Treatment of Metastatic Spinal Epidural Disease: Surgery Versus Radiotherapy

  • Chester K. Yarbrough
  • Wilson Z. Ray
  • Meic H. Schmidt
Chapter
Part of the Tumors of the Central Nervous System book series (TCNS, volume 10)

Abstract

Metastatic spinal disease occurs frequently, affecting as many as 40% of cancer patients over time. Approximately 10% of these patients experience malignant epidural spinal cord compression. Metastasis to the spine causes significant morbidity and often leads an inexorable decline into paraplegia and loss of bowel and bladder function. Advances in surgical techniques have allowed a more aggressive approach to treatments for cytoreduction and spinal stabilization. Fractionated radiotherapy has proved effective in treatment of these patients, but inability to design and implement highly conformal plans initially limited the use of radiation delivery until the development of stereotactic and highly conformal radiation delivery techniques. The current data supporting surgery and radiation for treatment of metastatic spinal disease will be reviewed in this chapter.

Keywords

Spinal Metastasis Vertebral Column Resection Metastatic Spinal Disease Epidural Metastasis Conformal Treatment Planning 
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.

References

  1. Bach F, Larsen BH, Rohde K, Borgesen SE, Gjerris F, Boge-Rasmussen T, Agerlin N, Rasmusson B, Stjernholm P, Sorensen PS (1990) Metastatic spinal cord compression. Occurrence, symptoms, clinical presentations and prognosis in 398 patients with spinal cord compression. Acta Neurochir (Wien) 107:37–43CrossRefGoogle Scholar
  2. Barron KD, Hirano A, Araki S, Terry RD (1959) Experiences with metastatic neoplasms involving the spinal cord. Neurology 9:91–106PubMedCrossRefGoogle Scholar
  3. Bijl HP, van Luijk P, Coppes RP, Schippers JM, Konings AW, van Der Kogel AJ (2005) Regional differences in radiosensitivity across the rat cervical spinal cord. Int J Radiat Oncol Biol Phys 61:543–551PubMedCrossRefGoogle Scholar
  4. Bilsky MH, Yamada Y, Yenice KM, Lovelock M, Hunt M, Gutin PH, Leibel SA (2004) Intensity-modulated stereotactic radiotherapy of paraspinal tumors: a preliminary report. Neurosurgery 54:823–830, discussion 830–821PubMedCrossRefGoogle Scholar
  5. Byrne TN (1992) Spinal cord compression from epidural metastases. N Engl J Med 327:614–619PubMedCrossRefGoogle Scholar
  6. 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 (2007) Phase I/II study of stereotactic body radiotherapy for spinal metastasis and its pattern of failure. J Neurosurg Spine 7:151–160PubMedCrossRefGoogle Scholar
  7. Constans JP, de Divitiis E, Donzelli R, Spaziante R, Meder JF, Haye C (1983) Spinal metastases with neurological manifestations. Review of 600 cases. J Neurosurg 59:111–118PubMedCrossRefGoogle Scholar
  8. Fourney DR, Frangou EM, Ryken TC, Dipaola CP, Shaffrey CI, Berven SH, Bilsky MH, 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, Fisher CG (2011) Spinal instability neoplastic score: an analysis of reliability and validity from the spine oncology study group. J Clin Oncol 29:3072–3077PubMedCrossRefGoogle Scholar
  9. Gerszten PC, Welch WC (2000) Current surgical management of metastatic spinal disease. Oncology (Williston Park) 14:1013–1024, discussion 1024, 1029–1030Google Scholar
  10. Gerszten PC, Lunsford LD, Rutigliano MJ, Kondziolka D, Flickinger JC, Martinez AJ (1995) Single-stage stereotactic diagnosis and radiosurgery: feasibility and cost implications. J Image Guid Surg 1:141–150PubMedCrossRefGoogle Scholar
  11. Gerszten PC, Burton SA, Ozhasoglu C, Welch WC (2007) Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution. Spine (Phila Pa 1976) 32:193–199CrossRefGoogle Scholar
  12. Harrington KD (1984) Anterior cord decompression and spinal stabilization for patients with metastatic lesions of the spine. J Neurosurg 61:107–117PubMedCrossRefGoogle Scholar
  13. Helweg-Larsen S (1996) Clinical outcome in metastatic spinal cord compression. A prospective study of 153 patients. Acta Neurol Scand 94:269–275PubMedCrossRefGoogle Scholar
  14. Kirkpatrick JP, van der Kogel AJ, Schultheiss TE (2010) Radiation dose-volume effects in the spinal cord. Int J Radiat Oncol Biol Phys 76:S42–S49PubMedCrossRefGoogle Scholar
  15. Klimo P Jr, Schmidt MH (2004) Surgical management of spinal metastases. Oncologist 9:188–196PubMedCrossRefGoogle Scholar
  16. Kostuik JP, Weinstein JN (1991) Differential diagnosis and surgical treatment of metastatic spine tumors. In: Frymoyer JW (ed) The adult spine: principles and practice. Raven, Baltimore, pp 861–888Google Scholar
  17. Kwok Y, Tibbs PA, Patchell RA (2006) Clinical approach to metastatic epidural spinal cord compression. Hematol Oncol Clin North Am 20:1297–1305PubMedCrossRefGoogle Scholar
  18. Loblaw DA, Laperriere NJ, Mackillop WJ (2003) A population-based study of malignant spinal cord compression in Ontario. Clin Oncol (R Coll Radiol) 15:211–217CrossRefGoogle Scholar
  19. National Institute for Health and Clinical Excellence (2008) Metastatic spinal cord compression. Retrieved 15 Sep, 2011, from http://guidance.nice.org.uk/CG75
  20. Nielsen OS, Bentzen SM, Sandberg E, Gadeberg CC, Timothy AR (1998) Randomized trial of single dose versus fractionated palliative radiotherapy of bone metastases. Radiother Oncol 47:233–240PubMedCrossRefGoogle Scholar
  21. Overby MC, Rothman AS (1985) Anterolateral decompression for metastatic epidural spinal cord tumors. Results of a modified costotransversectomy approach. J Neurosurg 62:344–348PubMedCrossRefGoogle Scholar
  22. Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, Mohiuddin M, Young B (2005) Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet 366:643–648PubMedCrossRefGoogle Scholar
  23. Perrin RG, Laxton AW (2004) Metastatic spine disease: epidemiology, pathophysiology, and evaluation of patients. Neurosurg Clin N Am 15:365–373PubMedCrossRefGoogle Scholar
  24. Quraishi NA, Gokaslan ZL, Boriani S (2010) The surgical management of metastatic epidural compression of the spinal cord. J Bone Joint Surg Br 92:1054–1060PubMedCrossRefGoogle Scholar
  25. Rades D, Lange M, Veninga T, Stalpers LJ, Bajrovic A, Adamietz IA, Rudat V, Schild SE (2011) Final results of a prospective study comparing the local control of short-course and long-course radiotherapy for metastatic spinal cord compression. Int J Radiat Oncol Biol Phys 79:524–530PubMedCrossRefGoogle Scholar
  26. Ryu S, Rock J, Jain R, Lu M, Anderson J, Jin JY, Rosenblum M, Movsas B, Kim JH (2010) Radiosurgical decompression of metastatic epidural compression. Cancer 116:2250–2257PubMedGoogle Scholar
  27. Schaberg J, Gainor BJ (1985) A profile of metastatic carcinoma of the spine. Spine (Phila Pa 1976) 10:19–20CrossRefGoogle Scholar
  28. Schiff D, O’Neill BP, Suman VJ (1997) Spinal epidural metastasis as the initial manifestation of malignancy: clinical features and diagnostic approach. Neurology 49:452–456PubMedCrossRefGoogle Scholar
  29. Schiff D, O’Neill BP, Wang CH, O’Fallon JR (1998) Neuroimaging and treatment implications of patients with multiple epidural spinal metastases. Cancer 83:1593–1601PubMedCrossRefGoogle Scholar
  30. Sheehan JP, Shaffrey CI, Schlesinger D, Williams BJ, Arlet V, Larner J (2009) Radiosurgery in the treatment of spinal metastases: tumor control, survival, and quality of life after helical tomotherapy. Neurosurgery 65:1052–1061, discussion 1061–1052PubMedCrossRefGoogle Scholar
  31. Siegal T, Robin G, Lubetzki-Korn I, Fuks Z (1982) Anterior decompression of the spine for metastatic epidural cord compression: a promising avenue of therapy? Ann Neurol 11:28–34PubMedCrossRefGoogle Scholar
  32. Sundaresan N, Galicich JH, Bains MS, Martini N, Beattie EJ Jr (1984) Vertebral body resection in the treatment of cancer involving the spine. Cancer 53:1393–1396PubMedCrossRefGoogle Scholar
  33. Yamada Y, Bilsky MH, Lovelock DM, Venkatraman ES, Toner S, Johnson J, Zatcky J, Zelefsky MJ, Fuks Z (2008) High-dose, single-fraction image-guided intensity-modulated radiotherapy for metastatic spinal lesions. Int J Radiat Oncol Biol Phys 71:484–490PubMedCrossRefGoogle Scholar
  34. Young RF, Post EM, King GA (1980) Treatment of spinal epidural metastases. Randomized prospective comparison of laminectomy and radiotherapy. J Neurosurg 53:741–748PubMedCrossRefGoogle Scholar
  35. Zaikova O, Fossa SD, Bruland OS, Giercksky KE, Sandstad B, Skjeldal S (2011) Radiotherapy or surgery for spine metastases? Acta Orthop 82:365–371PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Chester K. Yarbrough
    • 2
  • Wilson Z. Ray
    • 1
  • Meic H. Schmidt
    • 1
  1. 1.Department of NeurosurgeryUniversity of Utah, Clinical Neurosciences CenterSalt Lake CityUSA
  2. 2.Department of NeurosurgeryWashington UniversitySt. LouisUSA

Personalised recommendations