Separation surgery for metastatic epidural spinal cord compression: A qualitative review
| Autor: | Francesco Zenga, Umberto Ricardi, Fulvio Tartara, Nicola Marengo, Giuseppe Di Perna, Diego Garbossa, Cristina Mantovani, Serena Badellino, Marco Ajello, Fabio Cofano, Giuseppe Palmieri, Ludovico Maria Comite |
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| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
lcsh:Diseases of the musculoskeletal system ESCC Epidural Spinal Cord Compression NSCLC Non-Small Cell Lung Cancer medicine.medical_treatment Review Article PLL Posterior Longitudinal Ligament MAS Minimal Access Spine 0302 clinical medicine Carbon fiber/PEEK cement Epidural spinal cord compression MIS techniques Separation surgery Spinal metastases Stereotactic body radiation therapy KPS Karnofsky Performance Status GTV Gross tumor volume MESCC Metastatic Epidural Spinal Cord Compression ECOG PS Eastern Cooperative Oncology Group Performance Status Scale PEEK Polyetheretherketone Surgical approach PTV Planning target volume lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens medicine.anatomical_structure LITT Laser Interstitial Thermal Therapy Oncology 030220 oncology & carcinogenesis cEBRT conventional External Beam Radiation Therapy Cytoreductive surgery SBRT Stereotactic Body Radiation Therapy medicine.medical_specialty PMMA Poly-Methyl-Methacrylate Less invasive surgery lcsh:RC254-282 CTV Clinical tumor volume PRV Spinal cord planning risk volume 03 medical and health sciences Qualitative analysis Spinal cord compression medicine SINS Spinal Instability Neoplastic Score NSE Neurologic Stability Epidural compression MIS Minimally Invasive Surgical business.industry LC Local Control medicine.disease Spinal cord Surgery Radiation therapy SRS Stereotactic Radiosurgery SS Separation Surgery 030104 developmental biology lcsh:RC925-935 business |
| Zdroj: | Journal of Bone Oncology Journal of Bone Oncology, Vol 25, Iss, Pp 100320-(2020) |
| ISSN: | 2212-1366 |
| Popis: | Highlights • Separation surgery is a new concept for metastatic spinal cord compression treatment. • Stereotactic radiosurgery increased local control, overcoming radio-resistance’s idea. • The surgery goal shifted towards creating targets for radiations avoiding cord damages. • Minimal invasive strategies could allow quick return to systemic therapies. Introduction The new concept of separation surgery has changed the surgical paradigms for the treatment of metastatic epidural spinal cord compression (MESCC), shifting from aggressive cytoreductive surgery towards less invasive surgery with the aim to achieve circumferential separation of the spinal cord and create a safe target for high dose Stereotactic Body Radiation Therapy (SBRT), which turned out to be the real game-changer for disease’s local control. Discussion In this review a qualitative analysis of the English literature has been performed according to the rating of evidence, with the aim to underline the increasingly role of the concept of separation surgery in MESCC treatment. A review of the main steps in the evolution of both radiotherapy and surgery fields have been described, highlighting the important results deriving from their integration. Conclusion Compared with more aggressive surgical approaches, the concept of separation surgery together with the advancements of radiotherapy and the use of SBRT for the treatment of MESCC showed promising results in order to achieve a valuable local control while reducing surgical related morbidities and complications. |
| Databáze: | OpenAIRE |
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