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The Role of Radiotherapy in Spinal Metastases

  • Francesca De Felice
  • Daniela Musio
  • Vincenzo Tombolini
Chapter

Abstract

Nowadays metastatic disease dominates the survival outcomes of cancer patients, due to modern combined modality therapies. The spine represents the most common site of bone metastases.

Treatment decisions primarily depend on clinical symptoms, spinal stability, extent of disease, and medical comorbidities. Radiation therapy (RT) plays a crucial role in the palliative management of spinal metastases (SM). The main objective is to provide pain relief and preserve neurological function.

Keywords

Spinal metastases Palliative radiotherapy External beam radiotherapy Stereotactic body radiotherapy Spinal cord compression Pain Quality of life 

References

  1. 1.
    Schmidt MH, Klimo P Jr, Vrionis FD. Metastatic spinal cord compression. J Natl Compr Cancer Netw. 2005;3(5):711–9.CrossRefGoogle Scholar
  2. 2.
    Sutcliffe P, Connock M, Shyangdan D, Court R, Kandala NB, Clarke A. A systematic review of evidence on malignant spinal metastases: natural history and technologies for identifying patients at high risk of vertebral fracture and spinal cord compression. Health Technol Assess. 2013;17(42):1–274.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Jabehdar Maralani P, Lo SS, Redmond K, Soliman H, Myrehaug S, Husain ZA, Heyn C, Kapadia A, Chan A, Sahgal A. Spinal metastases: multimodality imaging in diagnosis and stereotactic body radiation therapy planning. Future Oncol. 2017;13(1):77–91.CrossRefPubMedGoogle Scholar
  4. 4.
    Maccauro G, Spinelli MS, Mauro S, Perisano C, Graci C, Rosa MA. Physiopathology of spine metastasis. Int J Surg Oncol. 2011;2011:107969.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Sciubba DM, Petteys RJ, Dekutoski MB, Fisher CG, Fehlings MG, Ondra SL, Rhines LD, Gokaslan ZL. Diagnosis and management of metastatic spine disease. A review. J Neurosurg Spine. 2010;13(1):94–108.CrossRefPubMedGoogle Scholar
  6. 6.
    Fisher CG, DiPaola CP, Ryken TC, Bilsky MH, Shaffrey CI, Berven SH, Harrop JS, Fehlings MG, Boriani S, Chou D, Schmidt MH, Polly DW, Biagini R, Burch S, Dekutoski MB, Ganju A, Gerszten PC, Gokaslan ZL, Groff MW, Liebsch NJ, Mendel E, Okuno SH, Patel S, Rhines LD, Rose PS, Sciubba DM, Sundaresan N, Tomita K, Varga PP, Vialle LR, Vrionis FD, Yamada Y, Fourney DR. 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
  7. 7.
    Bilsky MH, Laufer I, Fourney DR, Groff M, Schmidt MH, Varga PP, Vrionis FD, Yamada Y, Gerszten PC, Kuklo TR. Reliability analysis of the epidural spinal cord compression scale. J Neurosurg Spine. 2010;13(3):324–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Lutz S. The role of radiation therapy in controlling painful bone metastases. Curr Pain Headache Rep. 2012;16(4):300–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Lutz S, Berk L, Chang E, Chow E, Hahn C, Hoskin P, Howell D, Konski A, Kachnic L, Lo S, Sahgal A, Silverman L, von Gunten C, Mendel E, Vassil A, Bruner DW, Hartsell W, American Society for Radiation Oncology (ASTRO). Palliative radiotherapy for bone metastases: an ASTRO evidence-based guideline. Int J Radiat Oncol Biol Phys. 2011;79(4):965–76.CrossRefPubMedGoogle Scholar
  10. 10.
    Bhattacharya IS, Hoskin PJ. Stereotactic body radiotherapy for spinal and bone metastases. Clin Oncol (R Coll Radiol). 2015;27(5):298–306.CrossRefGoogle Scholar
  11. 11.
    Saarto T, Janes R, Tenhunen M, Kouri M. Palliative radiotherapy in the treatment of skeletal metastases. Eur J Pain. 2002;6(5):323–30.CrossRefPubMedGoogle Scholar
  12. 12.
    Wu JS, Wong RK, Lloyd NS, Johnston M, Bezjak A, Whelan T, Supportive Care Guidelines Group of Cancer Care Ontario. Radiotherapy fractionation for the palliation of uncomplicated painful bone metastases—an evidence-based practice guideline. BMC Cancer. 2004;4:71.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    No Authors. 8 Gy single fraction radiotherapy for the treatment of metastatic skeletal pain: randomised comparison with a multifraction schedule over 12 months of patient follow-up. Bone Pain Trial Working Party. Radiother Oncol. 1999;52(2):111–21.CrossRefGoogle Scholar
  14. 14.
    Hartsell WF, Scott CB, Bruner DW, Scarantino CW, Ivker RA, Roach M 3rd, Suh JH, Demas WF, Movsas B, Petersen IA, Konski AA, Cleeland CS, Janjan NA, DeSilvio M. Randomized trial of short- versus long-course radiotherapy for palliation of painful bone metastases. J Natl Cancer Inst. 2005;97(11):798–804.CrossRefPubMedGoogle Scholar
  15. 15.
    Foro Arnalot P, Fontanals AV, Galcerán JC, Lynd F, Latiesas XS, de Dios NR, Castillejo AR, Bassols ML, Galán JL, Conejo IM, López MA. Randomized clinical trial with two palliative radiotherapy regimens in painful bone metastases: 30 Gy in 10 fractions compared with 8 Gy in single fraction. Radiother Oncol. 2008;89(2):150–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Steenland E, Leer JW, van Houwelingen H, Post WJ, van den Hout WB, Kievit J, de Haes H, Martijn H, Oei B, Vonk E, van der Steen-Banasik E, Wiggenraad RG, Hoogenhout J, Wárlám-Rodenhuis C, van Tienhoven G, Wanders R, Pomp J, van Reijn M, van Mierlo I, Rutten E. The effect of a single fraction compared to multiple fractions on painful bone metastases: a global analysis of the Dutch Bone Metastasis Study. Radiother Oncol. 1999;52(2):101–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Nielsen OS, Bentzen SM, Sandberg E, Gadeberg CC, Timothy AR. Randomized trial of single dose versus fractionated palliative radiotherapy of bone metastases. Radiother Oncol. 1998;47(3):233–40.CrossRefPubMedGoogle Scholar
  18. 18.
    Gaze MN, Kelly CG, Kerr GR, Cull A, Cowie VJ, Gregor A, Howard GC, Rodger A. Pain relief and quality of life following radiotherapy for bone metastases: a randomised trial of two fractionation schedules. Radiother Oncol. 1997;45(2):109–16.CrossRefPubMedGoogle Scholar
  19. 19.
    Chow E, Zeng L, Salvo N, Dennis K, Tsao M, Lutz S. Update on the systematic review of palliative radiotherapy trials for bone metastases. Clin Oncol (R Coll Radiol). 2012;24(2):112–24.CrossRefGoogle Scholar
  20. 20.
    Sahgal A, Bilsky M, Chang EL, Ma L, Yamada Y, Rhines LD, Létourneau D, Foote M, Yu E, Larson DA, Fehlings MG. Stereotactic body radiotherapy for spinal metastases: current status, with a focus on its application in the postoperative patient. J Neurosurg Spine. 2011;14(2):151–66.CrossRefPubMedGoogle Scholar
  21. 21.
    Chang EL, Shiu AS, Mendel E, Mathews LA, Mahajan A, Allen PK, Weinberg JS, Brown BW, Wang XS, Woo SY, Cleeland C, Maor MH, Rhines LD. Phase I/II study of stereotactic body radiotherapy for spinal metastasis and its pattern of failure. J Neurosurg Spine. 2007;7(2):151–60.CrossRefGoogle Scholar
  22. 22.
    Koyfman SA, Djemil T, Burdick MJ, Woody N, Balagamwala EH, Reddy CA, Angelov L, Suh JH, Chao ST. Marginal recurrence requiring salvage radiotherapy after stereotactic body radiotherapy for spinal metastases. Int J Radiat Oncol Biol Phys. 2012;83(1):297–302.CrossRefPubMedGoogle Scholar
  23. 23.
    Cox BW, Spratt DE, Lovelock M, Bilsky MH, Lis E, Ryu S, Sheehan J, Gerszten PC, Chang E, Gibbs I, Soltys S, Sahgal A, Deasy J, Flickinger J, Quader M, Mindea S, Yamada Y. International Spine Radiosurgery Consortium consensus guidelines for target volume definition in spinal stereotactic radiosurgery. Int J Radiat Oncol Biol Phys. 2012;83(5):e597–605.CrossRefPubMedGoogle Scholar
  24. 24.
    Redmond KJ, Robertson S, Lo SS, Soltys SG, Ryu S, McNutt T, Chao ST, Yamada Y, Ghia A, Chang EL, Sheehan J, Sahgal A. Consensus contouring guidelines for postoperative stereotactic body radiation therapy for metastatic solid tumor malignancies to the spine. Int J Radiat Oncol Biol Phys. 2017;97:64–74.CrossRefPubMedGoogle Scholar
  25. 25.
    De Felice F, Musio D, Tombolini V. Osteoradionecrosis and intensity modulated radiation therapy: an overview. Crit Rev Oncol Hematol. 2016;107:39–43.CrossRefPubMedGoogle Scholar
  26. 26.
    Withers HR, Taylor JM, Maciejewski B. Treatment volume and tissue tolerance. Int J Radiat Oncol Biol Phys. 1988;14(4):751–9.CrossRefPubMedGoogle Scholar
  27. 27.
    Kirkpatrick JP, van der Kogel AJ, Schultheiss TE. Radiation dose-volume effects in the spinal cord. Int J Radiat Oncol Biol Phys. 2010;76(3 Suppl):S42–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Chang JH, Shin JH, Yamada YJ, Mesfin A, Fehlings MG, Rhines LD, Sahgal A. Stereotactic body radiotherapy for spinal metastases: what are the risks and how do we minimize them? Spine (Phila Pa 1976). 2016;41(Suppl 20):S238–45.CrossRefGoogle Scholar
  29. 29.
    Cunha MV, Al-Omair A, Atenafu EG, Masucci GL, Letourneau D, Korol R, Yu E, Howard P, Lochray F, da Costa LB, Fehlings MG, Sahgal A. Vertebral compression fracture (VCF) after spine stereotactic body radiation therapy (SBRT): analysis of predictive factors. Int J Radiat Oncol Biol Phys. 2012;84(3):e343–9.CrossRefPubMedGoogle Scholar
  30. 30.
    Sahgal A, Whyne CM, Ma L, Larson DA, Fehlings MG. Vertebral compression fracture after stereotactic body radiotherapy for spinal metastases. Lancet Oncol. 2013;14(8):e310–20.CrossRefPubMedGoogle Scholar
  31. 31.
    Chow E, Hoskin P, Mitera G, Zeng L, Lutz S, Roos D, Hahn C, van der Linden Y, Hartsell W, Kumar E, International Bone Metastases Consensus Working Party. Update of the international consensus on palliative radiotherapy endpoints for future clinical trials in bone metastases. Int J Radiat Oncol Biol Phys. 2012;82(5):1730–7.CrossRefPubMedGoogle Scholar
  32. 32.
    Chow E, van der Linden YM, Roos D, Hartsell WF, Hoskin P, Wu JS, Brundage MD, Nabid A, Tissing-Tan CJ, Oei B, Babington S, Demas WF, Wilson CF, Meyer RM, Chen BE, Wong RK. Single versus multiple fractions of repeat radiation for painful bone metastases: a randomised, controlled, non-inferiority trial. Lancet Oncol. 2014;15(2):164–71.CrossRefPubMedGoogle Scholar
  33. 33.
    Sahgal A, Ames C, Chou D, Ma L, Huang K, Xu W, Chin C, Weinberg V, Chuang C, Weinstein P, Larson DA. 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
  34. 34.
    Choi CY, Adler JR, Gibbs IC, Chang SD, Jackson PS, Minn AY, Lieberson RE, Soltys SG. 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
  35. 35.
    Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, Mohiuddin M, Young B. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet. 2005;366(9486):643–8.CrossRefPubMedGoogle Scholar
  36. 36.
    Maranzano E, Trippa F, Casale M, Costantini S, Lupattelli M, Bellavita R, Marafioti L, Pergolizzi S, Santacaterina A, Mignogna M, Silvano G, Fusco V. 8Gy single-dose radiotherapy is effective in metastatic spinal cord compression: results of a phase III randomized multicentre Italian trial. Radiother Oncol. 2009;93(2):174–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Francesca De Felice
    • 1
  • Daniela Musio
    • 1
  • Vincenzo Tombolini
    • 1
  1. 1.Department of Radiological, Oncological and Anatomo-Pathological SciencesPoliclinico Umberto I “Sapienza” University of RomeRomeItaly

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