We use cookies to improve your experience. By continuing to browse this site, you accept our cookie policy.×
Skip main navigation
Aging Health
Bioelectronics in Medicine
Biomarkers in Medicine
Breast Cancer Management
CNS Oncology
Colorectal Cancer
Concussion
Epigenomics
Future Cardiology
Future Medicine AI
Future Microbiology
Future Neurology
Future Oncology
Future Rare Diseases
Future Virology
Hepatic Oncology
HIV Therapy
Immunotherapy
International Journal of Endocrine Oncology
International Journal of Hematologic Oncology
Journal of 3D Printing in Medicine
Lung Cancer Management
Melanoma Management
Nanomedicine
Neurodegenerative Disease Management
Pain Management
Pediatric Health
Personalized Medicine
Pharmacogenomics
Regenerative Medicine

Review of stereotactic radiosurgery for intradural spine tumors

    Taylor E Purvis

    Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    ,
    C Rory Goodwin

    Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    ,
    Daniel Lubelski

    Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    ,
    Ilya Laufer

    Department of Neurosurgery, Memorial Sloan–Kettering Hospital, New York, NY, USA

    &
    Daniel M Sciubba

    *Author for correspondence:

    E-mail Address: Dsciubb1@jhmi.edu

    Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Published Online:https://doi.org/10.2217/cns-2016-0039

    Stereotactic radiosurgery (SRS) has become an increasingly popular treatment modality for spinal tumors due to its noninvasive and targeted approach. Whether SRS has the promise of relieving pretreatment symptoms and providing local tumor control for patients with intradural spine tumors is still debated. This review explores the current literature on SRS treatment for both metastatic and benign intradural tumors, with a focus on differential use for intramedullary and intradural extramedullary neoplasms. Although mortality rates from underlying malignant disease remain high, SRS may benefit patients with spinal metastatic lesions. Benign tumors have shown a promising response to SRS therapy with low rates of complications. Larger studies are necessary to determine the indications and outcome profile of SRS for intradural spinal neoplasms.

    References

    • 1 Traul DE, Shaffrey ME, Schiff D. Part I: spinal-cord neoplasms-intradural neoplasms. Lancet Oncol. 8(1), 35–45 (2007).
    • 2 Hsu W, Nguyen T, Kleinberg L et al. Stereotactic radiosurgery for spine tumors: review of current literature. Stereotact. Funct. Neurosurg. 88(5), 315–321 (2010).
    • 3 Sohn S, Chung CK. The role of stereotactic radiosurgery in metastasis to the spine. J. Korean Neurosurg. Soc. 51(1), 1–7 (2012).
    • 4 Gerszten PC, Mendel E, Yamada Y. Radiotherapy and radiosurgery for metastatic spine disease: what are the options, indications, and outcomes? Spine (Phila PA 1976) 34(22 Suppl.), S78–S92 (2009).
    • 5 Linskey ME, Andrews DW, Asher AL et al. The role of stereotactic radiosurgery in the management of patients with newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. J. Neurooncol. 96(1), 45–68 (2010).
    • 6 Ryu S, Yoon H, Stessin A, Gutman F, Rosiello A, Davis R. Contemporary treatment with radiosurgery for spine metastasis and spinal cord compression in 2015. Radiat. Oncol. J. 33(1), 1–11 (2015).
    • 7 Hall WA, Stapleford LJ, Hadjipanayis CG, Curran WJ, Crocker I, Shu HK. Stereotactic body radiosurgery for spinal metastatic disease: an evidence-based review. Int. J. Surg. Oncol. 2011, 979214 (2011).
    • 8 Laufer I, Rubin DG, Lis E et al. The NOMS framework: approach to the treatment of spinal metastatic tumors. Oncologist 18(6), 744–751 (2013).
    • 9 Lo SS, Abdulrahman R, Desrosiers PM et al. The role of Gamma Knife Radiosurgery in the management of unresectable gross disease or gross residual disease after surgery in ependymoma. J. Neurooncol. 79(1), 51–56 (2006).
    • 10 Moussazadeh N, Laufer I, Yamada Y, Bilsky MH. Separation surgery for spinal metastases: effect of spinal radiosurgery on surgical treatment goals. Cancer Control 21(2), 168–174 (2014).
    • 11 Bijl HP, Van Luijk P, Coppes RP, Schippers JM, Konings AW, Van Der Kogel AJ. Regional differences in radiosensitivity across the rat cervical spinal cord. Int. J. Radiat. Oncol. Biol. Phys. 61(2), 543–551 (2005).
    • 12 Saraceni C, Ashman JB, Harrop JS. Extracranial radiosurgery – applications in the management of benign intradural spinal neoplasms. Neurosurg. Rev. 32(2), 133–140; discussion 140–131 (2009).
    • 13 Hamilton AJ, Lulu BA, Fosmire H, Gossett L. LINAC-based spinal stereotactic radiosurgery. Stereotact. Funct. Neurosurg. 66(1–3), 1–9 (1996).
    • 14 Santacroce A, Kamp MA, Budach W, Hanggi D. Radiobiology of radiosurgery for the central nervous system. Biomed. Res. Int. 2013, 362761 (2013).
    • 15 De Salles AA, Pedroso AG, Medin P et al. Spinal lesions treated with Novalis shaped beam intensity-modulated radiosurgery and stereotactic radiotherapy. J. Neurosurg. 101(Suppl. 3), 435–440 (2004).
    • 16 Degen JW, Gagnon GJ, Voyadzis JM et al. CyberKnife stereotactic radiosurgical treatment of spinal tumors for pain control and quality of life. J. Neurosurg. Spine 2(5), 540–549 (2005).
    • 17 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) 32(2), 193–199 (2007).
    • 18 Rock JP, Ryu S, Yin FF. Novalis radiosurgery for metastatic spine tumors. Neurosurg. Clin. N. Am. 15(4), 503–509 (2004).
    • 19 Ryu SI, Chang SD, Kim DH et al. Image-guided hypo-fractionated stereotactic radiosurgery to spinal lesions. Neurosurgery 49(4), 838–846 (2001).
    • 20 Shin DA, Huh R, Chung SS, Rock J, Ryu S. Stereotactic spine radiosurgery for intradural and intramedullary metastasis. Neurosurg. Focus 27(6), E10 (2009).
    • 21 Parikh S, Heron DE. Fractionated radiosurgical management of intramedullary spinal cord metastasis: a case report and review of the literature. Clin. Neurol. Neurosurg. 111(10), 858–861 (2009).
    • 22 Veeravagu A, Lieberson RE, Mener A et al. CyberKnife stereotactic radiosurgery for the treatment of intramedullary spinal cord metastases. J. Clin. Neurosci. 19(9), 1273–1277 (2012).
    • 23 Dodd RL, Ryu MR, Kamnerdsupaphon P, Gibbs IC, Chang SD Jr, Adler JR Jr. CyberKnife radiosurgery for benign intradural extramedullary spinal tumors. Neurosurgery 58(4), 674–685; discussion 674–685 (2006).
    • 24 Gerszten PC, Burton SA, Ozhasoglu C, Mccue KJ, Quinn AE. Radiosurgery for benign intradural spinal tumors. Neurosurgery 62(4), 887–895; discussion 895–886 (2008).
    • 25 Sahgal A, Chou D, Ames C et al. Image-guided robotic stereotactic body radiotherapy for benign spinal tumors: the University of California San Francisco preliminary experience. Technol. Cancer Res. Treat. 6(6), 595–604 (2007).
    • 26 Marchetti M, De Martin E, Milanesi I, Fariselli L. Intradural extramedullary benign spinal lesions radiosurgery. Medium- to long-term results from a single institution experience. Acta Neurochir. (Wien) 155(7), 1215–1222 (2013).
    • 27 Hernández-Durán S, Hanft S, Komotar RJ, Manzano GR. The role of stereotactic radiosurgery in the treatment of intramedullary spinal cord neoplasms: a systematic literature review. Neurosurg. Rev. 39(2), 175–183; discussion 183 (2016).
    • 28 Chang SD, Meisel JA, Hancock SL, Martin DP, McManus M, Adler JR Jr. Treatment of hemangioblastomas in von Hippel–Lindau disease with linear accelerator-based radiosurgery. Neurosurgery 43(1), 28–34; discussion 34–25 (1998).
    • 29 Daly ME, Choi CY, Gibbs IC et al. Tolerance of the spinal cord to stereotactic radiosurgery: insights from hemangioblastomas. Int. J. Radiat. Oncol. Biol. Phys. 80(1), 213–220 (2011).
    • 30 Ryu SI, Kim DH, Chang SD. Stereotactic radiosurgery for hemangiomas and ependymomas of the spinal cord. Neurosurg. Focus 15(5), E10 (2003).
    • 31 Gibbs IC, Patil C, Gerszten PC, Adler JR Jr, Burton SA. Delayed radiation-induced myelopathy after spinal radiosurgery. Neurosurgery 64(2 Suppl.), A67–A72 (2009).
    • 32 Bohm P, Huber J. The surgical treatment of bony metastases of the spine and limbs. J. Bone Joint Surg. Br. 84(4), 521–529 (2002).
    • 33 Wong DA, Fornasier VL, Macnab I. Spinal metastases: the obvious, the occult, and the impostors. Spine (Phila Pa 1976) 15(1), 1–4 (1990).
    • 34 Mehrotra R, Sharma K. Intradural extramedullary spinal metastasis from an ovarian carcinoma. Indian J. Cancer 39(4), 157–160 (2002).
    • 35 Landriel F, Ajler P, Tedesco N, Bendersky D, Vecchi E. Multicentric extramedullary myxopapillary ependymomas: two case reports and literature review. Surg. Neurol. Int. 3, 102 (2012).
    • 36 Lee CH, Kim KJ, Hyun SJ, Jahng TA, Kim HJ. Intradural extramedullary metastasis of small cell lung cancer: a case report. Korean J. Spine 9(3), 293–296 (2012).
    • 37 Petterwood J, Lim K, Gonzalvo A, Quan G. Intradural extramedullary colorectal adenocarcinoma metastasis to the cervical spine. ANZ J. Surg. 85(7–8), 582–583 (2015).
    • 38 Wolf A, Johnstone R, Siddiqi F. Intradural extramedullary spinal cord metastasis of the prostate: a case presentation and review of the literature. Can. J. Neurol. Sci. 43(4), 588–592 (2016).
    • 39 Knafo S, Pallud J, Le Rhun E et al. Intradural extramedullary spinal metastases of non-neurogenic origin: a distinct clinical entity or a subtype of leptomeningeal metastasis? A case-control study. Neurosurgery 73(6), 923–931; discussion 932 (2013).
    • 40 Akhavan A, Mehrabaniyan MR, Jarahi M, Navabii H. Intradural extramedullary metastasis from papillary carcinoma of thyroid. BMJ Case Rep. 2012, pii: bcr0220125801 (2012).
    • 41 Lin CL, Chang JL, Lo HC, Wu KA. Extramedullary-intradural spinal metastasis of small cell lung cancer causing cauda equina syndrome. Am. J. Med. Sci. 339(2), 192–194 (2010).
    • 42 Perrin RG, Livingston KE, Aarabi B. Intradural extramedullary spinal metastasis. A report of 10 cases. J. Neurosurg. 56(6), 835–837 (1982).
    • 43 Park HK, Chang JC. Review of stereotactic radiosurgery for intramedullary spinal lesions. Korean J. Spine 10(1), 1–6 (2013).
    • 44 Bhatnagar AK, Gerszten PC, Ozhasaglu C et al. CyberKnife frameless radiosurgery for the treatment of extracranial benign tumors. Technol. Cancer Res. Treat. 4(5), 571–576 (2005).
    • 45 Hopewell JW, Morris AD, Dixon-Brown A. The influence of field size on the late tolerance of the rat spinal cord to single doses of X rays. Br. J. Radiol. 60(719), 1099–1108 (1987).
    • 46 Travis EL. Genetic susceptibility to late normal tissue injury. Semin. Radiat. Oncol. 17(2), 149–155 (2007).
    • 47 Sohn S, Chung CK. The role of stereotactic radiosurgery in metastasis to the spine. J. Korean Neurosurg. S. 51(1), 1–7 (2012).
    • 48 Rock JP, Ryu S, Yin FF, Schreiber F, Abdulhak M. The evolving role of stereotactic radiosurgery and stereotactic radiation therapy for patients with spine tumors. J. Neuro-Oncol. 69(1–3), 319–334 (2004).
    • 49 Gagnon GJ, Nasr NM, Liao JJ et al. Treatment of spinal tumors using cyberknife fractionated stereotactic radiosurgery: pain and quality-of-life assessment after treatment in 200 patients. Neurosurgery 64(2), 297–306 (2009).
    • 50 Chang EL, Shiu AS, Mendel E et al. Phase I/II study of stereotactic body radiotherapy for spinal metastasis and its pattern of failure. J. Neurosurg-Spine 7(2), 151–160 (2007).
    • 51 Yamada Y, Lovelock DM, Yenice KM et al. Multifractionated image-guided and stereotactic intensity-modulated radiotherapy of paraspinal tumors: a preliminary report. Int. J. Radiat. Oncol. 62(1), 53–61 (2005).
    • 52 Roonprapunt C, Silvera VM, Setton A, Freed D, Epstein FJ, Jallo GI. Surgical management of isolated hemangioblastomas of the spinal cord. Neurosurgery 49(2), 321–327; discussion 327–328 (2001).
    • 53 Chang UK, Rhee CH, Youn SM, Lee DH, Park SQ. Radiosurgery using the cyberknife for benign spinal tumors: Korea Cancer Center Hospital experience. J. Neurooncol. 101(1), 91–99 (2011).