Introduction: Treatment of spinal metastases has evolved significantly over the last decade. Initial surgical decompression and stabilization, as opposed to radical oncologic resection, provides a margin around the spinal cord that facilitates subsequent treatment with high-dose (18-24 Gy) adjuvant SSRS or SSRT. If a safe margin exists between tumor and spinal cord on initial imaging, then high-dose SSRS/T may be used as the primary therapy, eliminating the need for surgery. This approach has shown greater efficacy of tumor control, neurologic outcome and duration of response when compared to external beam radiotherapy, regardless of tumor histology. This study evaluates the efficacy of this treatment approach at our institution in a series of consecutive patients.
Methods: Patients treated for spinal metastases between 2007 and 2011 on the Varian Trilogy Linear Accelerator were identified retrospectively. Each received SSRS/T, with or without initial surgical decompression. Medical records were reviewed to assess neurologic outcome and surgical or radiation-induced complications. MRI images were obtained for each patient at 3 month intervals post-treatment and radiographic response assessed as regression, stable or progression. Endpoints were neurologic outcome and local radiographic disease control at death or latest follow-up.
Results: Sixty-eight patients with 71 tumors were treated with SSRS/T for spinal metastases. Radiographically, local disease was unchanged or regressed in 67/71 tumors (94%). Frankel score improved or remained stable in 70/71 (99%) patients. No radiation induced myelopathy was observed.
Conclusions: SSRS/T, alone or as an adjunct following surgical decompression, provides durable local radiographic disease control while preserving or improving neurologic function. This less-invasive alternative to radical spinal oncologic resection appears to be effective regardless of tumor histology without sacrificing durability of radiographic or clinical response.
Patient Care: This approach to the treatment of spinal metastases can decrease operative morbidity and mortality. It can provide durable local radiographic disease control while preserving or improving neurologic function.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) describe the role of radiosurgery in the treatment of spinal metastases, 2) discuss, in small groups, which patients with spinal metastases may benefit from surgical decompression and stabilization prior to receiving radiosurgery, 3) Identify an effective treatment plan for patients with spinal metastases.