Combining spinal LITT and SSRS for treatment of thoracic spinal metastases with epidural compression
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Abstract
Combining spinal LITT and SSRS for treatment of thoracic spinal metastases with epidural compression
Authors: Jing Li1, Thomas Beckham1, Amol Ghia1, Mary Fran McAleer1, Todd Swanson1, Chenyang Wang1, Debra Yeboa1, Martin Tom1, Subha Perni1, Tina Briere2, Yumeng Yang1, Ethan B. Ludmir3, Shizheng Zhang1, Robert North4, Christopher Alvarez-Breckenridge5, Laurence Rhines4, Behrang Amini6, Claudio Tatsui4
1University of Texas - MD Anderson Cancer Center, Radiation Oncology, HOUSTON, USA; 2University of Texas - MD Anderson Cancer Center, Radiation Physics, HOUSTON, USA; 3University of Texas - MD Anderson Cancer Center, Radiation Oncology, Houston, USA; 4University of Texas - MD Anderson Cancer Center, Neurosurgery, HOUSTON, USA; 5Alvarez-Breckenridge, Neurosurgery, HOUSTON, USA; 6University of Texas - MD Anderson Cancer Center, Diagnostic Radiology, HOUSTON, USA
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Purpose or Objective
SSRS (spinal stereotactic radiosurgery) is highly effective in providing local control (LC) for spinal metastases; however, higher local failure has been reported in patients with epidural compression. In this study we present the results of a consecutive series of patients treated with percutaneous spinal laser interstitial thermal therapy (sLITT) to manage thoracic epidural spinal cord compression (ESCC) in combination with or as salvage to SSRS.
Material and Methods
A retrospective review from 2013 to 2022 was performed. Data collected included demographic, pathology, clinical, complications, pre and post-ESCC score (0,1a,1b,1c,2,3), location (vertebral body/paraspinal), length of hospital stay, interval to start adjuvant SSRS and systemic treatments. Independent-sample t-tests were used to compare means between pre- and post-sLITT treatments. Survival was estimated by the Kaplan-Meier method. Multivariate logistic regression was used to analyze predictive factors for local recurrence.
Results
148 patients were treated with sLITT, where 106 combined with SSRS and 31 alone as salvage. Median follow-up time was 11.5 months (95%CI 9.7-13.3). Primary tumor histology included RCC (37%), sarcoma (15.2%), NSCLC (10.9%), thyroid (7.2%) and others (29.7%). Pre-sLITT ESCC grade was 1c or higher in 95% of patients. Pre-sLITT Frankel scores were E(89.4%), D(9.4%), and C(1.2%). Median overall survival time was 15.2 months (95%CI 11.5-9). One and 2-year LC rates were 81.3% and 75.1%, respectively. Treatment was associated with a median decrease of 2 ESCC grades, and there was a significant difference between pre- and post-sLITT ESCC grades. Univariate analysis demonstrated that achievement of a low post-sLITT ESCC (0-1b) was associated with 90% LC rate, significantly higher than 54.3% observed in cases with high post-sLITT ESCC (1c-3) (p<0.001). Additionally, paraspinal location of disease(p=0.02) and complications (p=0.047) were associated with poorer LC. There was no relationship between LC and sex (p=0.60), primary tumor histology(p=0.95), Frankel score(p=0.86), and pre-sLITT ESCC score (p=0.38). In multivariate analyses lower post-sLITT ESCC continued to independently predict better LC (p<0.001), and a trend toward paraspinal disease lowering LC (p=0.06). Mean hospital stay for sLITT was 1 day.
Conclusion
sLITT, in combination with or as salvage to SSRS, is highly effective in providing local control in patients with ESCC. Low post-sLITT ESCC score is a strong predictor of improved local control. Treatment with sLITT in combination to SSRS should be considered as an alternative to open surgery for selected patients with spinal metastasis.