J Korean Neurosurg Soc.  2012 Jan;51(1):1-7. 10.3340/jkns.2012.51.1.1.

The Role of Stereotactic Radiosurgery in Metastasis to the Spine

• Sohn S
• Chung CK

• KMID: 2190460
• DOI: http://doi.org/10.3340/jkns.2012.51.1.1

Abstract

OBJECTIVE
The incidence and prevalence of spinal metastases are increasing, and although the role of radiation therapy in the treatment of metastatic tumors of the spine has been well established, the same cannot be said about the role of stereotactic radiosurgery. Herein, the authors present a systematic review regarding the value of spinal stereotactic radiosurgery in the management of spinal metastasis.
METHODS
A systematic literature search for stereotactic radiosurgery of spinal metastases was undertaken. Grades of Recommendation, Assessment, Development, and Education (GRADE) working group criteria was used to evaluate the qualities of study datasets.
RESULTS
Thirty-one studies met the study inclusion criteria. Twenty-three studies were of low quality, and 8 were of very low quality according to the GRADE criteria. Stereotactic radiosurgery was reported to be highly effective in reducing pain, regardless of prior treatment. The overall local control rate was approximately 90%. Additional asymptomatic lesions may be treated by stereotactic radiosurgery to avoid further irradiation of neural elements and further bone-marrow suppression. Stereotactic radiosurgery may be preferred in previously irradiated patients when considering the radiation tolerance of the spinal cord. Furthermore, residual tumors after surgery can be safely treated by stereotactic radiosurgery, which decreases the likelihood of repeat surgery and accompanying surgical morbidities. Encompassing one vertebral body above and below the involved vertebrae is unnecessary. Complications associated with stereotactic radiosurgery are generally self-limited and mild.
CONCLUSION
In the management of spinal metastasis, stereotactic radiosurgery appears to provide high rates of tumor control, regardless of histologic diagnosis, and can be used in previously irradiated patients. However, the quality of literature available on the subject is not sufficient.

Keyword

Radiosurgery; Spinal metastasis; Spine surgery; Radiation therapy; Local control; Spine tumors

MeSH Terms

Humans
Incidence
Neoplasm Metastasis
Neoplasm, Residual
Prevalence
Radiation Tolerance
Radiosurgery
Reoperation
Spinal Cord
Spine

Figure

• 

  Fig. 1 A representative case of a 48-year-old female with an isolated painful C3 metastasis. The patient experienced pain relief three months after Cyberknife stereotactic radiosurgery. A : Preoperative T1 weighted axial MR image with enhancement. B : Axial projection of the isodose line of the treatment plan. The 77% isodose line represents the prescribed dose of 31.7 Gy (5 fractions), the tumor volume is 14.5 mL, and the spinal cord received a maximum dose of 25.3 Gy. C : Six-month postoperative T1 weighted axial MR image with enhancement. D : Two-year postoperative T1 weighted axial MR image with enhancement showing good response. MR : magnetic resonance.

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