{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T07:04:13Z","timestamp":1767337453035},"reference-count":20,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2013,1]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>The objective of this study was to investigate the feasibility and safety of delivering a third course of radiation to patients with multiply recurrent metastatic disease to the spine.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Between 2009 and 2011, 10 patients received a third course of radiation to spinal metastases at Memorial Sloan\u2013Kettering Cancer Center using image-guided intensity-modulated radiation therapy (IMRT). Patient and tumor characteristics, dosimetry details, and outcomes were obtained using retrospective chart review. Spinal imaging was performed prior to treatment and at regular follow-up intervals. The cumulative biologically effective dose (BED) to the spinal cord and cauda equina was calculated and was normalized to 2 Gy equivalents (Gy<jats:sub>2\/2<\/jats:sub>). Toxicity and local control were assessed.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>The median time between the first and second courses of radiation was 18.5 months and the median time between the second and third courses was 11.5 months. The median follow-up from the third course of radiation was 12 months and the median overall survival was 13 months. Pain or neurological symptoms were improved in 80% of patients. The median spinal cord maximum dose normalized BED (nBED) for the whole cohort was 70.73 Gy<jats:sub>2\/2<\/jats:sub> (range 51.9\u2013101.7 Gy<jats:sub>2\/2<\/jats:sub>). The median dose to 5% of the spinal cord D<jats:sub>05<\/jats:sub> nBED for the entire cohort was 59.4 Gy<jats:sub>2\/2<\/jats:sub>. Acute toxicity was most commonly fatigue and dermatitis, with 1 patient experiencing Grade 3 fatigue and 1 patient Grade 3 dermatitis. Late toxicity was limited to 2 cases of Grade 1 dysphagia. There was 1 case of Grade 1 neuropathy and 1 case of Grade 2 neuropathy. The crude rate of local control was 80% with 1 in-field failure and 1 marginal failure.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>In this cohort of patients, a third course of IMRT to the spine was well tolerated with no significant late toxicities. Used as salvage therapy for select patients, a third course of radiation is a safe and effective treatment strategy.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2012.9.spine12433","type":"journal-article","created":{"date-parts":[[2012,10,26]],"date-time":"2012-10-26T14:05:24Z","timestamp":1351260324000},"page":"63-68","source":"Crossref","is-referenced-by-count":20,"title":["Delivering a third course of radiation to spine metastases using image-guided, intensity-modulated radiation therapy"],"prefix":"10.3171","volume":"18","author":[{"given":"Evangelia","family":"Katsoulakis","sequence":"first","affiliation":[{"name":"Departments of Radiation Oncology,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadeem","family":"Riaz","sequence":"additional","affiliation":[{"name":"Departments of Radiation Oncology,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brett","family":"Cox","sequence":"additional","affiliation":[{"name":"Departments of Radiation Oncology,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Mechalakos","sequence":"additional","affiliation":[{"name":"Neurosurgery, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joan","family":"Zatcky","sequence":"additional","affiliation":[{"name":"Departments of Radiation Oncology,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Bilsky","sequence":"additional","affiliation":[{"name":"Medical Physics, Memorial Sloan\u2013Kettering Cancer Center, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshiya","family":"Yamada","sequence":"additional","affiliation":[{"name":"Departments of Radiation Oncology,"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-spine12433","series-title":"Int J Radiat Oncol Biol Phys","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1016\/j.ijrobp.2010.06.013","article-title":"Impact of dose on local failure rates after image-guided reirradiation of recurrent paraspinal metastases","volume":"81","author":"Damast","year":"2011"},{"key":"b2-spine12433","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1227\/01.NEU.0000338072.30246.BD","article-title":"Treatment of spinal tumors using cyberknife fractionated stereotactic radiosurgery: pain and quality-of-life assessment after treatment in 200 patients","volume":"64","author":"Gagnon","year":"2009"},{"key":"b3-spine12433","series-title":"Cancer","doi-asserted-by":"publisher","first-page":"3509","DOI":"10.1002\/cncr.25918","article-title":"Prospective evaluation of spinal reirradiation by using stereotactic body radiation therapy: The University of Texas MD Anderson Cancer Center experience","volume":"117","author":"Garg","year":"2011"},{"key":"b4-spine12433","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1097\/01.brs.0000251863.76595.a2","article-title":"Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution","volume":"32","author":"Gerszten","year":"2007"},{"issue":"2 Suppl","key":"b5-spine12433","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"A67","DOI":"10.1227\/01.NEU.0000341628.98141.B6","article-title":"Delayed radiation-induced myelopathy after spinal radiosurgery","volume":"64","author":"Gibbs","year":"2009"},{"key":"b6-spine12433","series-title":"Int J Radiat Oncol Biol Phys","doi-asserted-by":"publisher","first-page":"1127","DOI":"10.1016\/S0360-3016(98)00288-0","article-title":"Clinical results of nonsurgical treatment for spinal metastases","volume":"42","author":"Katagiri","year":"1998"},{"issue":"3 Suppl","key":"b7-spine12433","series-title":"Int J Radiat Oncol Biol Phys","doi-asserted-by":"publisher","first-page":"S42","DOI":"10.1016\/j.ijrobp.2009.04.095","article-title":"Radiation dose-volume effects in the spinal cord","volume":"76","author":"Kirkpatrick","year":"2010"},{"key":"b8-spine12433","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"109","DOI":"10.3171\/2010.3.SPINE08670","article-title":"Repeat decompression surgery for recurrent spinal metastases. 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