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Robotic Radiosurgery for the Treatment of Intramedullary Spinal Cord Metastases: A Case Report and Literature Review



Abstract

Modern technologies allow the delivery of high radiation doses to intramedullary spinal cord metastases while lowering the dose to the neighboring organs at risk. Whether this dosimetric advantage translates into clinical benefit is not well known. This study evaluates the acute and late toxicity outcomes in a patient treated with robotic radiosurgery for an intramedullary spinal cord metastasis.

A 50-year-old woman diagnosed in May 2006 with invasive ductal carcinoma of the right breast T2N3M1 (two liver metastases) received chemotherapy with a complete response. Subsequently, she underwent adjuvant whole-breast radiotherapy, along with tamoxifen. After several distant relapses, treated mainly with systemic therapy, the patient developed an intramedullary lesion at the C3-C4 level and was referred to our CyberKnife unit for assessment. A total dose of 14 Gy prescribed to the 74% isodose line was administered to the intramedullary lesion in one fraction. One hundred and two treatment beams were used covering 95.63% of the target volume. The mean dose was 15.93 Gy and the maximum dose, 18.92 Gy. Maximum dose to the spinal cord was 13.96 Gy, V12 ~ 0.13 cc and V8 ~ 0.43 cc.

Three months after treatment, magnetic resonance imaging showed a reduction in size and enhancement of the intramedullary lesion with no associated toxicity. During this period, the patient showed a good performance status without neurological deficits. Currently, with a follow-up of 37 months, the patient has the ability to perform activities of daily life.

Intramedullary spinal cord metastases is a rare and aggressive disease, often treatment-refractory. Our case demonstrates that radiation therapy delivery with robotic radiosurgery allows the achievement of a high local control without adding toxicity.



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Case report
peer-reviewed

Robotic Radiosurgery for the Treatment of Intramedullary Spinal Cord Metastases: A Case Report and Literature Review


Author Information

Rafael Garcia

Robotic Radiosurgery Unit, Imoncology

Kita Sallabanda

Radiosurgery, Imoncology

Iciar Santa-Olalla

Radiation Physics, Imoncology

Jose Luis Lopez Guerra Corresponding Author

Radiation Oncology, Virgen del Rocío University Hospital

Lijia Avilés

Master in Advanced Technological Applications in Radiation Oncology, University of Murcia and Imoncology Foundation

Morena Sallabanda

Radiation Oncology, Hospital Universitario Puerta de Hierro

Eleonor Rivin

Radiation Oncology, Institut de cancérologie Gustave Roussy

José Samblás

Radiosurgery, Imoncology


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: The authors have declared that no conflicts of interest exist.


Case report
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Robotic Radiosurgery for the Treatment of Intramedullary Spinal Cord Metastases: A Case Report and Literature Review


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Robotic Radiosurgery for the Treatment of Intramedullary Spinal Cord Metastases: A Case Report and Literature Review

  • Author Information
    Rafael Garcia

    Robotic Radiosurgery Unit, Imoncology

    Kita Sallabanda

    Radiosurgery, Imoncology

    Iciar Santa-Olalla

    Radiation Physics, Imoncology

    Jose Luis Lopez Guerra Corresponding Author

    Radiation Oncology, Virgen del Rocío University Hospital

    Lijia Avilés

    Master in Advanced Technological Applications in Radiation Oncology, University of Murcia and Imoncology Foundation

    Morena Sallabanda

    Radiation Oncology, Hospital Universitario Puerta de Hierro

    Eleonor Rivin

    Radiation Oncology, Institut de cancérologie Gustave Roussy

    José Samblás

    Radiosurgery, Imoncology


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements


    Article Information

    Published: May 13, 2016

    DOI

    10.7759/cureus.609

    Cite this article as:

    Garcia R, Sallabanda K, Santa-olalla I, et al. (May 13, 2016) Robotic Radiosurgery for the Treatment of Intramedullary Spinal Cord Metastases: A Case Report and Literature Review. Cureus 8(5): e609. doi:10.7759/cureus.609

    Publication history

    Received by Cureus: February 28, 2016
    Peer review began: April 12, 2016
    Peer review concluded: May 02, 2016
    Published: May 13, 2016

    Copyright

    © Copyright 2016
    Garcia et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Modern technologies allow the delivery of high radiation doses to intramedullary spinal cord metastases while lowering the dose to the neighboring organs at risk. Whether this dosimetric advantage translates into clinical benefit is not well known. This study evaluates the acute and late toxicity outcomes in a patient treated with robotic radiosurgery for an intramedullary spinal cord metastasis.

A 50-year-old woman diagnosed in May 2006 with invasive ductal carcinoma of the right breast T2N3M1 (two liver metastases) received chemotherapy with a complete response. Subsequently, she underwent adjuvant whole-breast radiotherapy, along with tamoxifen. After several distant relapses, treated mainly with systemic therapy, the patient developed an intramedullary lesion at the C3-C4 level and was referred to our CyberKnife unit for assessment. A total dose of 14 Gy prescribed to the 74% isodose line was administered to the intramedullary lesion in one fraction. One hundred and two treatment beams were used covering 95.63% of the target volume. The mean dose was 15.93 Gy and the maximum dose, 18.92 Gy. Maximum dose to the spinal cord was 13.96 Gy, V12 ~ 0.13 cc and V8 ~ 0.43 cc.

Three months after treatment, magnetic resonance imaging showed a reduction in size and enhancement of the intramedullary lesion with no associated toxicity. During this period, the patient showed a good performance status without neurological deficits. Currently, with a follow-up of 37 months, the patient has the ability to perform activities of daily life.

Intramedullary spinal cord metastases is a rare and aggressive disease, often treatment-refractory. Our case demonstrates that radiation therapy delivery with robotic radiosurgery allows the achievement of a high local control without adding toxicity.



Want to read more?

Create a free account to continue reading this article.

Already a member? Login.



Rafael Garcia

Robotic Radiosurgery Unit, Imoncology

Kita Sallabanda

Radiosurgery, Imoncology

Iciar Santa-Olalla

Radiation Physics, Imoncology

Jose Luis Lopez Guerra

Radiation Oncology, Virgen del Rocío University Hospital

For correspondence:
chanodetriana@yahoo.es

Lijia Avilés

Master in Advanced Technological Applications in Radiation Oncology, University of Murcia and Imoncology Foundation

Morena Sallabanda

Radiation Oncology, Hospital Universitario Puerta de Hierro

Eleonor Rivin

Radiation Oncology, Institut de cancérologie Gustave Roussy

José Samblás

Radiosurgery, Imoncology

Rafael Garcia

Robotic Radiosurgery Unit, Imoncology

Kita Sallabanda

Radiosurgery, Imoncology

Iciar Santa-Olalla

Radiation Physics, Imoncology

Jose Luis Lopez Guerra

Radiation Oncology, Virgen del Rocío University Hospital

For correspondence:
chanodetriana@yahoo.es

Lijia Avilés

Master in Advanced Technological Applications in Radiation Oncology, University of Murcia and Imoncology Foundation

Morena Sallabanda

Radiation Oncology, Hospital Universitario Puerta de Hierro

Eleonor Rivin

Radiation Oncology, Institut de cancérologie Gustave Roussy

José Samblás

Radiosurgery, Imoncology