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Peripheral nervous system injury after high-dose single-fraction image-guided stereotactic radiosurgery for spine tumors.

Abstract OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSIONS Single-fraction SRS to the spine can result in PNS injury with major implications for function and quality of life.
PMID
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Authors

Mayor MeshTerms
Keywords

CTCAE = Common Terminology Criteria for Adverse Events

DRG = dorsal root ganglion

EGFR = epidermal growth factor

EMG = electromyography

GTV = gross tumor volume

PNS = peripheral nervous system

PTV = planning treatment volume

SF-SRS = single-fraction stereotactic radiosurgery

VEGF = vascular endothelial growth factor

complications

peripheral nerve

radiosurgery

spine

Journal Title neurosurgical focus
Publication Year Start




PMID- 28245730
OWN - NLM
STAT- MEDLINE
DA  - 20170301
DCOM- 20170308
LR  - 20170308
IS  - 1092-0684 (Electronic)
IS  - 1092-0684 (Linking)
VI  - 42
IP  - 3
DP  - 2017 Mar
TI  - Peripheral nervous system injury after high-dose single-fraction image-guided
      stereotactic radiosurgery for spine tumors.
PG  - E12
LID - 10.3171/2016.11.FOCUS16348 [doi]
AB  - OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSIONS
      Single-fraction SRS to the spine can result in PNS injury with major implications
      for function and quality of life.
FAU - Stubblefield, Michael D
AU  - Stubblefield MD
AD  - Kessler Institute for Rehabilitation Select Medical, West Orange, New Jersey.
FAU - Ibanez, Katarzyna
AU  - Ibanez K
AD  - Department of Neurology, Rehabilitation Medicine Service.
FAU - Riedel, Elyn R
AU  - Riedel ER
AD  - Departments of 3 Epidemiology and Biostatistics.
FAU - Barzilai, Ori
AU  - Barzilai O
AD  - Neurosurgery.
FAU - Laufer, Ilya
AU  - Laufer I
AD  - Neurosurgery.
AD  - Department of Neurological Surgery, Weill Cornell Medical College, New York, New 
      York.
FAU - Lis, Eric
AU  - Lis E
AD  - Radiology, and.
FAU - Yamada, Yoshiya
AU  - Yamada Y
AD  - Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York; and.
FAU - Bilsky, Mark H
AU  - Bilsky MH
AD  - Neurosurgery.
AD  - Department of Neurological Surgery, Weill Cornell Medical College, New York, New 
      York.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Neurosurg Focus
JT  - Neurosurgical focus
JID - 100896471
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Neuralgia/*diagnostic imaging/etiology
MH  - Peripheral Nervous System/*injuries
MH  - Postoperative Complications/*diagnostic imaging/etiology
MH  - Radiosurgery/*adverse effects
MH  - Retrospective Studies
MH  - Spinal Neoplasms/*diagnostic imaging/*surgery
MH  - Young Adult
OTO - NOTNLM
OT  - CTCAE = Common Terminology Criteria for Adverse Events
OT  - DRG = dorsal root ganglion
OT  - EGFR = epidermal growth factor
OT  - EMG = electromyography
OT  - GTV = gross tumor volume
OT  - PNS = peripheral nervous system
OT  - PTV = planning treatment volume
OT  - SF-SRS = single-fraction stereotactic radiosurgery
OT  - VEGF = vascular endothelial growth factor
OT  - complications
OT  - peripheral nerve
OT  - radiosurgery
OT  - spine
EDAT- 2017/03/02 06:00
MHDA- 2017/03/09 06:00
CRDT- 2017/03/02 06:00
AID - 10.3171/2016.11.FOCUS16348 [doi]
PST - ppublish
SO  - Neurosurg Focus. 2017 Mar;42(3):E12. doi: 10.3171/2016.11.FOCUS16348.

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