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

• Published in: World 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
• Language: English
• Published: United States 31.03.2018
• Subjects: metastasis; radiation therapy; cancer; neoplasm; spine; radiosurgery

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.