Mets to spinal chord? any info
 

Hi, I had MRI today, head and all spine, I am shuffling around like an old man and don't have much strength, looks like wheel chair may be next, and I hate not being independent, I have been shedding many tears, both inwards and outwards, so would appreciate some encouraging treatment. Steroids have altered my face so I look like I have had a stroke with a head like a pumpkin, not a good look, quite depressing.

Love & Hugs Lyn

You ask for any info--this is technical and cold--I will send more as I find it
 

I salute your indomitable spirit. These are dispassionate facts and figures and not based on treatment with herceptin. It seems weakness in the legs due to mets is usually due to encroachment on the space for the spinal cord due to mets in the nearby bones (vertebrae) rather than mets to the cord itself or meninges, but ask your doctors if there is evidence of involvement of the cord/meninges in light of my previous post on a SINGLE trial of herceptin in the cerebral spinal fluid of a patient with meningeal mets around the brain.

The relatively good news--39% of patients in this series got out of the wheelchair and walked again.

Here is the abstract and a selection of the original data:

1: Int J Radiat Oncol Biol Phys. 2006 Jan 1;64(1):182-8. Epub 2005 Sep 28.
Related Articles, Links



Prognostic factors predicting functional outcomes, recurrence-free survival, and overall survival after radiotherapy for metastatic spinal cord compression in breast cancer patients.

Rades D, Veninga T, Stalpers LJ, Schulte R, Hoskin PJ, Poortmans P, Schild SE, Rudat V.

Department of Radiation Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. Rades.Dirk@gmx.net

PURPOSE: To identify significant prognostic factors after irradiation of metastatic spinal cord compression (MSCC) in 335 breast cancer patients. METHODS AND MATERIALS: The potential prognostic factors investigated included involved vertebra, other bone metastases, visceral metastases, performance status, pretreatment ambulatory status, time until motor deficits developed before RT, radiation schedule (shorter-course RT [one fraction of 8 Gy/five fractions of 4 Gy] vs. longer-course RT [10 fractions of 3 Gy/15 fractions of 2.5 Gy/20 fractions of 2 Gy), and the response to RT. RESULTS: On multivariate analysis, better functional outcome was associated with slower development of motor deficits (p <0.001) and being ambulatory before RT (p <0.001). The overall recurrence rate of MSCC was greater if other bone metastases were present (p <0.001) and if shorter-course RT was used (p <0.001). In-field recurrences alone were more frequent after shorter-course RT (p = 0.008). Survival was negatively affected by the presence of visceral metastases (p <0.001), deterioration of motor function after RT (p <0.001), reduced performance status (p <0.001), and the rapid development of motor deficits (p = 0.044). CONCLUSION: Outcomes and survival after RT for MSCC in breast cancer patients are associated with several prognostic factors. Patients with poor expected survival may be treated with shorter-course RT to keep the overall treatment time short. If survival is expected to be relatively favorable, longer-course RT appears preferable, because it is associated with fewer MSCC recurrences.

Publication Types:
Multicenter Study

PMID: 16198069 [PubMed - indexed for MEDLINE]

Here is a selection from the data:



Of the 335 patients, 105 (31%) had improvement in motor function, 192 (57%) had no change, and 38 (11%) had deterioration. Of the 77 patients who were nonambulatory before RT, 30 (39%) regained the ability to walk. The impact of the potential prognostic factors on functional outcomes is shown in Table 2 and Table 3. Functional outcomes were significantly associated with the time until motor deficits developed before RT and pre-RT ambulatory status. The results at 1 month after RT were similar to those at 3 and 6 months after RT.



Table 2.

Potential prognostic factors in relation to functional outcomes

Factor
Motor function

Improvement
No change
Deterioration
Age (y)



?60
57 (33)
95 (56)
19 (11)
>60
48 (29)
97 (59)
19 (12)
ECOG performance status



1–2
77 (32)
137 (58)
23 (10)
3–4
28 (29)
55 (56)
15 (15)
Involved vertebra (n)



1–3
67 (32)
126 (59)
19 (9)
?4
38 (31)
66 (54)
19 (15)
Ambulatory before RT



Yes
84 (33)
150 (58)
24 (9)
No
21 (27)
42 (55)
14 (18)
Time until motor deficits developed before RT (d)



1–7
5 (9)
31 (54)
21 (37)
8–14
20 (22)
54 (60)
16 (18)
>14
80 (43)
107 (56)
1 (1)
Radiation schedule



Shorter-course RT (1 × 8 Gy/5 × 4 Gy)
44 (34)
74 (57)
12 (9)
Longer-course RT (10 × 3 Gy/15 × 2.5 Gy/20 × 2 Gy)
61 (30)
118 (58)
26 (12)
Abbreviations as in Table 1.

Data presented as number of patients, with percentages in parentheses.





Table 3.
Multivariate analysis with respect to functional outcomes (ordered logit model)
Potential prognostic factor
p
Age (y)

?60

>60
0.33
ECOG performance status

1–2

3–4
0.55
Involved vertebra (n)

1–3

?4
0.58
Ambulatory before RT

Yes

No
<0.001
Time until motor deficits developed before RT (d)

1–7

8–14
<0.001
>14

Radiation schedule

Shorter-course RT (1 × 8 Gy/5 × 4 Gy)

Longer-course RT (10 × 3 Gy/15 × 2.5 Gy/20 × 2 Gy)
0.31
Abbreviations as in Table 1.





Metastatic spinal cord compression recurrence was observed in 69 patients (21%) after a median interval of 11 months (range, 3–58 months). In-field MSCC recurrences developed in 30 patients (9%) and out-field recurrences in 49 patients (15%). The potential prognostic factors in relation to freedom from overall recurrence and freedom from in-field recurrence are summarized in Table 4 and Table 5. The overall MSCC recurrence rate was significantly influenced by the presence of other bone metastases at RT and the radiation schedule. The rate of in-field recurrences was significantly affected by the radiation schedule. More MSCC recurrences were observed after shorter-course RT (one fraction of 8 Gy or five fractions of 4 Gy) than after longer-course RT (10 fractions of 3 Gy, 15 fractions of 2.5 Gy, or 20 fractions of 2 Gy).

Because of this 21% rate of recurrence, perhaps your doctors could think of adding a radiosensitizing drug. This is because I believe that they usually give so much radiation that repeat radiation therapy is not possible in the same area.(Maybe I am wrong and they put that in their initial calculation of how much to give you at one time--ie, leave the potential to give some later) If it comes back in a different area it is, of course possible.In order to increase the chance that it gives its maximum effect see if, even theoretically, there is something they can give simultaneously to maximize the effect. With head and neck tumors, even somethiing as simple as Celebrex has been found to greatly increase the effectiveness of a fixed amount of radiation therapy.

Will review a bit more of the literature and get back to you.

Please post "stop" if you REALLY do NOT want this much info.

Hoping this helps!

Lani

more info--vertebral metastases in breast cancer far more common than thought!!!!!!
 

1: Clin Orthop Relat Res. 2006 Feb;443:233-47. Related Articles, Links

Vertebral tumors: surgical versus nonsurgical treatment.

Simmons ED, Zheng Y.

Department of Orthopaedic Surgery, State University of New York at Buffalo Buffalo, NY 14201, USA. Simmonsortho@att.net

The treatment of spinal tumors represents a challenge to spine care professionals. Fortunately, the incidence of new cases of primary malignant bone tumors is lower compared with that of other tumors. In the United States approximately 2000 malignant bone tumors of 7000 new sarcomas are diagnosed each year. Of these, 4% to 20% (80-400 tumors) of bone tumors are spinal tumors. Metastatic tumors are the most frequent tumor of bone and the most frequent tumor of the spinal column regardless of the origin of the primary tumor. More than 90% of spinal tumors are metastatic. Thirty to seventy percent of patients who die from cancer have evidence of vertebral metastases visible on careful postmortem examination, with the potential that this number could reach 85% in patients with breast cancer. Less than 10% of patients with spinal tumors present with spinal instability requiring surgical treatment; this accounts for approximately 18,000 new cases yearly. We will focus on the most recent advances in nonsurgical and surgical treatment of vertebral tumors. In surgical treatment, the evaluation and selection of patients, indications and surgical strategies, open and minimally invasive techniques, outcomes and complications will be discussed. LEVEL OF EVIDENCE: Level V (expert opinion). See the Guidelines for Authors for a complete description of the levels of evidence.

Publication Types:
Review

PMID: 16462447 [PubMed - indexed for MEDLINE]

Depending what level the vertebral problem is located at, sometimes they just make an opening in the outside of the vertebra (which in the front has the shape of a marshmellow) and get rid of the metastasis inside and fill the gap with the same kind of plastic bone cement they use to attach hip or knee replacements.)

I assume you are already on Zometa or other nonsurgical treatment of bone mets...

THEY are now starting to use Cyberknife for spinal mets
 

Is there a Cyberknife anywhere near you in Australia? It is much more specific in what areas receive radiation ie, only those that need it and therefore potentially more effective with less side effects
1: Cancer. 2005 Nov 15;104(10):2244-54. Related Articles, Links

Single-fraction radiosurgery for the treatment of spinal breast metastases.

Gerszten PC, Burton SA, Welch WC, Brufsky AM, Lembersky BC, Ozhasoglu C, Vogel WJ.

Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA. gersztenpc@upmc.edu

BACKGROUND: The spine is the most common site of bony metastases in patients with osseous breast carcinoma metastases. Spine metastases are the source of significant pain and occasionally neurologic deficit in this patient population. 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. This study evaluated the clinical efficacy of the treatment of spinal breast carcinoma metastases with a single-fraction radiosurgical technique. METHODS: In this prospective cohort evaluation, 68 breast carcinoma metastases to the spine in 50 patients were treated with a single-fraction radiosurgery technique with a follow-up period of 6-48 months, median 16 months. The most common indication for radiosurgery treatment was pain in 57 lesions, as a primary treatment modality in 8 patients, and for radiographic tumor progression, as a postsurgical boost, and for a progressive neurologic deficit in 1 patient each. RESULTS: Tumor volume ranged from 0.8-197 cm3 (mean, 27.7 cm3). Maximum tumor dose was maintained at 15-22.5 Gy (mean, 19 Gy). No radiation-induced toxicity occurred during the follow-up period (6-48 mo). Long-term axial and radicular pain improvement occurred in 55 of 57 (96%) patients who were treated primarily for pain. Long-term radiographic tumor control was seen in all patients who underwent radiosurgery as their primary treatment modality, for radiographic tumor progression, or as a postsurgical treatment. CONCLUSIONS: Spinal radiosurgery was found to be feasible, safe, and clinically effective for the treatment of spinal metastases from breast carcinoma. The results indicate the potential of radiosurgery in the treatment of patients with spinal breast metastases, especially those with solitary sites of spine involvement, to improve long-term palliation. Copyright 2005 American Cancer Society

PMID: 16216003 [PubMed - indexed for MEDLINE]

good results with surgical option --97% walking
 

1: J Neurosurg Spine. 2005 May;2(5):564-73. Related Articles, Links

Surgical management of spinal metastases: analysis of prognostic factors during a 10-year experience.

North RB, LaRocca VR, Schwartz J, North CA, Zahurak M, Davis RF, McAfee PC.

Department of Neurosurgery, School of Medicine, The Johns Hopkins University, Baltimore, Maryland 21287-7881, USA. RNorth@jhmi.edu

OBJECT: Refinement of surgical techniques, especially anterior approaches, for the management of spinal metastases has improved patient outcomes, despite the fact that a complete analysis of the prognostic factors that would inform patient selection has not been undertaken. The authors sought to identify such prognostic factors for neurological outcome and life expectancy in patients with spinal metastases. METHODS: The authors used Kaplan-Meier techniques, log-rank comparisons, and a multivariate model stratified by tumor type to identify prognostic factors for duration of ability to walk and survival in patients who underwent surgical treatment for spinal metastases during a decade when all current treatment options were available. Preoperatively, 53 (87%) of the 61 patients in the study population suffered neurological symptoms (for example, weakness) and 52 (85%) were ambulatory. Postoperatively, 59 (97%) were ambulatory. Most patients who survived 6 months (81%) remained ambulatory, as did 66% of those alive at 1.6 years. The median postoperative survival was 10 months. The risk factors for loss of ambulation were preoperative loss of ambulatory ability, recurrent or persistent disease after primary radiotherapy of the operative site, a procedure other than corpectomy, and tumor type other than breast cancer. Prognostic factors for reduced survival were surgical intervention extending over two or more spinal segments, recurrent or persistent disease after primary radiotherapy involving the operative site, diagnosis other than breast cancer, and a cervical spinal procedure. CONCLUSIONS: The results of this analysis allowed the authors to create a simple prognostic factor scoring system that can be applied to individual patients. The positive experience derived from this study supports an expanded role for the surgical treatment of metastatic spinal disease.

PMID: 15945430 [PubMed - indexed for MEDLINE]

Note that the anterior approach is what they attribute their good results to. THAT MEANS NOT MAKING AN INCISION ON YOUR BACK SIDE AND GOING THROUGH THE AREA WHERE THE NERVE ROOTS AND SPINAL CORD ARE BEFORE BEING ABLE TO GET TO THE MARSHMELLOW SHAPED PART OF THE BONE WHERE THE METASTASIS IS.

Some successes
 

Dear Lyn -
So sorry you feel so down in the dumps. Being able to stand up tall and face this beast at least keeps our pride. So - sit up straight and tall and try to take it all in. Our Lyn must keep her courage up!

My neighbor's sister had mets to spine and the radiation knocked it out. She was an older lady and passed three years later of another health problem.

Are you taking Zometa or any other biphosphanate for your bones??

I sure know how you feel when you look in the mirror. Last year I really had the "full moon" look after taking the Decadron. Could barely recognize my self. Keep the thought that it is temporary.

Lani sure took some time to look things up and post. Very interesting and gives you a lot of "bullet points" to bring up with your docs.
This is definitely the worst blow as far as this cancer has dealt you. I certainly can easily recall the shock I had over my mets.
As you begin to work through it, the shock will become dull and strength will emerge.

Dear Lyn,

I have a chemo buddy who's had radiation for mets to her hip that has really helped with mobility, and as Steph says it can be done on the spine also.

If you need a wheelchair for temporary help until you get this latest challenge under control, just remember without you in it the wheelchair is just a chair on wheels but add Lyn and

WATCH OUT, IT'S HECK ON WHEELS!!!
(that's to make you smile :))

<3 and HUGS,
Lolly

One of the hospitals in New Orleans is running a lot of commercials on the Cyber Knife being used to treat brain and spine mets. You might check into that. My prayers are with you..sherryg683

Dear Lyn
I tried to find a cyberknife thing near you but could not locate it on the net. Your Onc is really good though he will know.
I hated being on steroids as they change the way i looked and although in the scheme of things this is not important it did change how I felt and rocked my confidence. I do hope you have radiation to help you and relieve the discomfort. i am thinking about you.

love
linda

Snooped A Little In Google
 

CYBERKNIFE DOES NOT SEEM TO HAVE MADE IT TO AUSTRALIA, CLOSEST SINGAPORE

WHEN GOOGLED GAMMAKNIFE AUSTRALIA GOT THIS (DATE UNKNOWN):
The gamma knife should soon be available in Australia. It is also used to treat vascular problems in the brain and some kinds of chronic pain.

For further information, please contact:

Dr Christer Lindquist
International Enquiries
Phone: 0011 44 20 7460 5907
Fax: 0011 44 20 7370 5015
e-mail: enquiries@cromwell-hospital.co.uk
Web site: www.cromwell-hospital.co.uk

Australia has a similar treatment called "Stereotatic Radiation"
using a linear accelerator. It is available at the following centres:

Alfred Hospital, Melbourne
William Buckland
Radiotherapy Centre
(03) 9276 2000

Prince of Wales, Sydney
Radiotherapy Centre
(02) 9382 2222

Westmead Hospital, Sydney
Radiotherapy Centre
Dr Michael Barton
(02) 9845 5555

RPA Hospital, Sydney
Radiotherapy Centre
(02) 9515 6111

Flinders Medical Centre, Adelaide
Radiotherapy Centre
Dr Brophy
(08) 8204 5511

Charles Gardiner Hospital, Perth
Radiotherapy Centre
Dr Thomas
(08) 9346 3333

ninemsn, Nine Network Australia Pty Limited and their related companies and licensors expressly disclaim all responsibility for, and liability in respect of, the accuracy of the information in the fact sheets in any particular circumstances, the improper application of the information and the consequences of anyone's failure to obtain a proper medical examination and advice from a qualified medical practitioner. Always consult your doctor if you are suffering any medical complaint.

From 2000--govt Decision Not To Fund Gammaknife In Australia
 

This is the html version of the file http://www.msac.gov.au/pdfs/summary/summary1028.pdf.
G o o g l e automatically generates html versions of documents as we crawl the web.
To link to or bookmark this page, use the following url: http://www.google.com/search?q=cache...s&ct=clnk&cd=3

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These search terms have been highlighted: australia
These terms only appear in links pointing to this page: gammaknife
Page 1
Title:
Gamma knife radiosurgery October 2000
Agency:
Medicare Services Advisory Committee (MSAC)
Commonwealth Department of Health and Ageing
GPO Box 9848 Canberra ACT 2601 Australia
http://www.msac.gov.au
Reference:
MSAC application 1028. Assessment report ISSN 1443-7120
Aim
To assess the safety and effectiveness of the service and under what circumstances public
funding should be supported for the service in relation to the treatment of arteriovenous
malformation (AVM), cerebral metastases and acoustic neuroma.
Conclusions and results
Methodological limitations of studies and patient heterogeneity preclude comprehensive
assessment of the safety and effectiveness of gamma knife radiosurgery relative to alternative
treatment.
Indication
AVM
Cerebral metastases
Acoustic neuroma
Safety
There is insufficient information to assess
the relative safety of gamma knife or linear
accelerator (LINAC) radiosurgery and
microsurgery. Studies contain
methodological limitations, patient
selection biases and inconsistent adverse
event definitions. Permanent neurological
complications occurred in 1-10% of
radiosurgery patients and up to 15% of
microsurgery patients (5% for small
accessible lesions).
The only useful data is from
case series: 10% incidence of
radiation necrosis (1%fatal),
20% incidence of acute
radiation induced odema 20%.
One study suggests
radiosurgery and whole brain
radiotherapy (WBRT) incur
similar complication rates.
Complication rates
are similar for
radiosurgery and
microsurgery:
facial nerve
problems (20%)
and hearing
preservation (30-
90%). Few studies
reported other
complications.
Effectiveness
Two year AVM obliteration rates are 26-
35% for gamma knife radiosurgery and 44-
68% for LINAC radiosurgery as a
percentage of patients eligible for
angiography. These are likely to be
overestimates as only some of the patients
eligible for angiography undertook the
procedure and patient follow up was
inadequate. This compares to 85-100%
obliteration rates for microsurgery (higher
for small accessible lesions).
One randomised trial (and
some supportive case series
data) suggest that radiosurgery
in addition to WBRT shows no
survival benefit, but may
provide slightly improved local
control when compared just to
WBRT.
Microsurgical
excision rates are
close to 100% and
tumour control
rates with
radiosurgery are
measured at 80-
100%.
Cost
effectiveness
Gamma knife was 1.7-2.9 times more expensive than LINAC radiosurgery. Uncertainties as to
safety and effectiveness preclude an economic evaluation of gamma knife and comparators.
Recommendation
Public funding should not be supported for gamma knife radiosurgery at this time.
Method
MSAC conducted a systematic review of medical literature using Medline, PreMedline, EmBase,
the Cochrane Library, ISTAHC, Current Contends, HealthSTAR and NHS databases: (DARE,
EED, HTA) from commencement until March 2000. Internet sites of certain health technology
assessment groups were also included. The AANS and CNS Meeting Abstract Archive and the
table of contents for Radiosurgery were also searched.

HOPE THIS DECISION HAS BEEN CHANGED!

Gamma Knife Center Of Pacific In Hawaii Advertises Services To Australians
 

The Gamma Knife Center of the Pacific, located in Honolulu, Hawaii is proud to offer Leksell Gamma Knife® Stereotactic Radiosurgery for patients in Hawaii, Australia, New Zealand, Guam, Canada and the Pacific Rim.

Gamma Knife Radiosurgery is the most current technologically advanced non invasive, incision-free treatment for a variety of disorders involving the brain. Leksell Gamma Knife® uses focused beams of radiation to destroy tumors (malignant and benign), vascular malformations and is used to treat benign conditions such as trigeminal neuralgia and Parkinson's disease.

In the Spirit of Aloha, our professional staff provides the services and personal attention needed to make a patient feel comfortable and welcome in our center. Prior to your arrival we will schedule and coordinate your appointments, assist with travel arrangements and lodging, provide you with cost estimates, and work with your insurance to secure payment. Please refer to our (travel page) regarding travel arrangements.

Our Vision
We offer new hope to our patients by providing the opportunity to receive optimal treatment with minimal complications for their brain tumors, neuralgias and functional brain disorders.

On Target, Spring 2004
1st New Zealand Man to Receive Treatment
TV 3 - a New Zealand TV station

TV NZ One News - a New Zealand TV station

Both videos were posted with permission from their respective TV Stations.

As a leader in Health Services, we are integrating new medical concepts and innovations, and are involved in research studies and the sharing of information through our physicians training courses. As visionaries looking to the next century, we are exploring new and precise diagnostic and treatment imaging technologies and modalities.

This web site is designed for both patients and physicians. The Gamma Knife Center of the Pacific is a resource for information about Gamma Knife Radiosurgery, brain tumor, patient support groups and treatment options.

Hi Lyn,
Although I regularly visit the site, I hardly ever post – a bit shy I guess. I just wanted to say that throughout the last couple of years I have really admired your fighting spirit. You have brought us into your life like few others have – the highs, the lows, the fun and not so easy parts of life. To have so much going on all at once and the future seeming uncertain must feel overwhelming. There was a time when I was afraid I was going to need a wheel chair because of some neurological problems I was having – I hated the idea – I am independent woman and the last thing I wanted was to have to rely on others. Family and friends were empathic and helpful, but sometimes that just makes it worse. On top of that steroids are such a drag (one of their side effects is depression) - sometimes I feel the cure is worse than the disease. Keep up the fight – the “Living Legend” will prevail.
Best,
Monica

Hi guys, thank you soooooo much for all the info and encouragement, and Lani for all of your research. I have been reallllly ill this last week and not had the strength to even get to the computer so I have now weaned myself off the steroids and I have not had the feeling that I even need them, but still walking around like a drunk and my BP is low most of the time which isn't helping. I had the MRI on Friday, it took 2 hours to do the head and total spine, I was pretty much spaced out, I had 2 sleeping tablets the night before, morphine for breakfast as usual, no steroid at that time, so I was in a fog so I figure my BP would have been low as well, I was even hallucinating at some stage, the weird thing was last time I had a MRI I couldn't lie flat because I couldn't breathe properly, this time I lay flat the whole time and didn't have any problems at all breathing, but I have to wait a couple of days for the result and it is very nerve racking, tropuble is I even look like death when I look in the mirror, but not today or any time soon either, my my turned 86 in February, so longivity here I think that is only fair. she does have something wrong with her now though, she has a spur on her foot she has to deal with. I got thrush back in the mouth this weekend, I should have told the doc I should have 2 rounds, anyway my pharmacy lets me owe him prescriptions so I got my antibiotics, but I am passing so much fluid without a deuritic. My friend took me to the shops yesterday, what a relief to get out of the house, she happily pushed the wheel chair for hours, I talking hours, we left at 10am and got home about 3.00pm and I felt fine, but not the walking bit yet. She said we are going to do it more often, have girly days, sounds good to me. My Ron has been an ANGEL through this, he is so caring and gentle, a side I haven't needed to see before, he looks like a cross between the bikie in the village people and Tom Selluck, I thought he looked evil when I first met him and I tried to give him to my girlfriend but I definately won out in the end, and that was 18 years ago, he helps me with everything, including all of my personal needs, maybe he was a nurse in his previous life. Well I have been having a lot of teary moments, but I hope it is just all of the drugs, I do appear to be a junky when you look at what I have to have. Well I have been told I am not allowed to stay up late, so I will fill you in as soon as I know.

Love & Hugs Lyn

Lyn,

My heart goes out to you. You are truly an inspiration for women and how blessed you are to have such a wonderful man in you life. I am only in the early stages of fighting this beast and in reading your posts I know that I can and will win the battle. It doesn't matter if you have to be in a wheel chair or not. Just let others take care of you for a while. Sit back and enjoy the ride. You're in my thoughts and prayers.