| Abstract: |
Spinal tumors are a frequent occurrence and the improvement in available cancer therapy is leading to longer survival. The biggest advancement in oncological treatment of spinal tumors has been the development and integration of spine stereotactic radiosurgery (SRS) which has dramatically improved the ability to provide safe and durable control of spine tumors. For treatment of metastatic spinal disease, an abundance of data show that radiosurgery provides high rates of local-tumor control with limited treatment-associated morbidity. Surgery continues to play an important role in the treatment of spinal metastases, but the integration of SRS has changed both the indications and surgical techniques. Radiosensitive tumors can be effectively treated with conventional external beam radiation therapy, while radioresistant tumors without significant epidural extension can be effectively treated with upfront SRS. In the setting of high-grade epidural spinal cord compression, dose constraints prohibit the delivery of an optimal radiation dose to the entire tumor volume without risking radiation-induced myelitis: thus, surgery is often required not only to decompress the spinal cord but also to provide a margin for the safe delivery of SRS. The role for SRS in the treatment of primary spinal tumors continues to evolve, but there is mounting clinical evidence that chordoma is radioresponsive to SRS. As radiosurgical technologies have become accessible worldwide, utilization of radiosurgery for the treatment of spinal pathology has grown. Spine surgeons must be familiar with radiosurgical concepts including simulation, contouring, and treatment planning to optimize decision making. |
