Stereotactic Radiosurgery for Metastatic Lesions of the Spine

  • Harun Badakhshi


Conventional radiotherapy can control spinal oligometastases. When lesions to the spine occur in diffuse pattern, conventional radiation is effective and it is a cost-efficient procedure. When spine metastases are limited by volume, number, and occurrence site, image-guided stereotactic radiosurgery might be a good alternative. It spares healthy tissue, especially the spinal cord.

Many patients (f/m) with metastasizing cancers like breast and lung cancer or prostate cancer could be controlled very well in long term.

Invasive surgical procedures indeed even when performed in a minimally invasive mode do not seem to be a good option. Any “standard” has to prove its superiority in terms of safety and effectiveness for patients (f/m), and it is true in the frame of cost efficiency too.

Image-guided stereotactic radiosurgery could affect spinal lesions by deactivating tumor cells because they are responsive to high-dose radiotherapy. The aim would be to prolong the time free of symptoms and, therefore, of a better quality of life.

Consecutively, it demonstrates a noninvasive high-precision and safe technique in treating patients (f/m).


Bone Metastasis Metastatic Lesion Spinal Metastasis Spinal Tumor American Spinal Injury Association 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Rades D, Segedin B, Conde-Moreno AJ, Garcia R, Perpar A, Metz M, et al. Radiotherapy with 4 Gy x 5 versus 3 Gy x 10 for metastatic epidural spinal cord compression: final results of the SCORE-2 trial (ARO 2009/01). J Clin Oncol Off J Am Soc Clin Oncol. 2016;34(6):597–602.CrossRefGoogle Scholar
  2. 2.
    Barragan-Campos HM, Jimenez-Zarazua O, Mondragon JD. Diagnosis and treatment options of spinal metastases. Revista de investigacion clinica organo del Hospital de Enfermedades de la Nutricion. 2015;67(3):140–57.PubMedGoogle Scholar
  3. 3.
    Ejima Y, Matsuo Y, Sasaki R. The current status and future of radiotherapy for spinal bone metastases. J Orthop Sci Off J Jpn Orthop Assoc. 2015;20(4):585–92.Google Scholar
  4. 4.
    Joaquim AF, Powers A, Laufer I, Bilsky MH. An update in the management of spinal metastases. Arq Neuropsiquiatr. 2015;73(9):795–802.CrossRefPubMedGoogle Scholar
  5. 5.
    Joaquim AF, Ghizoni E, Tedeschi H, Pereira EB, Giacomini LA. Stereotactic radiosurgery for spinal metastases: a literature review. Einstein. 2013;11(2):247–55.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Chen YJ, Chen HT, Hsu HC. Preoperative palsy score has no significant association with survival in non-small-cell lung cancer patients with spinal metastases who undergo spinal surgery. J Orthop Surg Res. 2015;10:149.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Switlyk MD, Kongsgaard U, Skjeldal S, Hald JK, Hole KH, Knutstad K, et al. Prognostic factors in patients with symptomatic spinal metastases and normal neurological function. Clin Oncol. 2015;27(4):213–21.CrossRefGoogle Scholar
  8. 8.
    Tang C, Hess K, Bishop AJ, Pan HY, Christensen EN, Yang JN, et al. Creation of a prognostic index for spine metastasis to stratify survival in patients treated with spinal stereotactic radiosurgery: secondary analysis of mature prospective trials. Int J Radiat Oncol Biol Phys. 2015;93(1):118–25.CrossRefPubMedGoogle Scholar
  9. 9.
    Dong L, Tan M, Wu D, Yi P, Yang F, Tang X, et al. Palliative surgery for spinal metastases using posterior decompression and fixation combined with intra-operative vertebroplasty. J Spinal Disord Tech. 2015.Google Scholar
  10. 10.
    Kitagawa R, Murakami H, Kato S, Nakada M, Demura S, Tsuchiya H. En bloc resection and reconstruction using a frozen tumor-bearing bone for metastases of the spine and cranium from retroperitoneal paraganglioma. World Neurosurg. 2015. pii: S1878-8750(15)01303-0. doi:  10.1016/j.wneu.2015.09.102.
  11. 11.
    Rades D, Veninga T, Stalpers LJ, Basic H, Rudat V, Karstens JH, et al. Outcome after radiotherapy alone for metastatic spinal cord compression in patients with oligometastases. J Clin Oncol Off J Am Soc Clin Oncol. 2007;25(1):50–6.CrossRefGoogle Scholar
  12. 12.
    Chen H, Winey BA, Daartz J, Oh KS, Shin JH, Gierga DP. Efficiency gains for spinal radiosurgery using multicriteria optimization intensity modulated radiation therapy guided volumetric modulated arc therapy planning. Pract Radiat Oncol. 2015;5(1):49–55.CrossRefPubMedGoogle Scholar
  13. 13.
    Versteeg AL, van der Velden JM, Verkooijen HM, van Vulpen M, Oner FC, Fisher CG, et al. The effect of introducing the spinal instability neoplastic score in routine clinical practice for patients with spinal metastases. Oncologist. 2016;21(1):95–101.CrossRefPubMedGoogle Scholar
  14. 14.
    Schlampp I, Lang H, Forster R, Wolf R, Bostel T, Bruckner T, et al. Stability of spinal bone metastases and survival analysis in renal cancer after radiotherapy. Tumori. 2015;101(6):614–20.CrossRefPubMedGoogle Scholar
  15. 15.
    Bydon M, De la Garza-Ramos R, Bettagowda C, Gokaslan ZL, Sciubba DM. The use of stereotactic radiosurgery for the treatment of spinal axis tumors: a review. Clin Neurol Neurosurg. 2014;125:166–72.CrossRefPubMedGoogle Scholar
  16. 16.
    Mahadevan A, Floyd S, Wong E, Jeyapalan S, Groff M, Kasper E. Stereotactic body radiotherapy reirradiation for recurrent epidural spinal metastases. Int J Radiat Oncol Biol Phys. 2011;81(5):1500–5.CrossRefPubMedGoogle Scholar
  17. 17.
    Garg AK, Wang XS, Shiu AS, Allen P, Yang J, McAleer MF, et al. Prospective evaluation of spinal reirradiation by using stereotactic body radiation therapy: The University of Texas MD Anderson Cancer Center experience. Cancer. 2011;117(15):3509–16.CrossRefPubMedGoogle Scholar
  18. 18.
    Damast S, Wright J, Bilsky M, Hsu M, Zhang Z, Lovelock M, et al. Impact of dose on local failure rates after image-guided reirradiation of recurrent paraspinal metastases. Int J Radiat Oncol Biol Phys. 2011;81(3):819–26.CrossRefPubMedGoogle Scholar
  19. 19.
    Choi CY, Adler JR, Gibbs IC, Chang SD, Jackson PS, Minn AY, et al. Stereotactic radiosurgery for treatment of spinal metastases recurring in close proximity to previously irradiated spinal cord. Int J Radiat Oncol Biol Phys. 2010;78(2):499–506.CrossRefPubMedGoogle Scholar
  20. 20.
    Chang EL, Shiu AS, Mendel E, Mathews LA, Mahajan A, Allen PK, et al. Phase I/II study of stereotactic body radiotherapy for spinal metastasis and its pattern of failure. J Neurosurg Spine. 2007;7(2):151–60.CrossRefPubMedGoogle Scholar
  21. 21.
    Gerszten PC, Burton SA, Ozhasoglu C, Welch WC. Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution. Spine. 2007;32(2):193–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Chang EL, Shiu AS, Lii MF, Rhines LD, Mendel E, Mahajan A, et al. Phase I clinical evaluation of near-simultaneous computed tomographic image-guided stereotactic body radiotherapy for spinal metastases. Int J Radiat Oncol Biol Phys. 2004;59(5):1288–94.CrossRefPubMedGoogle Scholar
  23. 23.
    Gerszten PC, Burton SA, Ozhasoglu C, Vogel WJ, Welch WC, Baar J, et al. Stereotactic radiosurgery for spinal metastases from renal cell carcinoma. J Neurosurg Spine. 2005;3(4):288–95.CrossRefPubMedGoogle Scholar
  24. 24.
    Sheehan JP, Jagannathan J. Review of spinal radiosurgery: a minimally invasive approach for the treatment of spinal and paraspinal metastases. Neurosurg Focus. 2008;25(2):E18.CrossRefPubMedGoogle Scholar
  25. 25.
    Sahgal A, Ames C, Chou D, Ma L, Huang K, Xu W, et al. Stereotactic body radiotherapy is effective salvage therapy for patients with prior radiation of spinal metastases. Int J Radiat Oncol Biol Phys. 2009;74(3):723–31.CrossRefPubMedGoogle Scholar
  26. 26.
    Ahmed KA, Stauder MC, Miller RC, Bauer HJ, Rose PS, Olivier KR, et al. Stereotactic body radiation therapy in spinal metastases. Int J Radiat Oncol Biol Phys. 2012;82(5):e803–9.CrossRefPubMedGoogle Scholar
  27. 27.
    Balagamwala EH, Angelov L, Koyfman SA, Suh JH, Reddy CA, Djemil T, et al. Single-fraction stereotactic body radiotherapy for spinal metastases from renal cell carcinoma. J Neurosurg Spine. 2012;17(6):556–64.CrossRefPubMedGoogle Scholar
  28. 28.
    Garg AK, Shiu AS, Yang J, Wang XS, Allen P, Brown BW, et al. Phase 1/2 trial of single-session stereotactic body radiotherapy for previously unirradiated spinal metastases. Cancer. 2012;118(20):5069–77.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Mantel F, Glatz S, Toussaint A, Flentje M, Guckenberger M. Long-term safety and efficacy of fractionated stereotactic body radiation therapy for spinal metastases. Strahlentherapie und Onkologie Organ der Deutschen Rontgengesellschaft [et al]. 2014;190(12):1141–8.CrossRefGoogle Scholar
  31. 31.
    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.CrossRefPubMedGoogle Scholar
  32. 32.
    Ghia AJ, Chang EL, Bishop AJ, Pan HY, Boehling NS, Amini B, et al. Single-fraction versus multifraction spinal stereotactic radiosurgery for spinal metastases from renal cell carcinoma: secondary analysis of Phase I/II trials. J Neurosurg Spine. 2016:1–8.Google Scholar
  33. 33.
    Puvanesarajah V, Lo SL, Aygun N, Liauw JA, Jusue-Torres I, Lina IA, et al. Prognostic factors associated with pain palliation after spine stereotactic body radiation therapy. J Neurosurg Spine. 2015:1–10.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Harun Badakhshi
    • 1
  1. 1.Department of Radiation OncologyCharité School of MedicineBerlinGermany

Personalised recommendations