Stereotactic Radiosurgery in Treating Patients With Spinal Metastases

OBJECTIVES:

• To implement CyberKnife® technology for improving palliation in patients with spinal metastases.
• To determine the maximum tolerated dose of CyberKnife® hypofractionated stereotactic radiosurgery in these patients.
• To evaluate functional and diffusion MRI parameters in the spinal cord and tumor after treatment with Cyberknife® radiosurgery.

OUTLINE: Patients undergo placement of gold fiducial markers at the time of open surgical resection or percutaneous needle biopsy. Patients then undergo CyberKnife® hypofractionated stereotactic radiosurgery over 30-90 minutes daily for 2-3 days.

Patients undergo functional MRI and diffusion tensor imaging at baseline and then at 6 weeks and 6 months after completion of treatment. Patients also complete a pain questionnaire at baseline and then at 3, 6, 9, 12, 18, and 24 months after completion of treatment.

After completion of study treatment, patients are followed periodically for up to 2 years.

Inclusion criteria

DISEASE CHARACTERISTICS:

• Histologically confirmed metastatic spinal tumor

• Localized spinal metastasis, defined as one of the following:

• Solitary spinal metastasis
• Two contiguous spinal levels

• No more than 2 adjacent spinal levels involved by a single tumor
• Involvement of ≤ 3 separate sites (e.g., C5, T5, and T12)
• Tumor size ≤ 5 cm

PATIENT CHARACTERISTICS:

• Karnofsky performance status 60-100%
• Life expectancy ≥ 6 months
• Negative pregnancy test
• Fertile patients must use effective contraception
• Must be ambulatory

Exclusion criteria

• Not pregnant or nursing
• No spinal instability
• No rapid neurological decline
• No bony retropulsions causing neurological abnormalities
• No total paraplegia for > 48 hours
• No psychological issues that would preclude completion of study treatment

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics
• No prior treatment for spinal tumor that would result in potential overlap of radiotherapy fields
• No treatment that is expected to exceed spinal cord tolerance or other regional normal tissue tolerance
• No tumors that are exquisitely radiosensitive and controlled with conventional radiotherapy (e.g., lymphoma, leukemia, multiple myeloma, or germ cell tumors)