Stereotactic radiosurgery for metastatic spine tumors

N. K. Chan, K. G. Abdullah, D. Lubelski, M. P. Steinmetz, E. C. Benzel, J. H. Shin, T. E. Mroz

Research output: Contribution to journalReview article

13 Citations (Scopus)

Abstract

Spinal metastases invariably affect the majority of patients with cancer. Many will develop symptoms related to pain and disability from epidural spinal cord compression as well as pathologic fracture of the vertebrae. With the emergence of targeted systemic therapies and a better understanding of cancer biology, patients are living longer with bony metastases. This poses particular challenges, as palliation of pain and maintenance of local tumor control are paramount to quality of life and overall functional independence for these patients. Stereotactic radiosurgery (SRS) has emerged as a potent primary standalone and adjuvant treatment option for spinal metastases. To date, the primary indications for SRS include 1) upfront standalone treatment for painful bony metastases in the oligometastatic patient, 2) standalone or post-operative treatment following progression or recurrence of local disease despite previous conventional external beam radiation therapy (cEBRT), and 3) following surgery during which epidural disease is decompressed and the spine stabilized when indicated. SRS has demonstrated a significant advantage over cEBRT for tumors traditionally regarded as relatively radioresistant such as sarcoma, melanoma, renal cell carcinoma, non-small cell lung cancer and colon carcinoma. 9 The radiobiological advantage of increased tumoricidal dose delivery and spinal cord dose sparing in SRS have made this a powerful treatment alternative to cEBRT particularly within the context of re-irradiation. Given the limitations of spinal cord dose constraints, surgery is still the first-line therapy in patients with high-grade epidural spinal cord compression (ESCC). Epidural compression can be treated with SRS, however this risks radiation-induced myelopathy and challenges the safety of effective dose delivery at the dural margin.11 With increasing dose, radiation-induced vertebral fracture is the most serious and prevalent side effect of SRS.53 An overview of SRS, including the most common indications, complications, and outcomes for spinal metastases are presented here.

Original languageEnglish (US)
Pages (from-to)37-44
Number of pages8
JournalJournal of Neurosurgical Sciences
Volume58
Issue number1
StatePublished - Mar 2014
Externally publishedYes

Fingerprint

Radiosurgery
Spine
Neoplasm Metastasis
Neoplasms
Spinal Cord Compression
Radiotherapy
Spinal Cord
Therapeutics
Radiation
Compression Fractures
Pain
Spontaneous Fractures
Spinal Cord Diseases
Renal Cell Carcinoma
Non-Small Cell Lung Carcinoma
Sarcoma
Colonic Neoplasms
Melanoma
Maintenance
Quality of Life

Keywords

  • Radiosurgery
  • Spinal cord neoplasms, radiotherapy
  • Spinal neoplasms, secondary
  • Spinal neoplasms, surgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Chan, N. K., Abdullah, K. G., Lubelski, D., Steinmetz, M. P., Benzel, E. C., Shin, J. H., & Mroz, T. E. (2014). Stereotactic radiosurgery for metastatic spine tumors. Journal of Neurosurgical Sciences, 58(1), 37-44.

Stereotactic radiosurgery for metastatic spine tumors. / Chan, N. K.; Abdullah, K. G.; Lubelski, D.; Steinmetz, M. P.; Benzel, E. C.; Shin, J. H.; Mroz, T. E.

In: Journal of Neurosurgical Sciences, Vol. 58, No. 1, 03.2014, p. 37-44.

Research output: Contribution to journalReview article

Chan, NK, Abdullah, KG, Lubelski, D, Steinmetz, MP, Benzel, EC, Shin, JH & Mroz, TE 2014, 'Stereotactic radiosurgery for metastatic spine tumors', Journal of Neurosurgical Sciences, vol. 58, no. 1, pp. 37-44.
Chan NK, Abdullah KG, Lubelski D, Steinmetz MP, Benzel EC, Shin JH et al. Stereotactic radiosurgery for metastatic spine tumors. Journal of Neurosurgical Sciences. 2014 Mar;58(1):37-44.
Chan, N. K. ; Abdullah, K. G. ; Lubelski, D. ; Steinmetz, M. P. ; Benzel, E. C. ; Shin, J. H. ; Mroz, T. E. / Stereotactic radiosurgery for metastatic spine tumors. In: Journal of Neurosurgical Sciences. 2014 ; Vol. 58, No. 1. pp. 37-44.
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abstract = "Spinal metastases invariably affect the majority of patients with cancer. Many will develop symptoms related to pain and disability from epidural spinal cord compression as well as pathologic fracture of the vertebrae. With the emergence of targeted systemic therapies and a better understanding of cancer biology, patients are living longer with bony metastases. This poses particular challenges, as palliation of pain and maintenance of local tumor control are paramount to quality of life and overall functional independence for these patients. Stereotactic radiosurgery (SRS) has emerged as a potent primary standalone and adjuvant treatment option for spinal metastases. To date, the primary indications for SRS include 1) upfront standalone treatment for painful bony metastases in the oligometastatic patient, 2) standalone or post-operative treatment following progression or recurrence of local disease despite previous conventional external beam radiation therapy (cEBRT), and 3) following surgery during which epidural disease is decompressed and the spine stabilized when indicated. SRS has demonstrated a significant advantage over cEBRT for tumors traditionally regarded as relatively radioresistant such as sarcoma, melanoma, renal cell carcinoma, non-small cell lung cancer and colon carcinoma. 9 The radiobiological advantage of increased tumoricidal dose delivery and spinal cord dose sparing in SRS have made this a powerful treatment alternative to cEBRT particularly within the context of re-irradiation. Given the limitations of spinal cord dose constraints, surgery is still the first-line therapy in patients with high-grade epidural spinal cord compression (ESCC). Epidural compression can be treated with SRS, however this risks radiation-induced myelopathy and challenges the safety of effective dose delivery at the dural margin.11 With increasing dose, radiation-induced vertebral fracture is the most serious and prevalent side effect of SRS.53 An overview of SRS, including the most common indications, complications, and outcomes for spinal metastases are presented here.",
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