Robotic image-guided radiosurgery for the treatment of neoplastic vertebral pain

Pantaleo Romanelli

doi:10.7759/cureus.5

Abstract

Metastatic spinal lesions are a common event in cancer patients. Spinal metastases usually involve the vertebral bodies and are characterized by severe pain. Surgical treatment, as a consequence of its high invasivity, is rarely offered to patients with metastatic disease and expected limited life span. Spinal radiosurgery provides high rates of pain and local growth control in association with limited risk of neurological complications. The use of radiosurgery to treat spinal lesions has been strongly facilitated by the development of image-guided robotic radiosurgery, a technique able to deliver stereotactic irradiation to intra- and extracranial targets. Despite the exponential increase of treatments delivered to the spine using this novel approach and the growing number of papers reporting the outcomes of spine radiosurgery in terms of local growth control and analgesia following treatment of patients with metastatic and benign lesions of the spine, the awareness of the general medical public to the use of this technique remains limited. This paper aims to review the role of radiosurgery in the treatment of vertebral metastases and benign tumors and its efficacy in terms of pain and local growth control.

Highlights

BackgroundThe skeletal system is the third most frequent site of metastases after lung and liver, and the spine is the most common site of skeletal metastases [1]
Pain relief in patients with metastatic or primary spinal lesions is usually achieved with steroidal or non-steroidal anti-inflammatories [2] and opioids, often in combination with external beam radiation [3], surgery [4], and, in some cases, chemotherapy [3]
Steroids are effective in reducing the spinal cord edema temporarily and allowing radiotherapy or surgery of the lesion

Summary

Introduction

The skeletal system is the third most frequent site of metastases after lung and liver, and the spine is the most common site of skeletal metastases [1]. Three studies reported data on 2,206 randomized patients, 739 of whom had spinal metastases In this subgroup, the single-fraction treatment was as effective as the multifraction therapy in relieving pain. In another study [27], 31 patients with symptoms of pain and/or neurological deficits were treated with the same technique for 35 tumors, 26 of which were spinal metastases. Stereotactic delivery of radiation to metastatic lesions near the spinal cord can result in good tumor control, rapid and durable pain relief, and in some cases, recovery of neurologic function with little evidence of radiation-related side-effects or radiation necrosis. Taken along with the current findings, pain control and local control after single-fraction or hypofractionated radiosurgery are equivalent This is consistent with results of randomized studies that have failed to show significant difference in pain control between single- and multifraction regimens for external-beam radiation therapy. Control of tumor progression and palliation of symptoms are two disparate goals of any treatment that must be addressed on a case-by-case basis

Conclusions

Disclosures

Findings

14. Leksell L