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Stereotactic Radiosurgery for Intramedullary Spinal Cord Metastases: A Systematic Review and Meta-Analysis.
Felipe Carvajal1,2, Rafael García3, Felipe Rojas1
1Department of Radiotherapy and Oncology, Hospital Base Valdivia, Valdivia, CHL.
Cureus
|April 4, 2025
Summary
Stereotactic radiosurgery (SRS) and fractionated stereotactic radiosurgery (FSRS) show promise for treating intramedullary spinal cord metastases (ISCM), achieving good local control and neurological outcomes. However, further research is needed due to the low quality of current evidence.
Area of Science:
- Oncology
- Neurosurgery
- Radiation Oncology
Background:
- Intramedullary spinal cord metastases (ISCM) are rare but increasing.
- Stereotactic radiosurgery (SRS) and fractionated stereotactic radiosurgery (FSRS) are emerging local treatment options for ISCM.
Purpose of the Study:
- To systematically review and perform a meta-analysis on the safety and effectiveness of SRS/FSRS for ISCM.
- To assess local control, overall survival, neurological outcomes, and toxicity associated with SRS/FSRS in ISCM patients.
Main Methods:
- Systematic literature review following PRISMA guidelines, searching PubMed/MEDLINE and Google Scholar.
- Inclusion of 10 studies with 60 patients and 77 ISCM treated with SRS/FSRS.
- Bias risk assessment using JBI tools, data extraction, descriptive statistics, and Kaplan-Meier survival analysis.
Main Results:
- SRS/FSRS achieved 86.3% local control and favorable neurological control in 69% of patients.
- Median overall survival was nine months, with 12-month survival at 35.33% and 24-month survival at 25.98%.
- No spinal cord toxicity was reported in the analyzed studies.
Conclusions:
- SRS/FSRS appears to be a safe and effective treatment for ISCM, offering good local and neurological control.
- Findings should be interpreted cautiously due to the low quality of included studies.
- Prospective research is essential to further define the role of SRS/FSRS and evaluate spinal toxicity.
