Award: Brian D. Silber Award
Authors: Rafael A. Vega, MD; Dhiego de Almedia Bastos, MD; Amol Ghia, MD; Jing Li, MD; Andrew Bishop, MD; Debra Yeboa, MD; Behrang Amini, MD; Ganesh Rao, MD; Laurence Rhines, MD; Claudio Tatsui, MD (Houston, TX)
Introduction: Spinal laser interstitial thermal therapy (sLITT) is a novel minimally invasive therapeutic modality for the treatment of metastatic epidural spinal cord compression (ESCC). This approach is best used in patients who are poor candidates for larger-scale oncologic spinal surgery and can act synergistically with spinal stereotactic radiosurgery to maximize local control and palliate pain. Methods: The authors retrospectively reviewed a consecutive series of patients, from 2013 to 2018, with ESCC who were considered to be poor surgical candidates and instead were treated with MRI-guided sLITT. Demographic data, Spine Instability Neoplastic Scale score, degree of epidural compression before and after the procedure, length of hospital stay, progression, need for stabilization, and time to return to oncological treatment were analyzed. Results: A total of 100 patients with ESCC were treated since the inception of sLITT in 2013 at MD Anderson. Treated levels included 5 cervical, 8 lumbar, and 87 thoracic cases. The majority of preoperative ESCC were high grade with effacement of CSF around the spinal cord. The most common tumor histology was renal cell carcinoma (n=40), followed by non-small cell lung carcinoma (n=10), hepatocellular carcinoma (n=6), and 44 other less common metastasis. Systemic therapy was not interrupted to perform the procedure in any of the cases. Local control was achieved in 83 cases and 17 patients showed eventual progression at follow up. Levels containing motor nerve roots were avoided due to risk of nerve root palsy, which occurred in 3 of the early cases in the lumbar spine. Conclusions: Clinical data from the first 100 patients demonstrate that sLITT is a safe and viable ablative treatment options for patients with ESCC, and may be considered an alternative to separation surgery for carefully selected patients with lesions in the thoracic spine.