Stereotactic Body Radiation Therapy for Symptomatic Benign Spinal Tumors: A Single-Center Retrospective Experience

Benign spinal tumors (BSTs) are relatively uncommon, though can yield significant morbidity as related to location and size. Surgical resection is the primary management modality for symptomatic lesions; however, for patients who are nonsurgical candidates or have progressed post-surgery, radiation therapy can be employed for definitive treatment. This institutional series describes the local control and toxicity outcomes of stereotactic body radiation therapy (SBRT) for BST.

Patients treated with SBRT for BST at a single institution from 2010 to 2021 were retrospectively reviewed and analyzed. Patients were included if they underwent treatment with SBRT with or without prior surgical intervention. Evaluation of posttreatment toxicities, symptomatic improvement, imaging response, and local control were performed.

During the study period 31 patients were identified with a total of 36 BST. The distribution of the tumors included 16 in the cervical spine (44%), 13 thoracic (n = 36%), and 7 lumbosacral (n = 20%). Histologies included 14 schwannoma (39%), 12 meningioma (33%), and 8 hemangioma (22%), 1 melanocytic tumor (3%), and 1 neurofibroma (3%). Median radiation prescription dose was 25 Gy (range, 18-40 Gy) in 5 fractions (range, 3-5 fractions). Of the treated lesions, 17 (47%) had prior surgical management and 19 (53%) were treated upfront with SBRT. With median imaging follow-up was 49 months (range, 2-171) and the median clinical follow-up was 83 months (range, 10-171) with 86% of assessable patients having stable to improved symptoms in the treated lesion at 12 months. Two patients demonstrated progressive disease on imaging. There were no incidences of National Cancer Institute Common Terminology Criteria for Adverse Events version 4 grade 3 or greater observed toxicities and the most common toxicities were fatigue 6 (17%), and pain flare 5 (14%), both transient. There was no association between treatment course (prior surgery versus definitive radiation) and symptomatic stability or improvement, imaging response, or toxicity.

SBRT is well tolerated for treatment of symptomatic BST with high rates of symptomatic stability or improvement. This series demonstrated acceptable local control and no high-grade toxicities.