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Radiation Oncology
Published in: Radiation Oncology 1/2017

Open Access 01-12-2017 | Research

Risk for surgical complications after previous stereotactic body radiotherapy of the spine

Authors: Johannes Roesch, John B.C. Cho, Daniel K. Fahim, Peter C. Gerszten, John C. Flickinger, Inga S. Grills, Maha Jawad, Ronald Kersh, Daniel Letourneau, Frederick Mantel, Arjun Sahgal, John H. Shin, Brian Winey, Matthias Guckenberger

Published in: Radiation Oncology | Issue 1/2017

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Abstract

Object

Stereotactic body radiotherapy (SBRT) for vertebral metastases has emerged as a promising technique, offering high rates of symptom relief and local control combined with low risk of toxicity. Nonetheless, local failure or vertebral instability may occur after spine SBRT, generating the need for subsequent surgery in the irradiated region. This study evaluated whether there is an increased incidence of surgical complications in patients previously treated with SBRT at the index level.

Methods

Based upon a retrospective international database of 704 cases treated with SBRT for vertebral metastases, 30 patients treated at 6 different institutions were identified who underwent surgery in a region previously treated with SBRT.

Results

Thirty patients, median age 59 years (range 27–84 years) underwent SBRT for 32 vertebral metastases followed by surgery at the same vertebra. Median follow-up time from SBRT was 17 months. In 17 cases, conventional radiotherapy had been delivered prior to SBRT at a median dose of 30 Gy in median 10 fractions. SBRT was administered with a median prescription dose of 19.3 Gy (range 15–65 Gy) delivered in median 1 fraction (range 1–17) (median EQD2/10 = 44 Gy). The median time interval between SBRT and surgical salvage therapy was 6 months (range 1–39 months). Reasons for subsequent surgery were pain (n = 28), neurological deterioration (n = 15) or fracture of the vertebral body (n = 13). Open surgical decompression (n = 24) and/or stabilization (n = 18) were most frequently performed; Five patients (6 vertebrae) were treated without complications with vertebroplasty only. Increased fibrosis complicating the surgical procedure was explicitly stated in one surgical report. Two durotomies occurred which were closed during the operation, associated with a neurological deficit in one patient. Median blood loss was 500 ml, but five patients had a blood loss of more than 1 l during the procedure. Delayed wound healing was reported in two cases. One patient died within 30 days of the operation.

Conclusion

In this series of surgical interventions following spine SBRT, the overall complication rate was 19%, which appears comparable to primary surgery without previous SBRT. Prior spine SBRT does not appear to significantly increase the risk of intra- and post-surgical complications.
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Metadata
Title
Risk for surgical complications after previous stereotactic body radiotherapy of the spine
Authors
Johannes Roesch
John B.C. Cho
Daniel K. Fahim
Peter C. Gerszten
John C. Flickinger
Inga S. Grills
Maha Jawad
Ronald Kersh
Daniel Letourneau
Frederick Mantel
Arjun Sahgal
John H. Shin
Brian Winey
Matthias Guckenberger
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2017
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-017-0887-8

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