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2012 ; 11
(1
): 27-34
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Radiosurgery of spinal meningiomas and schwannomas
#MMPMID22181328
Kufeld M
; Wowra B
; Muacevic A
; Zausinger S
; Tonn JC
Technol Cancer Res Treat
2012[Feb]; 11
(1
): 27-34
PMID22181328
show ga
Purpose of this study is to analyze local control, clinical symptoms and toxicity
after image-guided radiosurgery of spinal meningiomas and schwannomas. Standard
treatment of benign spinal lesions is microsurgical resection. While a few
publications have reported about radiosurgery for benign spinal lesions, this is
the first study analyzing the outcome of robotic radiosurgery for benign spinal
tumors, treated exclusively with a non-invasive, fiducial free, single-fraction
setup. Thirty-six patients with spinal meningiomas or schwannomas were treated,
utilizing a robotic radiosurgery system (CyberKnife®, Accuray Inc. Sunnyvale CA),
and were followed prospectively. Medical history, histology, clinical symptoms
and radiographic outcome were recorded. Thirty-nine spinal lesions were treated
because of tumor recurrence, remnants after microsurgery, multiple lesions, or
rejection of open surgery. Median age was 45 years (range 18-80 years). Median
target volume was 3.4 cm(3) (range 0.2-43.4 cm(3)). Histology revealed 28
schwannomas and 11 meningiomas (WHO grade I). All spinal levels were affected.
Median prescription dose was 14 Gray (95% C.I. 13.4-14 Gy) to the 70% isodose.
After a median follow-up of 18 months (range 6-50 months) no local tumor
progression was detected. 20 lesions (51%) remained stable, 19 tumors (49%)
decreased in size. One patient with schwannomatosis was treated repeatedly for
three new tumor locations. Pain was the initial symptom in 16 of 25 schwannoma
patients, and in 3 of 11 patients with meningiomas. Pain levels decreased in 8/19
patients. All but one patient with motor deficits remained clinically stable. No
myelopathic signs where found. Single-session radiosurgery for benign spinal
tumors in selected patients has proven to inhibit tumor progression within the
observed period without signs of early toxicity. Radiosurgery offers an
additional treatment option, if microsurgery is not feasible in cases of tumor
recurrence, post-resection remnants, multiple lesions, or medical comorbidity.
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