Spine radiosurgery for the local treatment of spine metastases: Intensity-modulated radiotherapy, image guidance, clinical aspects and future directions

Authors

  • Fabio Ynoe de Moraes Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo; Instituto de Radiologia; Serviço de Radioterapia
  • Neil Kanth Taunk Department of Radiation Oncology; Memorial Sloan Kettering Cancer Center
  • Ilya Laufer Department of Neurosurgery; Memorial Sloan Kettering Cancer Center
  • Wellington Furtado Pimenta Neves-Junior Departamento de Radioterapia; Hospital Sírio-Libanês
  • Samir Abdallah Hanna Departamento de Radioterapia; Hospital Sírio-Libanês
  • Heloisa de Andrade Carvalho Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo; Instituto de Radiologia; Serviço de Radioterapia
  • Yoshiya Yamada Department of Radiation Oncology; Memorial Sloan Kettering Cancer Center

DOI:

https://doi.org/10.6061/clinics/2016(02)09

Abstract

Many cancer patients will develop spinal metastases. Local control is important for preventing neurologic compromise and to relieve pain. Stereotactic body radiotherapy or spinal radiosurgery is a new radiation therapy technique for spinal metastasis that can deliver a high dose of radiation to a tumor while minimizing the radiation delivered to healthy, neighboring tissues. This treatment is based on intensity-modulated radiotherapy, image guidance and rigid immobilization. Spinal radiosurgery is an increasingly utilized treatment method that improves local control and pain relief after delivering ablative doses of radiation. Here, we present a review highlighting the use of spinal radiosurgery for the treatment of metastatic tumors of the spine. The data used in the review were collected from both published studies and ongoing trials. We found that spinal radiosurgery is safe and provides excellent tumor control (up to 94% local control) and pain relief (up to 96%), independent of histology. Extensive data regarding clinical outcomes are available; however, this information has primarily been generated from retrospective and nonrandomized prospective series. Currently, two randomized trials are enrolling patients to study clinical applications of fractionation schedules spinal Radiosurgery. Additionally, a phase I clinical trial is being conducted to assess the safety of concurrent stereotactic body radiotherapy and ipilimumab for spinal metastases. Clinical trials to refine clinical indications and dose fractionation are ongoing. The concomitant use of targeted agents may produce better outcomes in the future.

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Published

2016-02-01

Issue

Section

Reviews

How to Cite

Moraes, F. Y. de, Taunk, N. K., Laufer, I., Neves-Junior, W. F. P., Hanna, S. A., Carvalho, H. de A., & Yamada, Y. (2016). Spine radiosurgery for the local treatment of spine metastases: Intensity-modulated radiotherapy, image guidance, clinical aspects and future directions . Clinics, 71(2), 101-109. https://doi.org/10.6061/clinics/2016(02)09