Abstract
Spinal metastasis is a problem that afflicts many cancer patients. Traditionally, conventional fractionated radiation therapy and/or surgery have been the most common approaches for managing such patients. Through technical advances in radiotherapy, high dose radiation with extremely steep drop off can now be delivered to a limited target volume along the spine under image-guidance with very high precision. This procedure, known as stereotactic body radiosurgery, provides a technique to rapidly treat selected spinal metastasis patients with single- or limited-fraction treatments that have similar to superior efficacies compared with more established approaches. This review describes current treatment systems in use to deliver stereotactic body radiosurgery as well as results of some of the larger case series from a number of institutions that report outcomes of patients treated for spinal metastatic disease. These series include nearly 1400 patients and report a cumulative local control rate of 90% with myelopathy risk that is significantly less than 1%. Based on this comprehensive review of the literature, we believe that stereotactic body radiosurgery is an established treatment modality for patients with spinal metastatic disease that is both safe and highly effective.
Highlights
Spine column tumors, both primary and metastatic lesions, are quite often seen in cancer patients
Further estimates conclude that 5–10% of cancer patients will develop spinal metastasis [3]
These include the precise definition of the dose tolerance of the spinal cord at radiosurgical doses, the influence of fraction number when giving high-dose, multifraction treatments, the most effective dose schedule to use with respect to symptom reduction and tumor control, and how spinal radiosurgery compares with more conventional radiation therapy treatments for safety and efficacy
Summary
Both primary and metastatic lesions, are quite often seen in cancer patients. It is estimated that 20,000–25,000 patients per year in the US develop spinal cord or root compression as a manifestation of their metastatic disease [1, 2]. Further estimates conclude that 5–10% of cancer patients will develop spinal metastasis [3]. With the advancement of image-guided radiation therapy technology, extracranial spinal radiosurgery has emerged as an effective and safe treatment modality for spinal tumors, both primary and metastatic. Extracranial radiosurgery, or stereotactic body radiosurgery (SBRS) was developed in the mid 1990s at various institutes around the world. Since the early days of SBRS development, the technique has become increasingly important and common in the management of both primary and metastatic spinal tumors. On prospective case series available that have led to the current standards, and will influence future directions in spinal radiosurgery
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