ESTRO 2024 - Abstract Book

S1935

Clinical - Mixed sites, palliation

ESTRO 2024

References:

1. Guckenberger M, Lievens Y, Bouma AB, Collette L, Dekker A, deSouza NM, et al. Characterisation and classification of oligometastatic disease: a European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer consensus recommendation. Lancet Oncol. 2020 Jan;21(1):e18-e28. doi: 10.1016/S1470-2045(19)30718-1.

1615

Digital Poster

Temporary halo-fixation and radiotherapy as alternative to spondylodesis for cervical metastases

Eline H. Huele 1 , Joanne M. van der Velden 2 , Nicolien Kasperts 2 , Helena M. Verkooijen 1 , Jorrit-Jan Verlaan 3

1 University Medical Center Utrecht, Division of Imaging and Oncology, Utrecht, Netherlands. 2 University Medical Center Utrecht, Department of Radiotherapy, Utrecht, Netherlands. 3 University Medical Center Utrecht, Department of Orthopedic Surgery, Utrecht, Netherlands

Purpose/Objective:

Quality of life (QoL) of patients with symptomatic spinal metastases can be severely affected due to local tumor pain and mechanical pain, pathological fractures and the occurrence of neurological deficits. The cervical spine is an anatomically challenging location and optimal treatment for patients with unstable metastases is unknown, many factors such as resulting range of motion, stability and alignment, local tumor control and risk of complications need to be taken into account. Radiotherapy has demonstrated to be effective for palliation and local tumor control, but cannot provide immediate mechanical stability. The surgical approach, consisting of long bridging constructs with screws and rods, provides stability but severely impairs range of motion of the neck and bears a high complication rate. In addition, in the palliative phase the possible gain in QoL needs to balanced carefully against the possible morbidity due to treatment. Previous studies have reported on reossification and increased bone density after radiation therapy for bone metastases. The aim of this study was to report the results of our treatment consisting of temporary halo-fixation and radiotherapy aiming for temporary immediate cervical stabilization, local tumor control, and reossification of the metastases, to provide durable long-term preservation of mobility.

Material/Methods:

For this retrospective study, twenty patients with painful, unstable cervical metastases from a variety of histological origins treated between September 2013 – July 2023 at a single tertiary referral hospital were included. All patients underwent halo-fixation for an intended duration of approximately three months to allow for reossification of the lesions as a result of the radiotherapy. External beam radiotherapy was administered with a fractionation scheme best suited to the histological origin of the tumor and the highest chance of reossification. After three months the halo frame was removed after a CT-scan or radiograph of the cervical spine confirmed acceptable alignment and ongoing reossification. Study endpoints, assessed at baseline, time of halo removal and last follow-up, included neck pain (assessed with the numeric rating score, NRS), neurological status as indicated by American Spinal Injury