epidural metastatic spine tumors involving the vertebral body with circumferential reconstruction: results in 140 patients. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine. 2004;1(3):287298.

    • Search Google Scholar
    • Export Citation
  • 26

    de Almeida Bastos DC, Everson RG, de Oliveira Santos BF, A comparison of spinal laser interstitial thermotherapy with open surgery for metastatic thoracic epidural spinal cord compression. J Neurosurg Spine. 2020;32(5):667675.

    • Search Google Scholar
    • Export Citation
  • 27

    Clohisy DR, Perkins SL, Ramnaraine ML. Review of cellular mechanisms of tumor osteolysis. Clin Orthop Relat Res. 2000;(373):104114.

  • 28

    Tatsui CE, Belsuzarri TA, Oro M, Percutaneous surgery for treatment of epidural spinal cord compression and spinal instability: technical note. Neurosurg Focus. 2016;41(4):E2.

    • Search Google Scholar
    • Export Citation
  • 29

    Ahrar S, Hwang M, Duncan PN, Hui EE. Microfluidic serial dilution ladder. Analyst (Lond). 2014;139(1):187190.

  • 30

    De la Garza Ramos R, Goodwin CR, Jain A, Development of a Metastatic Spinal Tumor Frailty Index (MSTFI) using a nationwide database and its association with inpatient morbidity, mortality, and length of stay after spine surgery. World Neurosurg. 2016;95:548555.e4.

    • Search Google Scholar
    • Export Citation
  • 31

    Schilling AT, Ehresman J, Huq S, Risk factors for wound-related complications after surgery for primary and metastatic spine tumors: a systematic review and meta-analysis. World Neurosurg. 2020;141:467478.e3.

    • Search Google Scholar
    • Export Citation
  • 32

    Tatsui CE, Suki D, Rao G, Factors affecting survival in 267 consecutive patients undergoing surgery for spinal metastasis from renal cell carcinoma. J Neurosurg Spine. 2014;20(1):108116.

    • Search Google Scholar
    • Export Citation
  • 33

    Barzilai O, McLaughlin L, Lis E, Outcome analysis of surgery for symptomatic spinal metastases in long-term cancer survivors. J Neurosurg Spine. 2019;31(2):285290.

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 817 817 186
Full Text Views 113 113 19
PDF Downloads 45 45 10
EPUB Downloads 0 0 0