ד"ר רן הראל
 מנהל היחידה לניתוחי עמוד שדרה ורדיוכירורגיה לגידולי עמוד שדרה



טיפול במחלות עמוד השדרה
הצווארי, הגבי והמותני
Spine Radiosurgery
Abstract:
Spine Radiosurgery is a relatively new tool utilizing advanced imaging systems, planning software, image-guided localization and intensity modulated dose delivery. Radiosurgery of spine tumors yields high rates of pain control and local control, and offer both the patients and the treating physicians an effective non-invasive alternative. This review covers the indications for SRS, the current techniques used and the outcome of SRS.

Radiosurgery is the delivery of high intensity radiation energy to a target while sparing the surrounding organs. Cranial radiosurgery is a routine treatment for intracranial tumors, however, the transition to extracranial radiosurgery required technological advances such as patient immobilization, radiation targeting and precision delivery. These technologies made spinal radiosurgery a viable tool for treatment of spinal tumors in recent years (1, 2). The treatment is planned according to a CT scan and MRI done with special high resolution protocols and immobilization device, targets and organs at risk are contoured, treatment is planned and quality assurance (Q/A) protocols are followed. Following Q/A procedures the patient undergoes the treatment with the same immobilization device in an outpatient setting. Indication for SRS treatment include solitary spine metastases, Radioresistant spine tumors (tumors with poor response to conventional radiation), Progression after prior conventional radiation, Residual/ progression after surgery, Difficult surgical approaches and Significant medical co-morbidities.
Large scale study of 500 treated lesions showed local control rates to be 86% (4). Studies examining the control rate of Radioresistant tumors like Renal Cell Carcinoma (RCC) or sarcoma also found high local recurrence rate uncomparable to convemtional radiation (8, 9, 17). A study of186 patients operated and instrumented for metastatic tumors compressing the spinal cord followed by spinal radiosurgery with local control rates of 84% (15).
The delivery of high levels of radiation energy to tumors opposing the spinal cord results good results in terms of rapid pain control and local control rate, however these doses should be delivered accurately to avoid damage to the spinal cord. Analyzes of 1775 treated lesions of 1388 patients with mean follow-up of 15 months yielded 79% pain reduction, 90% local control and less than 0.5% of radiation myelopathy(18).
The Author treats tumor of the spine including single metastases or Radioresistant multiple metastases, tumors that failed conventional radiation, tumors inside the spinal canal that cannot be operated, or had a recurrence after surgery and primary spine tumors such as sarcomas and chordomas.
Summary
Advanced in imaging and computers allows today to treat spine tumors with spine radiosurgery, a novel treatment allowing for a non-invasive, non-painful and very safe radiation therapy with very high control rate.
Key-Points:
  • New treatment method for spine tumors
  • Non-invasive
  • Very accurate radiation therapy using high resolution imaging and targeting methods
  • High pain control rate
  • High local  control rate
 
 

 
 

 
Refferences:
1.         Harel R, Angelov L. Spine metastases: Current treatments and future directions. Eur J Cancer 2010.
2.         Bilsky MH, Yamada Y, Yenice KM, et al. Intensity-modulated stereotactic radiotherapy of paraspinal tumors: a preliminary report. Neurosurgery 2004;54(4):823-830; discussion 830-821.
3.         Angelov l. Stereotactic Spine Radiosurgery (SRS) for Pain and Tumor Control in Patients with Spinal Metastases from Renal Cell Carcinoma: A Prospective Study. International Journal of Radiation Oncology Biology Physics 2009;75(3):s112-113.
4.         Gerszten PC, Burton SA, Ozhasoglu C, Welch WC. Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution. Spine (Phila Pa 1976) 2007;32(2):193-199.
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14.       Gibbs IC, Patil C, Gerszten PC, et al. Delayed radiation-induced myelopathy after spinal radiosurgery. Neurosurgery 2009;64(2 Suppl):A67-72.
15.       Laufer I, Iorgulescu JB, Chapman T, et al. Local disease control for spinal metastases following "separation surgery" and adjuvant hypofractionated or high-dose single-fraction stereotactic radiosurgery: outcome analysis in 186 patients. J Neurosurg Spine 2013;18(3):207-214.
16.       Benzil DL, Saboori M, Mogilner AY, et al. Safety and efficacy of stereotactic radiosurgery for tumors of the spine. J Neurosurg 2004;101 Suppl 3:413-418.
17.       Chang UK, Cho WI, Lee DH, et al. Stereotactic radiosurgery for primary and metastatic sarcomas involving the spine. J Neurooncol 2012;107(3):551-557.
18.       Hall WA, Stapleford LJ, Hadjipanayis CG, et al. Stereotactic body radiosurgery for spinal metastatic disease: an evidence-based review. Int J Surg Oncol 2011;2011:979214.
לתורים: 0733700700