{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T15:24:41Z","timestamp":1794324281883,"version":"4.9.0"},"reference-count":36,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2017,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Spine radiosurgery is increasingly being used to treat spinal metastases. As patients are living longer because of the increasing efficacy of systemic agents, appropriate follow-up and posttreatment management for these patients is critical. Tumor progression after spine radiosurgery is rare; however, vertebral compression fractures are recognized as a more common posttreatment effect. The use of radiographic imaging alone posttreatment may makeit difficult to distinguish tumor progression from postradiation changes such as fibrosis. This is the largest series from a prospective database in which the authors examine histopathology of samples obtained from patients who underwent surgical intervention for presumed tumor progression or mechanical pain secondary to compression fracture. The majority of patients had tumor ablation and resulting fibrosis rather than tumor progression. The aim of this study was to evaluate tumor histopathology and characteristics of patients who underwent pathological sampling because of radiographic tumor progression, fibrosis, or collapsed vertebrae after receiving high-dose single-fraction stereotactic radiosurgery.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Between January 2005 and January 2014, a total of 582 patients were treated with linear accelerator\u2013based single-fraction (18\u201324 Gy) stereotactic radiosurgery. The authors retrospectively identified 30 patients (5.1%) who underwent surgical intervention for 32 lesions with vertebral cement augmentation for either mechanical pain or instability secondary to vertebral compression fracture (n = 17) or instrumentation (n = 15) for radiographic tumor progression. Radiation and surgical treatment, histopathology, and long-term outcomes were reviewed. Survival and time to recurrence were calculated using the Kaplan-Meier method.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n The mean age at the time of radiosurgery was 59 years (range 36\u201380 years). The initial pathological diagnoses were obtained for all patients and primarily included radioresistant tumor types, including renal cell carcinoma in 7 (22%), melanoma in 6 (19%), lung carcinoma in 4 (12%), and sarcoma in 3 (9%). The median time to surgical intervention was 24.7 months (range 1.6\u201350.8 months). The median follow-up and overall survival for all patients were 42.5 months and 41 months (overall survival range 7\u201386 months), respectively. The majority of assessed lesions showed no evidence of tumor on pathological review (25 of 32, 78%), while a minority of lesions revealed residual tumor (7 of 32, 22%). The median survival for patients after tumor recurrence was 5 months (range 2\u201370 months).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n High-dose single-fraction radiosurgery is tumor ablative in the majority of instances. In a minority of cases, tumor persists and salvage treatments should be considered.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2016.10.focus16368","type":"journal-article","created":{"date-parts":[[2017,1,1]],"date-time":"2017-01-01T03:37:18Z","timestamp":1483241838000},"page":"E7","source":"Crossref","is-referenced-by-count":16,"title":["Pathological characteristics of spine metastases treated with high-dose single-fraction stereotactic radiosurgery"],"prefix":"10.3171","volume":"42","author":[{"given":"Evangelia","family":"Katsoulakis","sequence":"first","affiliation":[{"name":"Departments of Radiation Oncology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilya","family":"Laufer","sequence":"additional","affiliation":[{"name":"Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Bilsky","sequence":"additional","affiliation":[{"name":"Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narasimhan P.","family":"Agaram","sequence":"additional","affiliation":[{"name":"Pathology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Lovelock","sequence":"additional","affiliation":[{"name":"Medical Physics, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiya","family":"Yamada","sequence":"additional","affiliation":[{"name":"Departments of Radiation Oncology,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus16368","series-title":"J Neurosurg Spine","first-page":"430","article-title":"Radiation-induced vertebral compression fracture following spine stereotactic radiosurgery: clinicopathological correlation","volume":"18","author":"Al-Omair","year":"2013"},{"key":"b2-focus16368","series-title":"Hematol Oncol Clin North Am","first-page":"1307","article-title":"Surgical approach to epidural spinal cord compression","volume":"20","author":"Bilsky","year":"2006"},{"key":"b3-focus16368","series-title":"Int J Radiat Oncol Biol Phys","first-page":"1016","article-title":"Outcomes for spine stereotactic body radiation therapy and an analysis of predictors of local recurrence","volume":"92","author":"Bishop","year":"2015"},{"key":"b4-focus16368","series-title":"J Neurosurg Spine","first-page":"379","article-title":"Vertebral compression fracture risk after stereotactic body radiotherapy for spinal metastases","volume":"16","author":"Boehling","year":"2012"},{"key":"b5-focus16368","series-title":"Int J Radiat Oncol Biol Phys","first-page":"e343","article-title":"Vertebral compression fracture (VCF) after spine stereotactic body radiation therapy (SBRT): analysis of predictive factors","volume":"84","author":"Cunha","year":"2012"},{"key":"b6-focus16368","series-title":"Cancer Treat Rev","first-page":"1","article-title":"Radiotherapy and immunotherapy: Can this combination change the prognosis of patients with melanoma brain metastases?","volume":"50","author":"Franceschini","year":"2016"},{"key":"b7-focus16368","series-title":"Science","first-page":"1155","article-title":"Tumor response to radiotherapy regulated by endothelial cell apoptosis","volume":"300","author":"Garcia-Barros","year":"2003"},{"key":"b8-focus16368","series-title":"Neurosurgery","first-page":"208","article-title":"Clinical and pathological characteristics of brain metastasis resected after failed radiosurgery","volume":"66","author":"Jagannathan","year":"2010"},{"key":"b9-focus16368","series-title":"Lancet Oncol","first-page":"700","article-title":"Ipilimumab versus placebo after radiotherapy in patients with metastatic castration-resistant prostate cancer that had progressed after docetaxel chemotherapy (CA184-043): a multicentre, randomised, double-blind, phase 3 trial","volume":"15","author":"Kwon","year":"2014"},{"key":"b10-focus16368","series-title":"J Neurosurg Spine","first-page":"207","article-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","volume":"18","author":"Laufer","year":"2013"},{"key":"b11-focus16368","series-title":"Med Phys","first-page":"2606","article-title":"Accurate setup of paraspinal patients using a noninvasive patient immobilization cradle and portal imaging","volume":"32","author":"Lovelock","year":"2005"},{"key":"b12-focus16368","series-title":"Int J Radiat Oncol Biol Phys","first-page":"361","article-title":"Five-year outcomes of high-dose single-fraction spinal stereotactic radiosurgery","volume":"93","author":"Moussazadeh","year":"2015"},{"key":"b13-focus16368","series-title":"Neuro Oncol","first-page":"1312","article-title":"Two heads better than one? Ipilimumab immunotherapy and radiation therapy for melanoma brain metastases","volume":"17","author":"Patel","year":"2015"},{"key":"b14-focus16368","series-title":"J Clin Oncol","first-page":"5075","article-title":"Risk of fracture after single fraction image-guided intensity-modulated radiation therapy to spinal metastases","volume":"27","author":"Rose","year":"2009"},{"key":"b15-focus16368","series-title":"J Clin Oncol","first-page":"3426","article-title":"Vertebral compression fracture after spine stereotactic body radiotherapy: a multi-institutional analysis with a focus on radiation dose and the spinal instability neoplastic score","volume":"31","author":"Sahgal","year":"2013"},{"key":"b16-focus16368","series-title":"Korean J Spine","first-page":"103","article-title":"Evaluation of risk factors for vertebral compression fracture after stereotactic radiosurgery in spinal tumor patients","volume":"11","author":"Sung","year":"2014"},{"key":"b17-focus16368","series-title":"Int J Radiat Oncol Biol Phys","first-page":"484","article-title":"High-dose, single-fraction image-guided intensity-modulated radiotherapy for metastatic spinal lesions","volume":"71","author":"Yamada","year":"2008"},{"issue":"2","key":"b18-focus16368","series-title":"Neurosurg Focus","first-page":"E14","article-title":"Histopathological examination of spine tumors after treatment with radiosurgery","volume":"41","author":"Zwagerman","year":"2016"},{"key":"b1-focus16368","series-title":"J Neurosurg Spine","first-page":"430","article-title":"Radiation-induced vertebral compression fracture following spine stereotactic radiosurgery: clinicopathological correlation","volume":"18","author":"Al-Omair","year":"2013"},{"key":"b2-focus16368","series-title":"Hematol Oncol Clin North Am","first-page":"1307","article-title":"Surgical approach to epidural spinal cord compression","volume":"20","author":"Bilsky","year":"2006"},{"key":"b3-focus16368","series-title":"Int J Radiat Oncol Biol Phys","first-page":"1016","article-title":"Outcomes for spine stereotactic body radiation therapy and an analysis of predictors of local recurrence","volume":"92","author":"Bishop","year":"2015"},{"key":"b4-focus16368","series-title":"J Neurosurg Spine","first-page":"379","article-title":"Vertebral compression fracture risk after stereotactic body radiotherapy for spinal metastases","volume":"16","author":"Boehling","year":"2012"},{"key":"b5-focus16368","series-title":"Int J Radiat Oncol Biol Phys","first-page":"e343","article-title":"Vertebral compression fracture (VCF) after spine stereotactic body radiation therapy (SBRT): analysis of predictive factors","volume":"84","author":"Cunha","year":"2012"},{"key":"b6-focus16368","series-title":"Cancer Treat Rev","first-page":"1","article-title":"Radiotherapy and immunotherapy: Can this combination change the prognosis of patients with melanoma brain metastases?","volume":"50","author":"Franceschini","year":"2016"},{"key":"b7-focus16368","series-title":"Science","first-page":"1155","article-title":"Tumor response to radiotherapy regulated by endothelial cell apoptosis","volume":"300","author":"Garcia-Barros","year":"2003"},{"key":"b8-focus16368","series-title":"Neurosurgery","first-page":"208","article-title":"Clinical and pathological characteristics of brain metastasis resected after failed radiosurgery","volume":"66","author":"Jagannathan","year":"2010"},{"key":"b9-focus16368","series-title":"Lancet Oncol","first-page":"700","article-title":"Ipilimumab versus placebo after radiotherapy in patients with metastatic castration-resistant prostate cancer that had progressed after docetaxel chemotherapy (CA184-043): a multicentre, randomised, double-blind, phase 3 trial","volume":"15","author":"Kwon","year":"2014"},{"key":"b10-focus16368","series-title":"J Neurosurg Spine","first-page":"207","article-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","volume":"18","author":"Laufer","year":"2013"},{"key":"b11-focus16368","series-title":"Med Phys","first-page":"2606","article-title":"Accurate setup of paraspinal patients using a noninvasive patient immobilization cradle and portal imaging","volume":"32","author":"Lovelock","year":"2005"},{"key":"b12-focus16368","series-title":"Int J Radiat Oncol Biol Phys","first-page":"361","article-title":"Five-year outcomes of high-dose single-fraction spinal stereotactic radiosurgery","volume":"93","author":"Moussazadeh","year":"2015"},{"key":"b13-focus16368","series-title":"Neuro Oncol","first-page":"1312","article-title":"Two heads better than one? Ipilimumab immunotherapy and radiation therapy for melanoma brain metastases","volume":"17","author":"Patel","year":"2015"},{"key":"b14-focus16368","series-title":"J Clin Oncol","first-page":"5075","article-title":"Risk of fracture after single fraction image-guided intensity-modulated radiation therapy to spinal metastases","volume":"27","author":"Rose","year":"2009"},{"key":"b15-focus16368","series-title":"J Clin Oncol","first-page":"3426","article-title":"Vertebral compression fracture after spine stereotactic body radiotherapy: a multi-institutional analysis with a focus on radiation dose and the spinal instability neoplastic score","volume":"31","author":"Sahgal","year":"2013"},{"key":"b16-focus16368","series-title":"Korean J Spine","first-page":"103","article-title":"Evaluation of risk factors for vertebral compression fracture after stereotactic radiosurgery in spinal tumor patients","volume":"11","author":"Sung","year":"2014"},{"key":"b17-focus16368","series-title":"Int J Radiat Oncol Biol Phys","first-page":"484","article-title":"High-dose, single-fraction image-guided intensity-modulated radiotherapy for metastatic spinal lesions","volume":"71","author":"Yamada","year":"2008"},{"issue":"2","key":"b18-focus16368","series-title":"Neurosurg Focus","first-page":"E14","article-title":"Histopathological examination of spine tumors after treatment with radiosurgery","volume":"41","author":"Zwagerman","year":"2016"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/42\/1\/article-pE7.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/42\/1\/article-pE7.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/42\/1\/article-pE7.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T08:20:14Z","timestamp":1780734014000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/42\/1\/article-pE7.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,1]]},"references-count":36,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3171\/2016.10.focus16368","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,1]]}}}