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Stereotactic Body Radiotherapy for Spinal Metastases: What are the Risks and How Do We Minimize Them?

Joe H Chang1, John H Shin2, Yoshiya J Yamada3

  • 1Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada.

Spine
|August 5, 2016
PubMed
Summary
This summary is machine-generated.

Stereotactic body radiotherapy (SBRT) for spinal metastases has a low risk of radiation myelopathy (RM) if dose constraints are followed. However, vertebral compression fractures (VCF) and epidural disease progression remain significant risks.

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Area of Science:

  • Oncology
  • Radiation Oncology
  • Neurosurgery

Background:

  • Stereotactic body radiotherapy (SBRT) is increasingly used for spinal metastases.
  • Key complications include radiation myelopathy (RM), vertebral compression fracture (VCF), and epidural disease progression.
  • Understanding the precise risks and mitigation strategies is crucial.

Purpose of the Study:

  • To systematically review the literature on SBRT for spinal metastases.
  • To quantify the risks of RM, VCF, and epidural disease progression.
  • To discuss strategies for minimizing these SBRT-related complications.

Main Methods:

  • Systematic literature review using MEDLINE.
  • Inclusion of relevant articles and review of bibliographies.
  • Analysis of identified studies for complication rates and risk factors.

Main Results:

  • The risk of RM is low (≤5%) when thecal sac dose constraints are met.
  • The crude risk of VCF is 13.7%, with 45% requiring surgical salvage.
  • Local failure at 1 year is 21.4%, with a high proportion occurring epidurally.

Conclusions:

  • Spinal SBRT has a low risk of RM with adherence to dose guidelines.
  • VCF and epidural disease progression are significant risks following spinal SBRT.
  • Minimizing risks involves identifying risk factors and careful treatment planning.