{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T22:47:12Z","timestamp":1792363632802,"version":"4.4.0"},"reference-count":31,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2013,3]]},"abstract":"\n Object<\/jats:title>\n Decompression surgery followed by adjuvant radiotherapy is an effective therapy for preservation or recovery of neurological function and achieving durable local disease control in patients suffering from metastatic epidural spinal cord compression (ESCC). The authors examine the outcomes of postoperative image-guided intensity-modulated radiation therapy delivered as single-fraction or hypofractionated stereotactic radiosurgery (SRS) for achieving long-term local tumor control.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A retrospective chart review identified 186 patients with ESCC from spinal metastases who were treated with surgical decompression, instrumentation, and postoperative radiation delivered as either single-fraction SRS (24 Gy) in 40 patients (21.5%), high-dose hypofractionated SRS (24\u201330 Gy in 3 fractions) in 37 patients (19.9%), or low-dose hypofractionated SRS (18\u201336 Gy in 5 or 6 fractions) in 109 patients (58.6%). The relationships between postoperative adjuvant SRS dosing and fractionation, patient characteristics, tumor histology\u2013specific radiosensitivity, grade of ESCC, extent of surgical decompression, response to preoperative radiotherapy, and local tumor control were evaluated by competing risks analysis.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The total cumulative incidence of local progression was 16.4% 1 year after SRS. Multivariate Gray competing risks analysis revealed a significant improvement in local control with high-dose hypofractionated SRS (4.1% cumulative incidence of local progression at 1 year, HR 0.12, p = 0.04) as compared with low-dose hypofractionated SRS (22.6% local progression at 1 year, HR 1). Although univariate analysis demonstrated a trend toward greater risk of local progression for patients in whom preoperative conventional external beam radiation therapy failed (22.2% local progression at 1 year, HR 1.96, p = 0.07) compared with patients who did not receive any preoperative radiotherapy (11.2% local progression at 1 year, HR 1), this association was not confirmed with multivariate analysis. No other variable significantly correlated with progression-free survival, including radiation sensitivity of tumor histology, grade of ESCC, extent of surgical decompression, or patient sex.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Postoperative adjuvant SRS following epidural spinal cord decompression and instrumentation is a safe and effective strategy for establishing durable local tumor control regardless of tumor histology\u2013specific radiosensitivity. Patients who received high-dose hypofractionated SRS demonstrated 1-year local progression rates of less than 5% (95% CI 0%\u201312.2%), which were superior to the results of low-dose hypofractionated SRS. The local progression rate after single-fraction SRS was less than 10% (95% CI 0%\u201319.0%).<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2012.11.spine12111","type":"journal-article","created":{"date-parts":[[2013,1,22]],"date-time":"2013-01-22T10:55:22Z","timestamp":1358852122000},"page":"207-214","source":"Crossref","is-referenced-by-count":460,"title":["Local disease control for spinal metastases following \u201cseparation surgery\u201d and adjuvant hypofractionated or high-dose single-fraction stereotactic radiosurgery: outcome analysis in 186 patients"],"prefix":"10.3171","volume":"18","author":[{"given":"Ilya","family":"Laufer","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery,"},{"name":"Spine Tumor Center, Memorial Sloan\u2013Kettering Cancer Center; and"},{"name":"Department of Neurological Surgery, Weill Cornell Medical College, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Bryan","family":"Iorgulescu","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Talia","family":"Chapman","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Lis","sequence":"additional","affiliation":[{"name":"Spine Tumor Center, Memorial Sloan\u2013Kettering Cancer Center; and"},{"name":"Radiology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiji","family":"Shi","sequence":"additional","affiliation":[{"name":"Epidemiology and Biostatistics,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhigang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Epidemiology and Biostatistics,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett W.","family":"Cox","sequence":"additional","affiliation":[{"name":"Spine Tumor Center, Memorial Sloan\u2013Kettering Cancer Center; and"},{"name":"Radiation Oncology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiya","family":"Yamada","sequence":"additional","affiliation":[{"name":"Spine Tumor Center, Memorial Sloan\u2013Kettering Cancer Center; and"},{"name":"Radiation Oncology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark H.","family":"Bilsky","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"},{"name":"Spine Tumor Center, Memorial Sloan\u2013Kettering Cancer Center; and"},{"name":"Department of Neurological Surgery, Weill Cornell Medical College, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"22 Suppl","key":"b1-spine12111","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"S101","DOI":"10.1097\/BRS.0b013e3181bac4b2","article-title":"Shifting paradigms in the treatment of metastatic spine disease","volume":"34","author":"Bilsky","year":"2009"},{"key":"b2-spine12111","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"324","DOI":"10.3171\/2010.3.SPINE09459","article-title":"Reliability analysis of the epidural spinal cord compression scale. 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