Stereotactic body radiotherapy for solitary spine metastasis
A 56-year-old woman patient was treated with modified radical mastectomy followed by chemoradiation therapy for breast cancer, pT2N2M0, stage IIIA in 1996. Nine years after primary treatment, a bone metastasis was detected in the T9 and T10 spine. Palliative radiotherapy was administered with a total dose of 30 Gy over 12 fractions to the T8-T11 spine, and palliative chemotherapy was continued.\nThe patient returned to hospital in 2007 because of back pain. At presentation, she complained of pain with VAS score of 5, without neurologic symptoms and an ECOG performance status of 1. MRI revealed bone metastasis on the left side of the vertebral body, pedicle, lamina, both articular processes of T10 spine, and left articular process of T9 spine (). Radiosurgery was administered to the metastatic spine lesions at 6 Gy/fraction to a total dose of 24 Gy. The patient reported being in less pain within 7 days of radiosurgery and was subsequently pain-free and continued to be so until the last follow-up. She did not receive further chemotherapy or hormonal therapy until 74 months after the radiosurgery. In May 2013, a new lung metastasis was noted in the right upper lobe and treated with wedge resection. The histological findings were compatible with lung metastasis and the pathological report confirmed that the 3 × 2.2-cm tumor, visceral pleural invasion, and hormonal receptors were again negative. On follow-up PET-CT and chest CT at 80 months after the radiosurgery (6 months after the wedge resection), no fluorodeoxyglucose uptake was seen in the T9 and T10 spine and there were no abnormal lesions suggestive of recurrence or metastasis.