Stereotactic Body Radiotherapy for Treatment of Spinal Metastasis: A Systematic Review of the Literature

Abstract

Abstract Advances in local and systemic therapies continue to improve overall survival for patients with cancer, resulting in an increase in the incidence of spine metastases. Metastases to the spine are the most common bony metastasis. Up to 15% of patients with solid tumors develop spinal metastases. Spinal metastases can be particularly devastating for quality of life given the potential pain, neurological deficits from spinal cord compression or cauda equina syndrome, spinal instability, and pathological fractures that may result. Stereotactic body radiotherapy (SBRT) with or without the addition of less invasive surgical techniques for stabilization or separation has gained favor. SBRT uses smaller, more precise treatment volumes, allowing for higher doses per fracture, thus increasing ablative abilities. In this systematic review we discuss the literature regarding SBRT’s effectiveness in providing local control and pain control for patients with metastatic disease to the spine. This remains true for patients with spinal cord compression managed with surgical separation followed by postoperative spine SBRT. While not all patients are appropriate candidates for SBRT, careful consideration of appropriate frameworks which take into account the patient’s overall prognosis can guide a multidisciplinary team towards the patients who will benefit the most from this treatment modality.