Second time’s a charm.
Here is an excellent comprehensive review of modern radiation and surgical techniques to address the unpleasant situation of recurrent, previously-irradiated spine mets. First up is the safe option for conventional treatment (e.g., 8 Gy x 1) with some degree of pain relief expected in roughly half of patients (complete response more like 10%), typically achieved 3-5 weeks out with a duration of 15-22 weeks. Then there is the option for spine radiosurgery, whose merits really shine in the setting of complicated recurrence. Finally, it’s a must to include neurosurgical colleagues as surgical intervention may be the best and only way to avoid paralysis with cord compression by a proven-radioresistant tumor. TBL: Table 3 is a print-out and tape-on-the-wall table graphing out spinal cord tolerances based on previous and current prescribed doses. | Kotecha, Neurooncol Pract 2020