Skip to main content
SpringerLink
Log in

Spinal Cord Tumors

  • Chapter
Target Volume Definition in Radiation Oncology

  • 2259 Accesses

Abstract

The purpose of this chapter is to first provide an overview of the anatomy and histology of the normal spinal cord, followed by an overview of normal and abnormal MR imaging findings. Selected common primary intramedullary spinal tumors (IMST) are then discussed in detail (spinal cord ependymoma, spinal cord pilocytic astrocytoma, spinal cord low-grade glioma), in addition to a selected extramedullary intradural tumor (meningioma), as a case-based discussion providing a brief overview of the tumor type, MR imaging findings, radiotherapy treatment planning guidelines as per practice at the University of Toronto, and a discussion of selected evidence. A brief discussion of vertebral and intramedullary metastases follows and an introduction to the emerging technique of spine stereotactic body radiotherapy (SBRT). Lastly, we discuss spinal cord tolerance in the setting of both conventionally fractionated and hypofractionated radiation for both radiation naïve and previously radiated patients.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Alfonso ER, De Gregorio MA, Mateo P, Esco R, Bascon N, Morales F et al (1997) Radiation myelopathy in over-irradiated patients: MR imaging findings. Eur Radiol 7(3):400–404

    Article  CAS  PubMed  Google Scholar 

  • Bagley CA, Wilson S, Kothbauer KF, Bookland MJ, Epstein F, Jallo GI (2009) Long term outcomes following surgical resection of myxopapillary ependymomas. Neurosurg Rev 32(3):321–334; discussion 34. Epub 2009/02/18

    Article  PubMed  Google Scholar 

  • Barton VN, Donson AM, Kleinschmidt-DeMasters BK, Birks DK, Handler MH, Foreman NK (2010) Unique molecular characteristics of pediatric myxopapillary ependymoma. Brain Pathol 20(3):560–570. Epub 2009/10/02

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Bentzen SM, Dörr W, Gahbauer R, Howell RW, Joiner MC, Jones B et al (2012) Bioeffect modeling and equieffective dose concepts in radiation oncology – terminology, quantities and units. Radiother Oncol 105(2):266–268. Epub 2012/11/20

    Article  PubMed  Google Scholar 

  • Bhatnagar AK, Gerszten PC, Ozhasaglu C, Vogel WJ, Kalnicki S, Welch WC et al (2005) CyberKnife frameless radiosurgery for the treatment of extracranial benign tumors. Technol Cancer Res Treat 4(5):571–576

    Article  PubMed  Google Scholar 

  • Brenner DJ (2008) The linear-quadratic model is an appropriate methodology for determining isoeffective doses at large doses per fraction. Semin Radiat Oncol 18(4):234–239

    Article  PubMed Central  PubMed  Google Scholar 

  • Chamberlain MC, Tredway TL (2011) Adult primary intradural spinal cord tumors: a review. Curr Neurol Neurosci Rep 11(3):320–328. Epub 2011/02/18

    Article  PubMed  Google Scholar 

  • Chao ST, Kobayashi T, Benzel E, Reddy CA, Stevens GH, Prayson RA et al (2011) The role of adjuvant radiation therapy in the treatment of spinal myxopapillary ependymomas. J Neurosurg Spine 14(1):59–64. Epub 2010/12/15

    Article  PubMed  Google Scholar 

  • Chow E, Harris K, Fan G, Tsao M, Sze WM (2007) Palliative radiotherapy trials for bone metastases: a systematic review. J Clin Oncol 25(11):1423–1436

    Article  PubMed  Google Scholar 

  • Cohen-Gadol AA, Zikel OM, Koch CA, Scheithauer BW, Krauss WE (2003) Spinal meningiomas in patients younger than 50 years of age: a 21-year experience. J Neurosurg 98(3 Suppl):258–263. Epub 2003/04/15

    PubMed  Google Scholar 

  • Daly ME, Choi CY, Gibbs IC, Adler JR Jr, Chang SD, Lieberson RE et al (2011a) Tolerance of the spinal cord to stereotactic radiosurgery: insights from hemangioblastomas. Int J Radiat Oncol Biol Phys 80(1):213–220. Epub 2011/04/13

    Article  PubMed  Google Scholar 

  • Daly ME, Luxton G, Choi CY, Gibbs IC, Chang SD, Adler JR et al (2011b) Normal tissue complication probability estimation by the Lyman-Kutcher-Burman method does not accurately predict spinal cord tolerance to stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 82(5):2025–2032. Epub 2011/05/03

    Article  PubMed  Google Scholar 

  • Dolecek TA, Propp JM, Stroup NE, Kruchko C (2012) CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2005–2009. Neuro Oncol 14(Suppl 5):v1–v49. Epub 2012/11/01

    Article  PubMed Central  PubMed  Google Scholar 

  • Emami B, Lyman J, Brown A, Coia L, Goitein M, Munzenrider JE et al (1991) Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 21(1):109–122

    Article  CAS  PubMed  Google Scholar 

  • Foro Arnalot P, Fontanals AV, Galceran JC, Lynd F, Latiesas XS, de Dios NR et al (2008) 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 89(2):150–155

    Article  PubMed  Google Scholar 

  • Gray H (1918/2000) In: Lewis WH (ed) Anatomy of the human body. Central nervous system. Lea & Febiger, Philadelphia, 1396 p

    Google Scholar 

  • Howell DD, James JL, Hartsell WF, Suntharalingam M, Machtay M, Suh JH et al (2013) Single-fraction radiotherapy versus multifraction radiotherapy for palliation of painful vertebral bone metastases-equivalent efficacy, less toxicity, more convenient: a subset analysis of Radiation Therapy Oncology Group trial 97-14. Cancer 119:888–896

    Article  PubMed  Google Scholar 

  • ICRU (1993) Report 50. Prescribing, recording, reporting photon beam therapy. ICRU, Bethesda

    Google Scholar 

  • Ishkanian A, Laperriere NJ, Xu W, Millar BA, Payne D, Mason W et al (2011) Upfront observation versus radiation for adult pilocytic astrocytoma. Cancer 117(17):4070–4079

    Article  PubMed  Google Scholar 

  • Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A et al (2007) The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 114(2):97–109. Epub 2007/07/10

    Article  PubMed Central  PubMed  Google Scholar 

  • Masucci GL, Yu E, Ma L, Chang EL, Letourneau D, Lo S et al (2011) Stereotactic body radiotherapy is an effective treatment in reirradiating spinal metastases: current status and practical considerations for safe practice. Expert Rev Anticancer Ther 11(12):1923–1933. Epub 2011/11/26

    Article  PubMed  Google Scholar 

  • Mizumoto M, Harada H, Asakura H, Hashimoto T, Furutani K, Hashii H et al (2011) Radiotherapy for patients with metastases to the spinal column: a review of 603 patients at Shizuoka Cancer Center Hospital. Int J Radiat Oncol Biol Phys 79(1):208–213

    Article  PubMed  Google Scholar 

  • Moore K, Dalley A (1999) Clinically oriented anatomy, 4th edn. Williams and Wilkins, Philadelphia, 1164 p

    Google Scholar 

  • Nakamura M, Tsuji O, Fujiyoshi K, Hosogane N, Watanabe K, Tsuji T et al (2012) Long-term surgical outcomes of spinal meningiomas. Spine (Phila Pa 1976) 37(10):E617–E623. Epub 2011/12/08

    Article  Google Scholar 

  • Nguyen J, Chow E, Zeng L, Zhang L, Culleton S, Holden L et al (2011) Palliative response and functional interference outcomes using the Brief Pain Inventory for spinal bony metastases treated with conventional radiotherapy. Clin Oncol (R Coll Radiol) 23(7):485–491

    Article  CAS  Google Scholar 

  • Nieder C, Grosu AL, Andratschke NH, Molls M (2005) Proposal of human spinal cord reirradiation dose based on collection of data from 40 patients. Int J Radiat Oncol Biol Phys 61(3):851–855

    Article  PubMed  Google Scholar 

  • Park C, Papiez L, Zhang S, Story M, Timmerman RD (2008) Universal survival curve and single fraction equivalent dose: useful tools in understanding potency of ablative radiotherapy. Int J Radiat Oncol Biol Phys 70(3):847–852

    Article  PubMed  Google Scholar 

  • Rodrigues GB, Waldron JN, Wong CS, Laperriere NJ (2000) A retrospective analysis of 52 cases of spinal cord glioma managed with radiation therapy. Int J Radiat Oncol Biol Phys 48(3):837–842. Epub 2000/10/06

    Article  CAS  PubMed  Google Scholar 

  • Sahgal A, Chou D, Ames C, Ma L, Lamborn K, Huang K et al (2007) Image-guided robotic stereotactic body radiotherapy for benign spinal tumors: the university of california san francisco preliminary experience. Technol Cancer Res Treat 6(6):595–604

    Article  CAS  PubMed  Google Scholar 

  • Sahgal A, Van der Kogel AJ, Wong CS (2008a) Spinal cord radiobiology. In: Ryu S, Gerszten P (eds) Spine radiosurgery. Thieme Medical Publishers Inc, New York

    Google Scholar 

  • Sahgal A, Larson DA, Chang EL (2008b) Stereotactic body radiosurgery for spinal metastases: a critical review. Int J Radiat Oncol Biol Phys 71(3):652–665

    Article  PubMed  Google Scholar 

  • Sahgal A, Ames C, Chou D, Ma L, Huang K, Xu W et al (2009) Stereotactic body radiotherapy is effective salvage therapy for patients with prior radiation of spinal metastases. Int J Radiat Oncol Biol Phys 74(3):723–731

    Article  PubMed  Google Scholar 

  • Sahgal A, Ma L, Gibbs I, Gerszten PC, Ryu S, Soltys S et al (2010) Spinal cord tolerance for stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys 77(2):548–553

    Article  PubMed  Google Scholar 

  • Sahgal A, Bilsky M, Chang EL, Ma L, Yamada Y, Rhines LD et al (2011a) Stereotactic body radiotherapy for spinal metastases: current status, with a focus on its application in the postoperative patient. J Neurosurg Spine 14(2):151–166

    Article  PubMed  Google Scholar 

  • Sahgal A, Wong CS, Van der Kogel AJ (2011b) Spinal cord. In: Shrieve D, Loeffler JS (eds) Human radiation injury. Lippincott Williams & Wilkins, Philadelphia, pp 225–235

    Google Scholar 

  • Sahgal A, Roberge D, Schellenberg D, Purdie TG, Swaminath A, Pantarotto J et al (2012a) The Canadian Association of Radiation Oncology scope of practice guidelines for lung, liver and spine stereotactic body radiotherapy. Clin Oncol (R Coll Radiol) 24(9):629–639. Epub 2012/05/29

    Article  CAS  Google Scholar 

  • Sahgal A, Ma L, Weinberg V, Gibbs IC, Chao S, Chang UK et al (2012b) Reirradiation human spinal cord tolerance for stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys 82(1):107–116

    Article  PubMed  Google Scholar 

  • Sahgal A, Weinberg V, Ma L, Chang E, Chao S, Muacevic A et al (2013) Probabilities of radiation myelopathy specific to stereotactic body radiation therapy to guide safe practice. Int J Radiat Oncol Biol Phys 85:341–347

    Article  PubMed  Google Scholar 

  • Sansur CA, Pouratian N, Dumont AS, Schiff D, Shaffrey CI, Shaffrey ME (2007) Part II: spinal-cord neoplasms–primary tumours of the bony spine and adjacent soft tissues. Lancet Oncol 8(2):137–147. Epub 2007/02/03

    Article  PubMed  Google Scholar 

  • Schultheiss TE, Stephens LC, Maor MH (1988) Analysis of the histopathology of radiation myelopathy. Int J Radiat Oncol Biol Phys 14(1):27–32

    Article  CAS  PubMed  Google Scholar 

  • Schultheiss TE, Kun LE, Ang KK, Stephens LC (1995) Radiation response of the central nervous system. Int J Radiat Oncol Biol Phys 31(5):1093–1112

    Article  CAS  PubMed  Google Scholar 

  • Sung WS, Sung MJ, Chan JH, Manion B, Song J, Dubey A et al (2013) Intramedullary spinal cord metastases: a 20-year institutional experience with a comprehensive literature review. World Neurosurg 79:576–584

    Article  PubMed  Google Scholar 

  • Traul DE, Shaffrey ME, Schiff D (2007) Part I: spinal-cord neoplasms-intradural neoplasms. Lancet Oncol 8(1):35–45. Epub 2007/01/02

    Article  PubMed  Google Scholar 

  • Veeravagu A, Lieberson RE, Mener A, Chen YR, Soltys SG, Gibbs IC et al (2012) CyberKnife stereotactic radiosurgery for the treatment of intramedullary spinal cord metastases. J Clin Neurosci 19(9):1273–1277. Epub 2012/07/07

    Article  PubMed  Google Scholar 

  • Waldron JN, Laperriere NJ, Jaakkimainen L, Simpson WJ, Payne D, Milosevic M et al (1993) Spinal cord ependymomas: a retrospective analysis of 59 cases. Int J Radiat Oncol Biol Phys 27(2):223–229. Epub 1993/09/30

    Article  CAS  PubMed  Google Scholar 

  • Wang PY, Shen WC, Jan JS (1995) Serial MRI changes in radiation myelopathy. Neuroradiology 37(5):374–377

    Article  CAS  PubMed  Google Scholar 

  • Wang XS, Rhines LD, Shiu AS, Yang JN, Selek U, Gning I et al (2012) Stereotactic body radiation therapy for management of spinal metastases in patients without spinal cord compression: a phase 1-2 trial. Lancet Oncol 13(4):395–402. Epub 2012/01/31

    Article  PubMed Central  PubMed  Google Scholar 

  • Weiss S, Dunne C, Hewson J, Wohl C, Wheatley M, Peterson AC et al (1996) Multipotent CNS stem cells are present in the adult mammalian spinal cord and ventricular neuroaxis. J Neurosci 16(23):7599–7609

    CAS  PubMed  Google Scholar 

  • Wong CS, Van Dyk J, Milosevic M, Laperriere NJ (1994) Radiation myelopathy following single courses of radiotherapy and retreatment. Int J Radiat Oncol Biol Phys 30(3):575–581

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Sunnybrook Health Sciences Centre and Princess Margaret Cancer Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada

    Arjun Sahgal MD

  2. Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada

    Louis Lao MBChB & Normand J. Laperriere MD

  3. Department of Radiology, University Health Network, University of Toronto, Toronto, ON, Canada

    Eugene Yu MD

  4. Department of Radiation Oncology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada

    C. Shun Wong MD

  5. Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA

    David A. Larson MD, PhD

  6. Department of Anatomic Pathology, St. Michaels Hospital, University of Toronto, Toronto, ON, Canada

    Jason Karamchandani MD

Authors
  1. Arjun Sahgal MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Louis Lao MBChB
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eugene Yu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Shun Wong MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David A. Larson MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Normand J. Laperriere MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jason Karamchandani MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Arjun Sahgal MD .

Editor information

Editors and Affiliations

  1. Department of Radiation Oncology, University Medical Center Freiburg, Freiburg, Germany

    Anca-Ligia Grosu

  2. Department of Oncology, Nordland Hospital, Bodo, Norway

    Carsten Nieder

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Sahgal, A. et al. (2015). Spinal Cord Tumors. In: Grosu, AL., Nieder, C. (eds) Target Volume Definition in Radiation Oncology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-45934-8_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-45934-8_3

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-45933-1

  • Online ISBN: 978-3-662-45934-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation