Neoadjuvant Stereotactic Body Radiation Therapy for Spine Metastases

Study Design: Retrospective study Purpose: The aim of this study was to assess the feasibility and safety of stereotactic body radiation therapy (SBRT) followed by surgery for spine metastases. Overview of Literature: SBRT has emerged as an exciting field in the management of patients with spine metastases, including those who first undergo surgery. Similarly, neoadjuvant SBRT, which means planned preoperative SBRT, should also be promising. However, there was no literature supporting this approach. Methods: Ten consecutive patients who received surgical management for spine metastases within 30 days after SBRT were reviewed. For patients with limited spine metastases, SBRT was performed first if there is no severe myelopathy. Surgery for decompression and fixation was then performed. Perioperative events were recorded and analyzed. If available, they were followed up for at least 12 months. Results: The SBRT was delivered in single fraction of 14 to 18 Gy (median: 16 Gy). Surgical decompression with fixation was performed 0 to 24 days (median: 5.5 days) after SBRT. The blood loss ranged from 100 to 1500 mL (median: 775 mL). The patients were discharged or transferred 6 to 36 days (median: 7 days) after surgery. One patient developed transient Brown-Sequard syndrome postoperatively. There was no wound complication. Five patients passed away due to progressive disease 2.3 to 13 months after surgery. There was no local recurrence and no instrument failure. Conclusions: Our experience showed that neoadjuvant SBRT followed by surgery is safe and promising for spinal metastases. The long term benefit over postoperative radiotherapy should be determined by further investigation.