Management of metastatic spine disease.

PURPOSE OF REVIEW: In metastatic spine disease, technologic advancements, neurologic recovery, pain relief, cost-effectiveness, and health-related quality of life have all strengthened surgery's and radiation's role in its management.We evaluated different surgical approaches to the spine and the multimodality treatment in the management of these cases. RECENT FINDINGS: Recently, the survival rate of malignant spinal metastases has rapidly improved because of early detection and multimodality treatment. The goals of surgical intervention are to prolong survival and improve the quality of life of patients.The recent evolution of imaging, radiosurgery, advanced surgical decompressive techniques and instrumentation, as well as percutaneous vertebral body cement augmentation, needs to be considered in the decision-making to optimize patient outcomes. SUMMARY: Management of patients with spine tumors requires a multidisciplinary team that includes a medical and radiation oncologist and a spine surgeon. Newer surgical techniques that address both tumor resection and spinal stabilization offer the best outcome in selected patients. The prognostic parameters suggested for metastatic spine tumors include the general condition of the patient, neurological status number of spinal and extraspinal metastases, primary site of the cancer, visceral metastasis, and severity of spinal cord compression.

Radiotherapy in pediatric medulloblastoma: quality assessment of Pediatric Oncology Group Trial 9031.

PURPOSE: To evaluate the potential influence of radiotherapy quality on survival in high-risk pediatric medulloblastoma patients. METHODS AND MATERIALS: Trial 9031 of the Pediatric Oncology Group (POG) aimed to study the relative benefit of cisplatin and etoposide randomization of high-risk patients with medulloblastoma to preradiotherapy vs. postradiotherapy treatment. Two-hundred and ten patients were treated according to protocol guidelines and were eligible for the present analysis. Treatment volume (whole brain, spine, posterior fossa, and primary tumor bed) and dose prescription deviations were assessed for each patient. An analysis of first site of failure was undertaken. Event-free and overall survival rates were calculated. A log-rank test was used to determine the significance of potential survival differences between patients with and without major deviations in the radiotherapy procedure. RESULTS: Of 160 patients who were fully evaluable for all treatment quality parameters, 91 (57%) had 1 or more major deviations in their treatment schedule. Major deviations by treatment site were brain (26%), spinal (7%), posterior fossa (40%), and primary tumor bed (17%). Major treatment volume or total dose deviations did not significantly influence overall and event-free survival. CONCLUSIONS: Despite major treatment deviations in more than half of fully evaluable patients, underdosage or treatment volume misses were not associated with a worse event-free or overall survival.

[Interventional lumbar spine radiology]. / Radiologie interventionnelle du rachis lombaire.

Three different techniques will be discussed. The first procedure is the biopsy of the lumbar vertebra or lumbar intervertebral disc for patients with tumors or infections of the lumbar spine. The different needles that can be used in function of consistency and location of the lesion will be shown. The transpedicular and posterolateral techniques will be described. Cementoplasty for tumors and selected patients with osteoporotic vertebral collapse generates much interest. The transpedicular and posterolateral techniques will be described. Indications and complications, more frequent in patients with tumors, will be reviewed. Finally, foraminal injections of steroids in patients with radicular symptoms secondary to degenerative change will be discussed. Techniques for needle placement will be reviewed. Results from these injections will also be reviewed.