JRSBRT 9.4, p. 331-334

$40.00

Product Description

After payment has been processed for your order of a digital copy (PDF) of this article, you will see a download link on your completed order page and also receive an email containing a download link. The links, which will enable you to download one copy of the article, will expire after 24 hours.

Implementation of updated single-fraction SBRT spinal cord constraint for epidural spinal cord compression from metastatic sarcoma
Jared Gregston, Santaram Vallurupalli, Kristen Linden, Raghavendiran Boopathy and Shearwood Mcclelland III

Introduction
Spinal metastases with epidural extension are common and morbid. Surgical stabilization followed by radiotherapy remains the cornerstone of management.[1] Conventional postoperative radiotherapy is limited by spinal cord tolerance, restricting epidural dose. Stereotactic body radiation therapy (SBRT) enables ablative, steep-gradient dosing and improved local control.

However, the spinal cord remains the principal dose-limiting structure, especially postoperatively. Traditional single-fraction cord dose-maximum (D_max) constraints of 14 Gy (0.03 cm³) limit epidural coverage and often necessitate separation surgery to create tumor-cord distance for adequate dose coverage.[2-3] A recent prospective phase 1 trial from MD Anderson Cancer Center (MDACC) demonstrated the safety and efficacy of relaxing cord D_max to 16 Gy (0.01 cm³), yielding 2-year local control of 93% with no radiation myelopathy at 22-month median follow-up. [3-4] This finding has significant implications for postoperative SBRT, potentially reducing aggressive surgery while enabling dose escalation. Here we present a case of metastatic sarcoma of the thoracic spine managed with carbon fiber/polyetheretherketone (CF/PEEK) stabilization and postoperative single-fraction SBRT, highlighting the integration of updated cord constraints into clinical decision-making.

Keywords: metastatic epidural spinal cord compression, stereotactic body radiation therapy, carbon fiber instrumentation, spinal cord constraint, minimum dose, radioresistant histology