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| Spinal metastases are a common
source of pain as well as neurologic deficit in patients with lung
cancer. Metastases from lung cancer traditionally have been believed
to be relatively responsive to radiation therapy. However,
conventional external beam radiotherapy lacks the precision to allow
delivery of large single-fraction doses of radiation and
simultaneously limit the dose to radiosensitive structures such as
the spinal cord. The current study evaluated the efficacy of
single-fraction radiosurgery for the treatment of spinal lung cancer
metastases. METHODS. In the current prospective cohort evaluation, 87 lung cancer metastases to the spine in 77 patients were treated with a single-fraction radiosurgery technique with a follow-up period of 6 to 40 months (median, 12 months). The indication for radiosurgery treatment was pain in 73 cases, as a primary treatment modality in 7 cases, for radiographic tumor progression in 4 cases, and for progressive neurologic deficit in 3 cases. RESULTS. Tumor volume ranged from 0.2 to 264 cm3 (mean, 25.7 cm3). The maximum tumor dose was maintained at 15 to 25 grays (Gy) (mean, 20 Gy; median, 20 Gy). No radiation-induced toxicity occurred during the follow-up period. Long-term axial and radicular pain improvement occurred in 65 of 73 patients (89%) who were treated primarily for pain. Long-term radiographic tumor control was observed in all patients who underwent radiosurgery as their primary treatment modality or for radiographic tumor progression.
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