Introduction: High-grade spinal cord compression from metastatic tumor may be managed with a combination of surgery followed by stereotactic spinal radiosurgery (SSRS) with a goal of local tumor control. Here,we introduce the use of laser interstitial thermotherapy (LITT) as an alternative to surgery prior to SSRS. The delivery of heat is monitored in real time by thermal MR imaging. We have developed a minimally invasive procedure with lower morbidity and faster recovery than conventional surgery, that may be used in conjunction with SSRS to improve local control of epidural metastasis from radio-resistant tumors.
Methods: Eight consecutive patients with high degree of epidural malignant compression (L3,T2,T8,L1,T12,C2,T4,L4) from radio-resistant tumors were treated. Visual analog pain score (VAS) and quality of life score (QoL) were obtained before, 1 week, and 2 month after the procedure. We performed LITT in the epidural space a distance of 6mm from the dura mater. Real time fast spin echo MR sequences co-planar with anatomical T2 images were overlaid to monitor the tissue temperature and damage in the region of interest. All patients received post-op SSRS. Epidural spinal cord compression was graded according to the ESCC classification in pre- and post-procedure MRI.
Results: Average VAS was 6; 4; 1.2 and average QoL scores were 46.8%; 57.5%; 63.7% respectively at pre-op, 1- week and 2-month after treatment. 100% of patients demonstrated a decrease in spinal cord compression on imaging at least 3 weeks after the procedure.
Conclusions: This is the first report of an innovative minimally invasive alternative to the management of spinal metastasis; in this preliminary study, we demonstrate excellent local control with low morbidity and immediate improvement in pain and quality of life.
Patient Care: This is a minimally invasive treatment which provides faster recovery, lower procedure related morbidity, avoids interruption in systemic treatment and improves quality of life in patients with high degree of spinal cord compression from metastatic cancer.
Learning Objectives: By the conclusion of this section participants should be able to: 1)understand the rationale of the use of MR guider interstitial laser thermal therapy in conjunction with spinal stereotatic radiosurgery in the management of high grade malignant spinal cord compression; 2) identify the effects and benefits of the combined therapy in our cohort