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Treatment of Spinal Metastases using CT Myelography based Stereotactic Radiosurgery: An Imaging Primer 2014

Category Interventional Vahe M. Zohrabian Zain A. Husain Maxwell Laurans Veronica L. Chiang Amit Mahajan Michele H. Johnson Purpose The majority of spinal tumors are metastatic in nature, with approximately 18,000 new cases diagnosed yearly. In addition to surgical decompression, radiation plays an important role in local control, although the main challenge lies in balancing maximal tumoricidal dose and minimizing radiation injury. New techniques such as intensity-modulated radiation therapy (IMRT), in combination with imaging guidance, allow for increased radiation dose in a safe manner, although no consensus exists regarding planning or treatment. CT myelography has been used to distinctly delineate neural structures, allowing for precise treatment of tumor with high-dose irradiation. Materials & Methods Utilizing a case-based approach from a retrospective review of our interventional spine database, we will achieve the following learning objectives: Results 1. To present imaging manifestations of metastatic spinal tumor on CT and MRI 2. To discuss treatment approaches in spine tumor control, including nonsurgical, surgical, and palliative techniques 3. To briefly detail the CT pretreatment spinal radiotherapy algorithm 4. To present cases highlighting stereotactic radiosurgery treatment performed by Radiation Oncology and Neurosurgery 5. To discuss complications arising as a result of suboptimal image-guided stereotaxis, as well as complications unique to CT myelography in stereotactic radiosurgery, and general complications as a result of spine radiotherapy Conclusion CT myelography is one of several many methods of achieving stereotaxis in the setting of spinal radiosurgery that has its own advantages and disadvantages. st6 References Shiu AS, Chang EL, Ye JS, et al. Near simultaneous computed tomography image-guided stereotactic spinal radiotherapy: an emerging paradigm for achieving true stereotaxy. Int J Radiat Oncol Biol Phys. 2003 Nov 1;57(3):605-13. Thariat J, Castelli J, Chanalet S, et al. CyberKnife stereotactic radiotherapy for spinal tumors: value of computed tomographic myelography in spinal cord delineation. Neurosurgery. 2009 Feb;64(2 Suppl):A60-6. Uhl M, Sterzing F, Habl G, et al. CT-myelography for high-dose irradiation of spinal and paraspinal tumors with helical tomotherapy: revival of an old tool. Strahlenther Onkol. 2011 Jul;187(7):416-20.