Local recurrence outcomes using the 32P intraoperative brachytherapy plaque in the management of malignant lesions of the spine involving the dura Journal Article

Authors: Folkert, M. R.; Bilsky, M. H.; Cohen, G. N.; Voros, L.; Oh, J. H.; Zaider, M.; Laufer, I.; Yamada, Y.
Article Title: Local recurrence outcomes using the 32P intraoperative brachytherapy plaque in the management of malignant lesions of the spine involving the dura
Abstract: Purpose: Sterilization of surgical margins for lesions involving the dura is complicated by the tolerance of the spinal cord and/or cauda equina, especially in the setting of prior radiation therapy (RT); use of intraoperative brachytherapy may allow local delivery of therapeutic dose without damaging sensitive structures. Methods and Materials: Patients with malignant lesions involving the dura received intraoperative brachytherapy with a 32P plaque after maximal resection of the tumor. Local recurrence (LR) was analyzed using competing risks analysis; overall survival was analyzed using Kaplan-Meier statistics. Results: Between September 2009 and April 2013, 68 patients with 69 lesions in the spine were treated with the 32P plaque. Median followup was 10 months. Most patients (n=59, 85.5%) had previously been treated with at least one course of prior RT to the treated site. About 38 (55%) lesions received postoperative RT (median dose, 30Gy; range, 18-30Gy). The LR and overall survival at 12 months were 25.5% (95% confidence interval [CI]=15.5-37%) and 59.5% (95% CI=46-73%), respectively. For patients who received postoperative RT, LR at 12 months was 18.5% (95% CI=7.5-33%) compared with 34% (95% CI=18-51%) for those who were treated with the plaque alone (p=0.08 and 0.04 on univariate and multivariable analysis, respectively). There were no acute or long-term complications from treatment observed in this cohort. Conclusions: The 32P intraoperative brachytherapy plaque is a useful adjunct to surgical intervention for primary recurrent and metastatic lesions of the spine involving the dura, and is not associated with additional toxicity. © 2015 American Brachytherapy Society.
Keywords: adolescent; adult; child; controlled study; treatment outcome; aged; major clinical study; overall survival; cancer recurrence; treatment planning; radiation dose; nuclear magnetic resonance imaging; follow up; retrospective study; prescription; decompression surgery; spinal cord tumor; spine; brachytherapy; external beam radiotherapy; radiation safety; salvage; metastatic; intraoperative radiotherapy; recurrent; peroperative complication; multimodal imaging; dura; phosphorus 32; intraoperative radiation therapy; human; male; female; priority journal; article
Journal Title: Brachytherapy
Volume: 14
Issue: 2
ISSN: 1538-4721
Publisher: Elsevier Science, Inc.  
Date Published: 2015-03-01
Start Page: 202
End Page: 208
Language: English
DOI: 10.1016/j.brachy.2014.10.007
PROVIDER: scopus
PUBMED: 25483021
Notes: Export Date: 2 April 2015 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Yoshiya Yamada
    359 Yamada
  2. Mark H Bilsky
    223 Bilsky
  3. Michael Ryan Folkert
    36 Folkert
  4. Laszlo Voros
    13 Voros
  5. Gilad N Cohen
    132 Cohen
  6. Marco Zaider
    169 Zaider
  7. Jung Hun Oh
    114 Oh
  8. Ilya Laufer
    99 Laufer