Peripheral nervous system injury after high-dose single-fraction image-guided stereotactic radiosurgery for spine tumors
Identifieur interne : 000306 ( Main/Exploration ); précédent : 000305; suivant : 000307Peripheral nervous system injury after high-dose single-fraction image-guided stereotactic radiosurgery for spine tumors
Auteurs : Michael D. Stubblefield [États-Unis] ; Katarzyna Ibanez [États-Unis] ; Elyn R. Riedel [États-Unis] ; Ori Barzilai [États-Unis] ; Ilya Laufer [États-Unis] ; Eric Lis [États-Unis] ; Yoshiya Yamada [États-Unis] ; Mark H. Bilsky [États-Unis]Source :
- Neurosurgical focus [ 1092-0684 ] ; 2017.
Abstract
The object of this study was to determine the percentage of high-dose (1800–2600 cGy) single-fraction stereotactic radiosurgery (SF-SRS) treatments to the spine that result in peripheral nervous system (PNS) injury.
All patients treated with SF-SRS for primary or metastatic spine tumors between January 2004 and May 2013 and referred to the Rehabilitation Medicine Service for evaluation and treatment of neuromuscular, musculoskeletal, or functional impairments or pain were retrospectively identified.
Five hundred fifty-seven SF-SRS treatments in 447 patients resulted in 14 PNS injuries in 13 patients. All injures resulted from SF-SRS delivered to the cervical or lumbosacral spine at 2400 cGy. The overall percentage of SF-SRS treatments resulting in PNS injury was 2.5%, increasing to 4.5% when the thoracic spine was excluded from analysis. The median time to symptom onset following SF-SRS was 10 months (range 4–32 months). The plexus (cervical, brachial, and/or lumbosacral) was affected clinically and/or electrophysiologically in 12 (86%) of 14 cases, the nerve root in 2 (14%) of 14, and both in 6 (43%) of 14 cases. All patients experienced pain and most (93%) developed weakness. Peripheral nervous system injuries were CTCAE Grade 1 in 14% of cases, 2 in 64%, and 3 in 21%. No dose relationship between SF-SRS dose and PNS injury was detected.
Single-fraction SRS to the spine can result in PNS injury with major implications for function and quality of life.
Url:
DOI: 10.3171/2016.11.FOCUS16348
PubMed: 28245730
PubMed Central: 5546836
Affiliations:
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Stubblefield</name><affiliation wicri:level="2"><nlm:aff id="A1">Kessler Institute for Rehabilitation Select Medical, West Orange, New Jersey</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">New Jersey</region></placeName><wicri:cityArea>Kessler Institute for Rehabilitation Select Medical, West Orange</wicri:cityArea></affiliation></author><author><name sortKey="Ibanez, Katarzyna" sort="Ibanez, Katarzyna" uniqKey="Ibanez K" first="Katarzyna" last="Ibanez">Katarzyna Ibanez</name><affiliation wicri:level="2"><nlm:aff id="A2">Department of Neurology, Rehabilitation Medicine Service, Memorial Sloan Kettering Cancer Center, New York</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">État de New York</region></placeName><wicri:cityArea>Department of Neurology, Rehabilitation Medicine Service, Memorial Sloan Kettering Cancer Center</wicri:cityArea></affiliation></author><author><name sortKey="Riedel, Elyn R" sort="Riedel, Elyn R" uniqKey="Riedel E" first="Elyn R." last="Riedel">Elyn R. 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Stubblefield</name><affiliation wicri:level="2"><nlm:aff id="A1">Kessler Institute for Rehabilitation Select Medical, West Orange, New Jersey</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">New Jersey</region></placeName><wicri:cityArea>Kessler Institute for Rehabilitation Select Medical, West Orange</wicri:cityArea></affiliation></author><author><name sortKey="Ibanez, Katarzyna" sort="Ibanez, Katarzyna" uniqKey="Ibanez K" first="Katarzyna" last="Ibanez">Katarzyna Ibanez</name><affiliation wicri:level="2"><nlm:aff id="A2">Department of Neurology, Rehabilitation Medicine Service, Memorial Sloan Kettering Cancer Center, New York</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">État de New York</region></placeName><wicri:cityArea>Department of Neurology, Rehabilitation Medicine Service, Memorial Sloan Kettering Cancer Center</wicri:cityArea></affiliation></author><author><name sortKey="Riedel, Elyn R" sort="Riedel, Elyn R" uniqKey="Riedel E" first="Elyn R." last="Riedel">Elyn R. Riedel</name><affiliation wicri:level="2"><nlm:aff id="A3">Departments of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">État de New York</region></placeName><wicri:cityArea>Departments of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center</wicri:cityArea></affiliation></author><author><name sortKey="Barzilai, Ori" sort="Barzilai, Ori" uniqKey="Barzilai O" first="Ori" last="Barzilai">Ori Barzilai</name><affiliation wicri:level="2"><nlm:aff id="A4">Neurosurgery, Memorial Sloan Kettering Cancer Center, New York</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">État de New York</region></placeName><wicri:cityArea>Neurosurgery, Memorial Sloan Kettering Cancer Center</wicri:cityArea></affiliation></author><author><name sortKey="Laufer, Ilya" sort="Laufer, Ilya" uniqKey="Laufer I" first="Ilya" last="Laufer">Ilya Laufer</name><affiliation wicri:level="2"><nlm:aff id="A4">Neurosurgery, Memorial Sloan Kettering Cancer Center, New York</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">État de New York</region></placeName><wicri:cityArea>Neurosurgery, Memorial Sloan Kettering Cancer Center</wicri:cityArea></affiliation><affiliation wicri:level="2"><nlm:aff id="A7">Department of Neurological Surgery, Weill Cornell Medical College, New York, New York</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">État de New York</region></placeName><wicri:cityArea>Department of Neurological Surgery, Weill Cornell Medical College, New York</wicri:cityArea></affiliation></author><author><name sortKey="Lis, Eric" sort="Lis, Eric" uniqKey="Lis E" first="Eric" last="Lis">Eric Lis</name><affiliation wicri:level="2"><nlm:aff id="A5">Radiology, Memorial Sloan Kettering Cancer Center, New York</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">État de New York</region></placeName><wicri:cityArea>Radiology, Memorial Sloan Kettering Cancer Center</wicri:cityArea></affiliation></author><author><name sortKey="Yamada, Yoshiya" sort="Yamada, Yoshiya" uniqKey="Yamada Y" first="Yoshiya" last="Yamada">Yoshiya Yamada</name><affiliation wicri:level="2"><nlm:aff id="A6">Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">État de New York</region></placeName><wicri:cityArea>Radiation Oncology, Memorial Sloan Kettering Cancer Center</wicri:cityArea></affiliation></author><author><name sortKey="Bilsky, Mark H" sort="Bilsky, Mark H" uniqKey="Bilsky M" first="Mark H." last="Bilsky">Mark H. Bilsky</name><affiliation wicri:level="2"><nlm:aff id="A4">Neurosurgery, Memorial Sloan Kettering Cancer Center, New York</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">État de New York</region></placeName><wicri:cityArea>Neurosurgery, Memorial Sloan Kettering Cancer Center</wicri:cityArea></affiliation><affiliation wicri:level="2"><nlm:aff id="A7">Department of Neurological Surgery, Weill Cornell Medical College, New York, New York</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">État de New York</region></placeName><wicri:cityArea>Department of Neurological Surgery, Weill Cornell Medical College, New York</wicri:cityArea></affiliation></author></analytic><series><title level="j">Neurosurgical focus</title><idno type="eISSN">1092-0684</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>OBJECTIVE</title><p id="P1">The object of this study was to determine the percentage of high-dose (1800–2600 cGy) single-fraction stereotactic radiosurgery (SF-SRS) treatments to the spine that result in peripheral nervous system (PNS) injury.</p></sec><sec id="S2"><title>METHODS</title><p id="P2">All patients treated with SF-SRS for primary or metastatic spine tumors between January 2004 and May 2013 and referred to the Rehabilitation Medicine Service for evaluation and treatment of neuromuscular, musculoskeletal, or functional impairments or pain were retrospectively identified.</p></sec><sec id="S3"><title>RESULTS</title><p id="P3">Five hundred fifty-seven SF-SRS treatments in 447 patients resulted in 14 PNS injuries in 13 patients. All injures resulted from SF-SRS delivered to the cervical or lumbosacral spine at 2400 cGy. The overall percentage of SF-SRS treatments resulting in PNS injury was 2.5%, increasing to 4.5% when the thoracic spine was excluded from analysis. The median time to symptom onset following SF-SRS was 10 months (range 4–32 months). The plexus (cervical, brachial, and/or lumbosacral) was affected clinically and/or electrophysiologically in 12 (86%) of 14 cases, the nerve root in 2 (14%) of 14, and both in 6 (43%) of 14 cases. All patients experienced pain and most (93%) developed weakness. Peripheral nervous system injuries were CTCAE Grade 1 in 14% of cases, 2 in 64%, and 3 in 21%. No dose relationship between SF-SRS dose and PNS injury was detected.</p></sec><sec id="S4"><title>CONCLUSIONS</title><p id="P4">Single-fraction SRS to the spine can result in PNS injury with major implications for function and quality of life.</p></sec></div></front></TEI><affiliations><list><country><li>États-Unis</li></country><region><li>New Jersey</li><li>État de New York</li></region></list><tree><country name="États-Unis"><region name="New Jersey"><name sortKey="Stubblefield, Michael D" sort="Stubblefield, Michael D" uniqKey="Stubblefield M" first="Michael D." last="Stubblefield">Michael D. Stubblefield</name></region><name sortKey="Barzilai, Ori" sort="Barzilai, Ori" uniqKey="Barzilai O" first="Ori" last="Barzilai">Ori Barzilai</name><name sortKey="Bilsky, Mark H" sort="Bilsky, Mark H" uniqKey="Bilsky M" first="Mark H." last="Bilsky">Mark H. Bilsky</name><name sortKey="Bilsky, Mark H" sort="Bilsky, Mark H" uniqKey="Bilsky M" first="Mark H." last="Bilsky">Mark H. Bilsky</name><name sortKey="Ibanez, Katarzyna" sort="Ibanez, Katarzyna" uniqKey="Ibanez K" first="Katarzyna" last="Ibanez">Katarzyna Ibanez</name><name sortKey="Laufer, Ilya" sort="Laufer, Ilya" uniqKey="Laufer I" first="Ilya" last="Laufer">Ilya Laufer</name><name sortKey="Laufer, Ilya" sort="Laufer, Ilya" uniqKey="Laufer I" first="Ilya" last="Laufer">Ilya Laufer</name><name sortKey="Lis, Eric" sort="Lis, Eric" uniqKey="Lis E" first="Eric" last="Lis">Eric Lis</name><name sortKey="Riedel, Elyn R" sort="Riedel, Elyn R" uniqKey="Riedel E" first="Elyn R." last="Riedel">Elyn R. Riedel</name><name sortKey="Yamada, Yoshiya" sort="Yamada, Yoshiya" uniqKey="Yamada Y" first="Yoshiya" last="Yamada">Yoshiya Yamada</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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