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LINAC-based spinal stereotactic radiosurgery

A J Hamilton¹, B A Lulu, H Fosmire

¹Section of Neurosurgery, University of Arizona Health Sciences Center, Tucson, USA.

Stereotactic and Functional Neurosurgery

|January 1, 1996

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Spinal stereotactic radiosurgery offers a feasible treatment for recurrent spinal tumors, even with epidural compression. This technique showed tumor regression and was well-tolerated in a small patient group.

Area of Science:

Neurosurgery
Radiation Oncology
Oncology

Background:

Recurrent neoplastic involvement of the spinal column presents a significant challenge after standard therapies fail.
Patients often experience severe symptoms like epidural compression, myelopathy, radicular pain, and narcotic-dependent pain.
Limited treatment options exist for patients with failed prior treatments including surgery, radiation, and chemotherapy.

Purpose of the Study:

To evaluate the technical feasibility and safety of a prototype spinal stereotactic radiosurgery (SRS) frame.
To assess the efficacy of spinal SRS in controlling recurrent neoplastic spinal lesions, including those causing compression.
To determine complication rates and preliminary outcomes in patients treated with spinal SRS.

Main Methods:

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A prototype spinal stereotactic radiosurgery frame was used to treat 9 patients with recurrent spinal tumors.
Patients had failed standard therapies; lesions included metastatic tumors and primary osteosarcoma.
Treatment involved a median radiosurgical dose of 800 cGy, with careful consideration of prior spinal cord irradiation.

Main Results:

Three minor complications (esophagitis, wound infection, extended hospitalization) were observed; no major complications occurred.
Radiographic tumor regression and epidural compression relief were noted in 3 patients followed for over 1 year.
Histologic confirmation of tumor absence was found in 2 patients, and in 1 patient postmortem.

Conclusions:

Spinal stereotactic radiosurgery is technically feasible for managing recurrent spinal tumors, including those with epidural compression.
The treatment demonstrated preliminary efficacy in controlling tumor growth and alleviating compressive symptoms.
Further investigation with larger patient cohorts is warranted to fully establish the role of spinal SRS.