Advertisement

Radiation Therapy for Oncologic Spine Pain

  • Brent D. Cameron
  • Christien A. Kluwe
  • Albert AttiaEmail author
Chapter

Abstract

Spinal metastases are a common occurrence for many cancer patients. They can cause a variety of debilitating symptoms related to the spinal levels involved and have a significant impact on quality of life. External beam radiotherapy is a safe – often very effective – treatment modality for oncologic spine pain. In this chapter, clinical evaluation of patients with spinal metastases will be discussed along with indications for treatment and various approaches with radiation therapy. The evidence base for both traditional external beam radiotherapy and stereotactic ablative radiotherapy is also explored with examples of both treatment modalities. Finally, future developments in the role of radiotherapy in the management of oncologic spine pain are examined, including a brief discussion of the timing and role of systemic agents concurrently with radiotherapy.

Keywords

Radiation SBRT SRS EBRT 3D conformal therapy IMRT Palliation 

References

  1. 1.
    Quinn JA, DeAngelis LM. Neurologic emergencies in the cancer patient. Semin Oncol. 2000;27(3):311–21.PubMedGoogle Scholar
  2. 2.
    Byrne TN. Spinal cord compression from epidural metastases. N Engl J Med. 1992;327(9):614–9.CrossRefGoogle Scholar
  3. 3.
    Macedo F, Ladeira K, Pinho F, Saraiva N, Bonito N, Pinto L, et al. Bone metastases: an overview. Oncol Rev. 2017;11(1):321.CrossRefGoogle Scholar
  4. 4.
    Rades D, Rudat V, Veninga T, Stalpers LJ, Hoskin PJ, Schild SE. Prognostic factors for functional outcome and survival after reirradiation for in-field recurrences of metastatic spinal cord compression. Cancer. 2008;113(5):1090–6.CrossRefGoogle Scholar
  5. 5.
    Fisher CG, DiPaola CP, Ryken TC, Bilsky MH, Shaffrey CI, Berven SH, et al. A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine (Phila Pa 1976). 2010;35(22):E1221–9.CrossRefGoogle Scholar
  6. 6.
    Mirels H. Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop Relat Res. 1989;249:256–64.Google Scholar
  7. 7.
    Fürstenberg CH, Wiedenhöfer B, Gerner HJ, Putz C. The effect of early surgical treatment on recovery in patients with metastatic compression of the spinal cord. J Bone Joint Surg Br. 2009;91(2):240–4.CrossRefGoogle Scholar
  8. 8.
    Hessler C, Burkhardt T, Raimund F, Regelsberger J, Vettorazzi E, Madert J, et al. Dynamics of neurological deficit after surgical decompression of symptomatic vertebral metastases. Spine (Phila Pa 1976). 2009;34(6):566–71.CrossRefGoogle Scholar
  9. 9.
    Chaichana KL, Woodworth GF, Sciubba DM, McGirt MJ, Witham TJ, Bydon A, et al. Predictors of ambulatory function after decompressive surgery for metastatic epidural spinal cord compression. Neurosurgery. 2008;62(3):683–92; discussion 683-92.CrossRefGoogle Scholar
  10. 10.
    Bilsky MH, Laufer I, Fourney DR, Groff M, Schmidt MH, Varga PP, et al. Reliability analysis of the epidural spinal cord compression scale. J Neurosurg Spine. 2010;13(3):324–8.CrossRefGoogle Scholar
  11. 11.
    Ryu S, Yoon H, Stessin A, Gutman F, Rosiello A, Davis R. Contemporary treatment with radiosurgery for spine metastasis and spinal cord compression in 2015. Radiat Oncol J. 2015;33(1):1–11.CrossRefGoogle Scholar
  12. 12.
    Nomiya T, Teruyama K, Wada H, Nemoto K. Time course of pain relief in patients treated with radiotherapy for cancer pain: a prospective study. Clin J Pain. 2010;26(1):38–42.CrossRefGoogle Scholar
  13. 13.
    Hartsell WF, Scott CB, Bruner DW, Scarantino CW, Ivker RA, Roach M 3rd, et al. Randomized trial of short- versus long-course radiotherapy for palliation of painful bone metastases. J Natl Cancer Inst. 2005;97(11):798–804.CrossRefGoogle Scholar
  14. 14.
    Loblaw DA, Wu JS, Kirkbride P, Panzarella T, Smith K, Aslanidis J, et al. Pain flare in patients with bone metastases after palliative radiotherapy--a nested randomized control trial. Support Care Cancer. 2007;15(4):451–5.CrossRefGoogle Scholar
  15. 15.
    Chow E, Meyer RM, Ding K, Nabid A, Chabot P, Wong P, et al. Dexamethasone in the prophylaxis of radiation-induced pain flare after palliative radiotherapy for bone metastases: a double-blind, randomised placebo-controlled, phase 3 trial. Lancet Oncol. 2015;16(15):1463–72.CrossRefGoogle Scholar
  16. 16.
    Wang XS, Rhines LD, Shiu AS, Yang JN, Selek U, Gning I, et al. Stereotactic body radiation therapy for management of spinal metastases in patients without spinal cord compression: a phase 1-2 trial. Lancet Oncol. 2012;13(4):395–402.CrossRefGoogle Scholar
  17. 17.
    Ryu S, Pugh SL, Gerszten PC, Yin FF, Timmerman RD, Hitchcock YJ, et al. RTOG 0631 phase 2/3 study of image guided stereotactic radiosurgery for localized (1-3) spine metastases: phase 2 results. Pract Radiat Oncol. 2014;4(2):76–81.CrossRefGoogle Scholar
  18. 18.
    Gerszten PC, Burton SA, Ozhasoglu C, Welch WC. Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution. Spine (Phila Pa 1976). 2007;32(2):193–9.CrossRefGoogle Scholar
  19. 19.
    Chiang A, Zeng L, Zhang L, Lochray F, Korol R, Loblaw A, et al. Pain flare is a common adverse event in steroid-naïve patients after spine stereotactic body radiation therapy: a prospective clinical trial. Int J Radiat Oncol Biol Phys. 2013;86(4):638–42.CrossRefGoogle Scholar
  20. 20.
    Rose PS, Laufer I, Boland PJ, Hanover A, Bilsky MH, Yamada J, et al. Risk of fracture after single fraction image-guided intensity-modulated radiation therapy to spinal metastases. J Clin Oncol. 2009;27(30):5075–9.CrossRefGoogle Scholar
  21. 21.
    Kawashiro S, Harada H, Katagiri H, Asakura H, Ogawa H, Onoe T, et al. Reirradiation of spinal metastases with intensity-modulated radiation therapy: an analysis of 23 patients. J Radiat Res. 2016;57(2):150–6.CrossRefGoogle Scholar
  22. 22.
    Boyce-Fappiano D, Elibe E, Zhao B, Siddiqui MS, Lee I, Rock J, et al. Reirradiation of the spine with stereotactic radiosurgery: efficacy and toxicity. Pract Radiat Oncol. 2017;7(6):e409–17.CrossRefGoogle Scholar
  23. 23.
    Elibe E, Boyce-Fappiano D, Siddiqui S, Lee I, Rock J, Siddiqui F, et al. Repeat courses of spine stereotactic radiosurgery (SRS): efficacy and toxicity. Radiat Oncol. 2017;99(2):e518–9.Google Scholar
  24. 24.
    Ghia AJ, Guha-Thakurta N, Hess K, Yang JN, Settle SH, Sharpe HJ, et al. Phase 1 study of spinal cord constraint relaxation with single session spine stereotactic radiosurgery in the primary management of patients with inoperable, previously unirradiated metastatic epidural spinal cord compression. Int J Radiat Oncol Biol Phys. 2018;102(5):1481–8.CrossRefGoogle Scholar
  25. 25.
    Soria JC, Ohe Y, Vansteenkiste J, Reungwetwattana T, Chewaskulyong B, Lee KH, et al. Osimertinib in untreated EGFR-mutated advanced non-small-cell lung Cancer. N Engl J Med. 2018;378(2):113–25.CrossRefGoogle Scholar
  26. 26.
    Anker CJ, Grossmann KF, Atkins MB, Suneja G, Tarhini AA, Kirkwood JM. Avoiding severe toxicity from combined BRAF inhibitor and radiation treatment: consensus guidelines from the Eastern Cooperative Oncology Group (ECOG). Int J Radiat Oncol Biol Phys. 2016;95(2):632–46.CrossRefGoogle Scholar
  27. 27.
    Kvistborg P, Philips D, Kelderman S, Hageman L, Ottensmeier C, Joseph-Pietras D, et al. Anti-CTLA-4 therapy broadens the melanoma-reactive CD8+ T cell response. Sci Transl Med. 2014;6(254):254ra128.CrossRefGoogle Scholar
  28. 28.
    Luke JJ, Lemons JM, Karrison TG, Pitroda SP, Melotek JM, Zha Y, et al. Safety and clinical activity of pembrolizumab and multisite stereotactic body radiotherapy in patients with advanced solid tumors. J Clin Oncol. 2018;36(16):1611–8.CrossRefGoogle Scholar
  29. 29.
    Weichselbaum RR, Liang H, Deng L, Fu YX. Radiotherapy and immunotherapy: a beneficial liaison? Nat Rev Clin Oncol. 2017;14(6):365–79.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Brent D. Cameron
    • 1
  • Christien A. Kluwe
    • 1
  • Albert Attia
    • 1
    Email author
  1. 1.Department of Radiation OncologyVanderbilt University Medical CenterNashvilleUSA

Personalised recommendations