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Spinal Tumors and Radiosurgery

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Principles and Practice of Stereotactic Radiosurgery

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Abstract

Spinal tumors epitomize a challenging radiation-treatment paradigm due to the anatomic nature and proximity of the spinal cord. The spine comprises a chain of functional units, with serial-organ-like behavior. Late spinal cord injury or progressive myelopathy may manifest as paresthesias, hyperreflexia, and complete paresis below the irradiated spinal cord segment. Image-guided technology coupled with highly conformal treatment-planning techniques has allowed the safe delivery of tumor-ablative doses of radiotherapy for patients with benign tumors, primary malignant tumors, and spinal metastases. Spinal metastases are more prevalent and radiosurgery results in very high rates of local control for radioresistant metastases. Radiosurgery has been utilized for metastases in the setting of no prior treatment, but also in patients who have recurred after conventional palliative spine radiotherapy and in patients who have required surgical intervention and require postoperative radiation. Higher radiation doses provide better, more durable tumor control, even with hypofractionated regimens. Radiosurgical techniques limit the dose and the volume of normal tissues that are irradiated and treatment is well tolerated. Hence, the rate of severe complications with high-dose hypofractionated spine radiosurgery is extremely low, even when used as salvage therapy in previously irradiated tissue. In complex cases where tumor is located at the dural margin, novel techniques including high-dose intraoperative brachytherapy (i.e., 32P) in conjunction with image-guided radiation therapy offers a significant benefit.

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Conflict of Interest

Yoshiya Yamada is a member of the Speakers Bureau of the Institute for Medical Education and has served as a consultant for Varian Medical Systems.

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Authors and Affiliations

  1. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Evangelia Katsoulakis M.D. & Yoshiya Yamada M.D., F.R.C.P.C.

  2. Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Ilya Laufer

Authors
  1. Evangelia Katsoulakis M.D.
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  2. Ilya Laufer
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  3. Yoshiya Yamada M.D., F.R.C.P.C.
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Corresponding author

Correspondence to Yoshiya Yamada M.D., F.R.C.P.C. .

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Editors and Affiliations

  1. Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, USA

    Lawrence S. Chin

  2. Dept. of Radiation Oncology, Univ. of Maryland School of Medicine, Baltimore, Maryland, USA

    William F. Regine

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Katsoulakis, E., Laufer, I., Yamada, Y. (2015). Spinal Tumors and Radiosurgery. In: Chin, L., Regine, W. (eds) Principles and Practice of Stereotactic Radiosurgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8363-2_44

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  • DOI: https://doi.org/10.1007/978-1-4614-8363-2_44

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-8362-5

  • Online ISBN: 978-1-4614-8363-2

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