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• W4236029351 abstract "Sterilization of surgical margins for lesions arising from or metastasizing to the spine and involving the dura may be complicated by the tolerance of the spinal cord and/or cauda equina, especially in the setting of prior radiation therapy (RT); outcomes with surgery alone are poor, with local control rates of only 31% at 1 year.1 Use of intraoperative brachytherapy at the time of salvage surgery with a short-range, high-dose-rate source may allow local delivery of therapeutic dose without damaging sensitive structures and provide improved local control outcomes. Patients with malignant lesions arising from or metastasizing to the spine involving the dura were treated with an intraoperative brachytherapy plaque utilizing 32P following maximal surgical resection of tumor, receiving 10 Gy to a prescription depth of 1mm from the treated dural surface; while the corresponding dose at the dural surface is 25 Gy, rapid falloff in dose with depth for the 32P plaque limits the dose delivered at the spinal cord surface to less than 0.5 Gy. Local control (LC) and overall survival (OS) were analyzed using Kaplan-Meier statistics; univariate analysis was performed using Cox regression. Between 9/2009 and 4/2013, 68 patients with 69 lesions in the spine were treated intraoperatively with the 32P plaque, 48 (70%) metastatic lesions and 21 (30%) recurrent primary disease. Median followup was 10 months (range 0.2-44 months). Median age was 61 years (range 6-89 years). The majority of patients (n = 59, 85.5%) had previously been treated with at least one course of prior RT to the treated site; 21 (30%) received 2 courses of prior RT to the treated site and 4 (6%) had received 3 courses of prior RT to the treated site. Thirty-eight (55%) lesions received additional postoperative hypofractionated image-guided radiation therapy with a median dose of 30 Gy (range 18-30 Gy). Overall LC at 12 months was 70% (95% CI 57-83%); OS at 12 months was 60% (95% CI 46-73%). For patients who received postoperative external beam RT in addition to 32P plaque, LC at 12 months was 78% (95% CI 62-94%) compared to 59% (95% CI 49-80%) for those who were treated with the 32P plaque alone (P = .05). (Fig 1, below; local control for patients treated with surgery and intraoperative 32P plaque, patients receiving additional postoperative RT in green and patients treated with 32P plaque alone in blue.) No significant difference was noted on univariate analysis for LC based on recurrent primary vs. metastatic status (P = .16), prior RT (P = .25), or concurrent chemotherapy (P = .09). There were no acute or long-term complications from treatment observed in this cohort. 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. Local control outcomes using the 32P appear to be better than historical results with surgery alone, with or without additional postoperative external beam radiation therapy." @default.
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• W4236029351 date "2014-03-01" @default.
• W4236029351 modified "2023-10-05" @default.
• W4236029351 title "Local Control Outcomes Using the 32P Intraoperative Brachytherapy Plaque in the Management of Malignant Lesions of the Spine Involving the Dura" @default.
• W4236029351 doi "https://doi.org/10.1016/j.brachy.2014.02.225" @default.
• W4236029351 hasPublicationYear "2014" @default.
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