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

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

World Neurosurg. 2018 Mar 31;:

Authors: Almeida ND, Adams C, Davis GL, Buro J, Nasr N, McRae D, Cernica G, Caputy A, Hong R, Sherman J

Abstract
BACKGROUND: 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.
OBJECTIVE: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSION: 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.

PMID: 29614361 [PubMed - as supplied by publisher]

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