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.
KeywordsRadiation SBRT SRS EBRT 3D conformal therapy IMRT Palliation
- 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.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
- 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.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