A Study of Stereotactic Radiosurgery (SRS) to Treat Pain in the Chest and/or Stomach Wall

Exclusion Criteria

• •Patients with a life expectancy of \< 6 months as predicted by the Adult Comorbidity Index (ACE-27, see Appendix 1)
• •Patients with active autoimmune connective tissue disease
• •Patients with bilateral TAWP
• •Patients with preexisting pneumothorax
• •Patients with preexisting excessive pleural effusion (extending \> 3 vertebral levels)
• •Systemic chemotherapy delivered or planned to be delivered within +/- 5 days of SRS
• •Unable to undergo a diagnostic paravertebral nerve block
• •Unable to undergo at least one of either a myelogram or spine MRI
• •Patients for whom external beam treatment plans to deliver the prescription SRS dose to the lesion of interest cannot be safely designed as specified by the Dose Constraint Guidelines in Appendix 2
• •* Evaluation of any radiation doses previously delivered to spinal cord/cauda equina and other critical structures (bowel, esophagus, lungs, kidneys, rectum) will be taken into consideration
• •* If radiation dose from SRS would exceed any normal tissue constraint as noted in Appendix 2, the patient will be ineligible
• •Abnormal complete blood count. Any of the following:
• •* Platelet count \< 75 K/µL
• •* Hgb level \< 9 g/dl
• •* WBC \< 3.5 K/µl
• •Abnormal coagulation profile: INR \> 2.5 INR and/or APTT \> 80 seconds. Patients who are on anticoagulation medication that may not be safely held for the myelogram procedure (≥ 5 days for antiplatelet agents and warfarin; ≥ 24 hours for low-molecular weight heparin formulations) will be excluded.
• •Allergy to local anesthestics
• •Local infection at the site of injection of anesthetic
• •Severe spinal deformities with anatomic distortion (severe scoliosis/kyphoscoliosis)
• •Severe respiratory disease (i.e. oxygen dependent)