Novalis Spinal Radiosurgery

Abstract

Stereotactic radiosurgery (SRS) is a noninvasive approach to delivering high doses of conformal radiation. The majority of spinal tumors are metastatic lesions, and it is estimated that 30–90 % of cancer patients will develop metastatic spinal lesions. The potential benefit of spinal SRS may arise in cases of reirradiation where conformal dose distribution and a noninvasive approach are desired. Current techniques require a high degree of precision with patient simulation. Retrospective studies have favored a spinal SRS fractionation schema of ≥14 Gy in one fraction in previously unirradiated patients, with the majority of 1-year local and pain control estimates above 80 %. Radiation-induced myelopathy from spinal SRS is exceedingly rare, but may occur 6–12 months after treatment. Follow-up after spinal SRS is important since intervention after radiation-induced myelopathy may alleviate neurologic symptoms. Randomized clinical trials are examining the feasibility and ability of spinal SRS to deliver improved outcomes for pain relief compared with conventional three-dimensional conformal external beam radiotherapy.