Effectiveness of PET-CT as a guide for palliative radiation therapy for spinal metastases

As back pain is the presenting symptoms in 95% of patients with epidural spinal metastases, appropriately identifying and treating the most symptomatic levels can provide significant palliation. The purpose of this study is to analyze the ability of PET-CT to identify spinal metastases with high met...

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Bibliographic Details
Published inWorld neurosurgery
Main Authors Almeida, Neil D, Adams, Crystal, Davis, Gregory L, Buro, Justin, Nasr, Nadim, McRae, Don, Cernica, George, Caputy, Anthony, Hong, Robert, Sherman, Jonathan
Format Journal Article
LanguageEnglish
Published United States 31.03.2018
Subjects
metastasis
radiation therapy
cancer
neoplasm
spine
radiosurgery
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Summary:As back pain is the presenting symptoms in 95% of patients with epidural spinal metastases, appropriately identifying and treating the most symptomatic levels can provide significant palliation. The purpose of this study is to analyze the ability of PET-CT to identify spinal metastases with high metabolic activity and guide radiotherapy. We sought to correlate improvement in back pain with reduction in SUV uptake following treatment. We conducted a retrospective review of 72 patients with bony spinal metastases treated with stereotactic ablative radiation therapy at a single center between 2002 and 2014. PET-CT scan imaging was used to calculate SUV values for their spinal metastases and treatment planning was based on PET-CT results. Pre- and post-operative pain level was assessed in all patients. Analyses revealed a reduction in pain scores in 78% of treated patients. A significant reduction in pain was identified in patients with greater than 5 metastases as compared to a fewer number of lesions (p<0.05) Degree of change in SUV did not correlate with pain relief via statistical significance. However in comparing pre- and post-treatment PET-CT imaging, patients with improved pain consistently displayed a decreased SUV uptake. Within the limitations of our study, PET-CT was a useful adjunct in radiation treatment planning with change in SUV correlating with symptomatic improvement. This study paves the way for future prospective studies to further assess the utility and cost-effectiveness of this imaging modality in radiation treatment planning for spinal metastases.
ISSN:1878-8769