Common Radiotherapy Techniques for Spinal Tumors

  • Mohamed A. Elshaikh
  • Roger M. Macklis
Part of the Current Clinical Oncology book series (CCO)


Radiation therapy is an important modality in the management of both primary and metastatic tumors involving the spine and spinal cord. The mesenchymal elements of the spinal column and its contents may give rise to a wide variety of primary tumors. Yet, primary neoplastic lesions of the spine are rare, accounting for roughly 5 to 10% of all skeletal tumors. Metastatic lesions of the spine are far more common (1). True spinal cord neoplasms are relatively rare and typically intradural in location. Radiation therapy has evolved over the past decades to better meet these needs. Better pretreatment imaging studies, megavoltage linear accelerators, and computer-based three-dimentional (3D) treatment planning are all improving radiation dose distributions, thus, decreasing the likelihood of severe acute or late toxicity.


Spinal Cord Radiat Oncol Biol Phys Spinal Cord Compression Spinal Tumor Spinal Cord Tumor 
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.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Dahlin DC, Unni KK. Bone Tumors: General Aspects and Data on 8,542 Cases. Springfield, IL: Charles C. Thomas; 1986.Google Scholar
  2. 2.
    Atkins HL, Tretter P. Time-dose consideration in radiation myelopathy. Acta Radiol Ther Phys Biol 1966;5:79–94.Google Scholar
  3. 3.
    Wara WM, Philips TL, Sheline GE, et al. Radiation tolerance of the spinal cord. Cancer 1975;35:1558–1562.PubMedCrossRefGoogle Scholar
  4. 4.
    Emami B, Lyman J, Brown A, et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 1991;21:109–122.PubMedGoogle Scholar
  5. 5.
    Kim YH, Fayos JV. Radiation tolerance of the cervical spinal cord. Radiology 1981;139:473–478.PubMedGoogle Scholar
  6. 6.
    Van der Kogel AJ. Retreatment tolerance of the spinal cord. Int J Radiat Oncol Biol Phys 1993;26:715–717.PubMedGoogle Scholar
  7. 7.
    Marcus RB, Million RR. The incidence of myelitis after irradiation of the cervical spinal cord. Int J Radiat Oncol Biol Phys 1990;19:3–8.PubMedGoogle Scholar
  8. 8.
    Jeromic B, Djuric L, Mijatovic L. Incidence of radiation myelitis of the cervical spinal cord at doses of 5500 cGy or greater. Cancer 1991;8:2138–2141.CrossRefGoogle Scholar
  9. 9.
    Schulthesiss TE, Stephens LC, Ang KK, Price RE, Peters LJ. Volume effects in Rhesus monkey spinal cord. Int J Radiat Oncl Biol Phys 1994;9:67–72.CrossRefGoogle Scholar
  10. 10.
    Lavey RS, Johnstone AK, Taylor JM, McBride WH. The effect of hyperfractionation on spinal cord response to radiation. Int J Radiat Oncol Biol Phys 1992;4:68–686.Google Scholar
  11. 11.
    Ang KK, Jiang GL, Guttenberger, et al. Impact of spinal cord repair kinetics on the practice of altered fractionation schedules. Radiother Oncol 1992;5:287–294.CrossRefGoogle Scholar
  12. 12.
    Janjan, N: Radiotherapeutic management of spinal metastases. J of Pain and Symptom Manage 1995;1:47–56.Google Scholar
  13. 13.
    Ruifrok ACC, Kleiboer BJ, van der Kogel AJ. Reirradiation tolerance of the immature rat spinal cord. Radiother Oncol 1992;3:249–256.CrossRefGoogle Scholar
  14. 14.
    Pirzkall A, Lohr F, Rhein B, et al. Conformal radiotherapy of challenging paraspinal tumors using multiple arc segment technique. Int J Radiat Oncol Biol Phys 2000;48:1197–1204.PubMedCrossRefGoogle Scholar
  15. 15.
    Greenberg HS, Kim JH, Posner JB. Epidural spinal cord compression from metastatic tumor. Results from a new protocol. Ann Neurol 1980;8:361–366.PubMedCrossRefGoogle Scholar
  16. 16.
    Ushio Y, Posner R, Posner JB, Shapiro WR. Experimental spinal cord compression by epidural neoplasms. Neurology 1977;27:422–429.PubMedGoogle Scholar
  17. 17.
    Maranzano E, Latini P, Beneventi S, et al. Radiotherapy without steroids in selected metastatic spinal cord compression patients. A phase II trial. Am J of Clinical Oncol 1996;19:179–183.CrossRefGoogle Scholar
  18. 18.
    Boogerd W, van der Sande JJ. Diagnosis and treatment of spinal cord compression in malignant disease. Cancer Treat Rev 1993;19:129–150.PubMedCrossRefGoogle Scholar
  19. 19.
    Grant R, Papadopoulous SM, Greenberg HS. Metastatic epidural spinal cord compression. Neur Clin 1991;9:825–841.Google Scholar
  20. 20.
    Georgy BA, Hasselink JR. MR imaging of spine: recent advances in pulse sequence and special technique. Am J Roentgenol 1994;162:923–934.Google Scholar
  21. 21.
    Maranzano E, Latini P, Checcaglini F, et al. Radiation therapy in metastatic spinal cord compression-a prospective analysis of 105 patients. Cancer 1991;67:1311–1317.PubMedCrossRefGoogle Scholar
  22. 22.
    Maranzano E, Latini P, Checcaglini F, et al. Radiation therapy of spinal cord compression caused by breast cancer: report of a prospective trial. Int J Radiat Oncol Biol Phys 1992;24:301–306.PubMedGoogle Scholar
  23. 23.
    Gilbert RW, Kim JH, Posner JB. Epidural spinal cord compression from metastatic tumor: diagnosis and treatment. Ann Neurol 1978;3:40–51.PubMedCrossRefGoogle Scholar
  24. 24.
    Zelefsky MJ, Scher HI, Krol G, Portenoy RK, Leibel SA, Fuks ZY. Spinal epidural tumor in-patients with prostate cancer. Clinical and radiographic predictors of response to radiation therapy. Cancer 1992;70:2319–2325.PubMedCrossRefGoogle Scholar
  25. 25.
    Bach F, Agerlin N, Sorensen JB, et al. Metastatic spinal cord compression secondary to lung cancer. J Clin Oncol 1992;10:1781–1787.PubMedGoogle Scholar
  26. 26.
    Constans JP, de Divitiis E, Donzelli R, Spaziante R, Meder JF, Haye C. Spinal metastases with neurological manifestations. Review of 600 cases. J Neurosurg 1983;59:111–118.PubMedGoogle Scholar
  27. 27.
    Young RF, Post EM, King GA. Treatment of spinal epidural metastases: Randomized prospective comparison of laminectomy and radiotherapy. J Neurosurg 1980;53:741–748.PubMedGoogle Scholar
  28. 28.
    Shirato H, Kamada T, Hida K, et al. The role of radiotherapy in the management of spinal cord glioma. Int J Radiat Oncol Biol Phys 1995;33:323–328.PubMedGoogle Scholar
  29. 29.
    Epstein FJ, Farmer JP, Freed D. Adult intramedullary spinal cord ependymoma: the results of surgery in 38 patients. J Neurosurg 1993;79:204–209.PubMedGoogle Scholar
  30. 30.
    Hulshof MCCM, Menten J, Dito JJ, et al. Treatment results in primary intraspinal gliomas. Radioth Oncol 1993;29:294–300.CrossRefGoogle Scholar
  31. 31.
    Di Marco A, Griso C, Pradella R, Campostrini F, Garusi GF. Postoperative management of primary spinal cord ependymoma. Acta Oncol 1988;27:371–375.PubMedCrossRefGoogle Scholar
  32. 32.
    Cooper PR. Outcome after operative treatment of intramedullary spinal cord tumors in adults: Intermediate and long-term results in 51 patients. Neurosurgery 1989; 25:855–859.PubMedCrossRefGoogle Scholar
  33. 33.
    Schwade JG, Wara WM, Sheline GE. Management of primary spinal cord tumors. Int J Radiat Oncol Biol Phys 1978;4:389–393.PubMedGoogle Scholar
  34. 34.
    Peschel RE, Kapp DS, Cardinale F, Manuelidis EE. Ependymoma of the spinal cord. Int J Radiat Oncol Biol Phys 1983;9:1093–1096.PubMedGoogle Scholar
  35. 35.
    Sgouros S, Malluci CL, Jackowski A. Spinal ependymoma. The value of postoperative radiotherapy for residual disease control. Br J Neurosurg 1996;10:559–566.PubMedCrossRefGoogle Scholar
  36. 36.
    Ferrante L, Mastronardi L, Celli P, Lunardi P, Acqui M, Fortuna A. Intramedullary spinal cord ependymoma: a study of 45 cases with long term follow-up. Acta Neurochir 1992;119:74–79.CrossRefGoogle Scholar
  37. 37.
    Constantini S, Allen J, Epstein F. Pediatric and adult spinal cord tumors. In: Black PM, Loeffler J, eds. Cancer of the nervous system. Cambridge, MA: Blackwell Science; 1997:637–652.Google Scholar
  38. 38.
    Garret PG, Simpson WJK. Ependymomas: results of radiation treatment. Int J Radiat Oncol Biol Phys 1983;9:1121–1124.Google Scholar
  39. 39.
    Kopelson G, Linggood RM, Kleinman GM, Doucette J, Wang CC. Management of intramedullary spinal cord tumors. Radiology 1980;135:473–479.PubMedGoogle Scholar
  40. 40.
    Garcia DM. Primary spinal cord tumors treated with surgery and postoperative irradiation. Int J Radiat Oncol Biol Phys 1985;11:1933–1939.PubMedGoogle Scholar
  41. 41.
    Shaw EG, Evans RG, Scheithauer BW, Ilstrup DM, Earle JD. Radiotherapeutic management of adult intraspinal ependymomas. Int J radiat Oncol Biol Phys 1986;12:323–327.PubMedGoogle Scholar
  42. 42.
    Linstadt DE, Wara WM, Leibel SA, Gutin PH, Wilson CB, Sheline GE. Postoperative radiotherapy of primary spinal cord tumors. Int J Radiat Oncol Biol Phys 1989;16:1397–1403.PubMedGoogle Scholar
  43. 43.
    Whitaker SJ, Bessell EM, Ashley SE, Bloom HJ, Bell BA, Brada M. Postoperative radiotherapy in the management of spinal cord ependymoma. J Neurosurg 1991;74:720–728.PubMedGoogle Scholar
  44. 44.
    Waldron JN, Laperierre NJ, Jaakkimainen L, et al. Spinal cord ependymoma: a retrospective analysis of 59 cases. Int J Radiat Oncol Biol Phys 1993;27:223–229.PubMedGoogle Scholar
  45. 45.
    Reimer R, Onofrio BM. Astrocytoma of the spinal cord in children and adolescents. J Neurosurg 1985;63:669–675.PubMedCrossRefGoogle Scholar
  46. 46.
    Jyothirmayi R, Madhavan J, Nair M, Rajan B. Conservative surgery and radiotherapy in the treatment of spinal cord astrocytoma. J Neurooncol 1997;33:205–211.PubMedCrossRefGoogle Scholar
  47. 47.
    Minehan K, Shaw E, Scheithauer B, Davis DL, Onofrio BM. Spinal cord astrocytoma: pathological and treatment considerations. J Neurosurg 1995;83:590–595.PubMedGoogle Scholar
  48. 48.
    Innocenzi G, Salvati M, Cervoni L, Delfini R, Cantore G. Prognostic factors in intramedullary astrocytomas. Clin Neurol Neurosurg 1997;99:1–5.PubMedCrossRefGoogle Scholar
  49. 49.
    Huddart R, Traish D, Ashley S, Moore A, Brada M. Management of spinal astrocytoma with conservative surgery and radiotherapy. Br J Neurosurg 1993;7:473–481.PubMedCrossRefGoogle Scholar
  50. 50.
    Sandler HM, Papadopoulos SM, Thornton AF, Ross DA. Spinal cord astrocytoma. Result of therapy. Neurosurgery 1992;30:490–493.PubMedCrossRefGoogle Scholar
  51. 51.
    Chun HC, Schmidt-Ullrich RK, Wolfson A, Tercilla OF, Sagerman RH, King GA. External beam radiotherapy for primary spinal cord tumors. J Neurooncol 1990;9:211–217.PubMedCrossRefGoogle Scholar
  52. 52.
    Cohen AR, Wisoff JH, Allen JC, Epstein F. Malignant astrocytoma of the spinal cord. J Neurosurg 1989;70:50–54.PubMedGoogle Scholar
  53. 53.
    O’Neill P, Bell BA, Miller JD, Jacobson I, Guthrie W. Fifty years of experience with chordomas in Southeast Scotland. Neurosurgery 1985;16:166–170.PubMedCrossRefGoogle Scholar
  54. 54.
    Rich TA, Schiller A, Suit HD, Mankin HJ. Clinical and pathologic review of 48 cases of chordoma. Cancer 1985;56:182–187.PubMedCrossRefGoogle Scholar
  55. 55.
    Thieblemont C, Biron P, Rocher F, et al. Prognostic factors in chordoma: role of postoperative radiotherapy. Eur J Cancer 1995;31:2255–2259.CrossRefGoogle Scholar
  56. 56.
    Keisch ME, Garcia DM, Shibuya RB. Retrospective long-term follow-up analysis in 21 patients with chordomas of various sites treated at a single institution. J Neurosurg 1991;75:374–377.PubMedGoogle Scholar
  57. 57.
    Azzarelli A, Quagliuolo V, Cerasoli S, et al. Chordomas: natural history and treatment results in 33 cases. J Surg Oncol 1988;37:185–191.PubMedCrossRefGoogle Scholar
  58. 58.
    Chetiyawardana AD. Chordoma: results of treatment. Clin Radiol 1984;35:159–161.PubMedCrossRefGoogle Scholar
  59. 59.
    Fuller DB, Bloom JG. Radiotherapy for chordoma. Int J Radiat Oncol Biol Phys 1988;15:331–339.PubMedCrossRefGoogle Scholar
  60. 60.
    Sundaresan N, Galicich JH, Chu FCH, Huvos AG. Spinal chordoma. J Neurosurg 1979;50:312–319.PubMedGoogle Scholar
  61. 61.
    Amendola BE, Amendola MA, Oliver E, McClatchey KD. Chordoma: role of radiation therapy. Radiology 1986;158:839–843.PubMedGoogle Scholar
  62. 62.
    Solero CL, Fornari M, Giombini S, et al. Spinal meningiomas: review of 174 operated cases. Neurosurgery 1989;25:153–160.PubMedCrossRefGoogle Scholar
  63. 63.
    Klekamp J, Samii M. Surgical results of spinal meningioma. Acta Neurchir 1996;65:77–81.Google Scholar
  64. 64.
    Levy WJ Jr, Bay J, Dohn D. Spinal meningioma. J Neurosurg 1982;57:804–812.PubMedGoogle Scholar
  65. 65.
    Eeles RA, O’Brien P, Horwich A, Brada M. Non-Hodgkin’s lymphoma presenting with extradural spinal cord compression: functional outcome and survival. Br J Cancer 1991;63:126–129.PubMedGoogle Scholar
  66. 66.
    Raco A, Cervoni L, Salvati M, Delfini R. Primary spinal epidural non-Hodgkin’s lymphomas in childhood: a review of 6 cases. Acta Neurochir 1997;139:526–528.CrossRefGoogle Scholar
  67. 67.
    Selch MT, Parker RG. Radiation therapy in the management of Langerhan’s cell histiocytosis. Med Pediatr Oncol 1990;18:97–102.PubMedCrossRefGoogle Scholar
  68. 68.
    El-Sayed S, Brewin TB. Histiocytosis X: does radiotherapy still have a role? Clin Oncol 1992;4:27–31.CrossRefGoogle Scholar
  69. 69.
    Ruifork ACC, Stephens LC, van der Kogel AJ. Radiation response of the rat cervical spinal cord after irradiation at different ages: tolerance, latency, and pathology. Int J Radiat Oncol Biol Phys 1994;9:73–79.Google Scholar
  70. 70.
    Luk HK, Baker DG, Fellows CF. Hyperbaric oxygen after radiation and its effect on the production of radiation myelitis. Int J Radiat Oncol Biol Phys 1987;4:457–459.Google Scholar
  71. 71.
    Poulton TJ and Witcofski RL. Hyperbaric oxygen therapy for radiation myelitis. Undersea Biomed Res 1985;12:453–458.PubMedGoogle Scholar
  72. 72.
    Feldmeier JJ, Lange JD, Cox SD, Chou LJ, Ciaravino V. Hyperbaric oxygen as prophylaxis or treatment for radiation myelitis. Undersea Hyperb Med 1993;20:249–255.PubMedGoogle Scholar
  73. 73.
    Calabro F and Jinkins JR: MRI of radiation myelitis: A report of a case treated with hyperbaric oxygen. Eur Radiol 2000;10:1079–1084.PubMedCrossRefGoogle Scholar
  74. 74.
    Nadeem SQ, Feun LG, Bruce-Gregorios JH, Green B. Post-radiation sarcoma (malignant fibrous histiocytoma) of the cervical spine following ependymoma. J Neurooncol 1991;11:263–268.PubMedCrossRefGoogle Scholar
  75. 75.
    Rappaport ZH, Loven D, Ben-Aharon U. Radiation-induced cerebellar glioblastoma multiforme subsequent to treatment of an astrocytoma of the cervical spinal cord. Neurosurgery 1991;29:606–608.PubMedCrossRefGoogle Scholar
  76. 76.
    Pecher C. Biological investigations with radioactive calcium and strontium: preliminary report on the use of radioactive strontium in treatment of metastatic bone cancer. Univ CA Pub Pharmacol 1942;11:117–149.Google Scholar
  77. 77.
    McEwan AJB. Use of radionuclides for the palliation of bone metastases. Semin Rad Oncol 2000;10:103–114.CrossRefGoogle Scholar
  78. 78.
    Silberstein EB. The treatment of painful osseous metastases with phosphorus 32. Sem Oncol 1993;20:10–21.Google Scholar
  79. 79.
    Murray T and Hilditch TE. In: Sampson CB, ed. Therapeutic Applications of Radiopharmaceuticals. Text of Radiopharmacy. Theory and Practice, 3rd ed. The Netherlands: Gordon and Breach Science; 1999:369–383.Google Scholar
  80. 80.
    Maisey MN, Britton KE, Coller BD. In: Clinical Nuclear Medicine, 3rd ed. London: Chapman and Hall Medical, 1998.Google Scholar
  81. 81.
    Limouris GS, Shukla SK, Condi-Paphiti A, et al. Palliative therapy using rhenium-186 in painful breast osseous metastases. Anticancer Res 1997;17:1767–1772.PubMedGoogle Scholar
  82. 82.
    Robinson RG, Preston DF, Schiefelbein M, Baxter KG. Strontium-89 therapy for the palliation of pain due to osseous metastases. JAMA 1995;274:420–424.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press, Inc., Totowa, NJ 2006

Authors and Affiliations

  • Mohamed A. Elshaikh
    • 1
  • Roger M. Macklis
    • 2
  1. 1.Department of Radiation OncologyUniversity of Michigan School of MedicineAnn Arbor
  2. 2.Department of Radiation OncologyThe Cleveland Clinic FoundationCleveland

Personalised recommendations