Review of stereotactic radiosurgery for intradural spine tumors

Written by Purvis TE, Goodwin CR, Lubelski D, Laufer I, Sciubba DM

Stereotactic radiosurgery (SRS) has become an increasingly popular treatment modality for spinal tumors due to its noninvasive and targeted approach. Whether SRS has the promise of relieving pretreatment symptoms and providing local tumor control for patients with intradural spine tumors is still debated. This review explores the current literature on SRS treatment for both metastatic and benign intradural tumors, with a focus on differential use for intramedullary and intradural extramedullary neoplasms. Although mortality rates from underlying malignant disease remain high, SRS may benefit patients with spinal metastatic lesions. Benign tumors have shown a promising response to SRS therapy with low rates of complications. Larger studies are necessary to determine the indications and outcome profile of SRS for intradural spinal neoplasms.
Intradural spinal cord tumors represent approximately 30% of spinal cord neoplasms [1]. With its success in treating intracranial lesions, stereotactic radiosurgery (SRS) has been increasingly trialed in patients with intradural spinal tumors [2]. Surgical resection remains the mainstay treatment for these tumors, but among patients who may not tolerate surgical intervention and in those with residual disease after surgery, SRS is considered a potentially beneficial treatment option [3–7]. Due to the differences in radiosensitivity between healthy tissue and tumors, SRS is able to target tumors while still preserving normal tissue [8–12]. Commonly used SRS technologies currently include CyberKnife (Accuray, Inc., CA, USA), Novalis (BrainLAB, Heimstetten, Germany) and Synergy S (Elekta, Crawley, UK) [2]. The frame-based nature of early SRS initially limited the treatment to intracranial targets [13,14]. The recent development of image-guided technology has facilitated SRS treatment for extracranial spinal tumors, although evaluation of its use has largely been limited mostly to vertebral lesions and malignancies [15–19]. This narrative review article seeks to summarize the recent trends and outcomes associated with the treatment of intramedullary (IM) and intradural extramedullary (IDEM) spine tumors using SRS.

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Source

  1. CNS Oncology