Radio surgery specifically spinal stereotactic radio surgery is emerging to be a significant advancement in the treatment for malignant spinal tumors. The use of high dose single fraction and hypofractionated radiation is seen to better control tumors compared to conventional types of radiotherapy.
Spinal Stereotactic Radio Surgery (SRSS), How Does It Work?
SRSS works by delivering a high dose of energy radiation to the spinal tumor. It delivers radiation precisely; so surrounding tissues are scathed from damage. The high dose of radiation utilizes ionizing radiation, which uses highly charged particles to pull out electrons from their orbits. This destroys the cancer cell’s molecular structure, which eventually leads to cellular destruction. The SRSS uses single fraction and hypofractionated radiation to eradicate the tumor cells. The use of this type of radiation depends on the type of tumor and the extent of the malignancy.
SRSS for Metastatic Spinal Cancer and Radioresistant Tumors
Metastasized spinal tumors are seen to respond effectively to SRS surgery. Studies have shown that metastasized spinal tumors responded to high dose radiation from SRS surgery. Radiosensitive tumors are also seen to respond to SRSS better compared to conventional radiologic techniques. This is evidenced by a study done to 393 patients suffering metastasized spinal tumors; the patients were treated using SRSS. Pain and tumor control was achieved in 86% to 90% of the cases. Another study evaluated 63 patients who have undergone the treatment and the study results show an 84% tumor free progression. Other conditions such as myelopathy and radiculopathy were not observed.
SRSS for Primary Malignancies of the Spine
Malignancies that originate from the spine itself are also seen to respond well to SRS treatment. Malignant spinal tumors such as chondrosarcoma, chordoma, and osteogenic sarcoma can be effectively treated with SRSS. These malignant tumors are difficult to manage because of their anatomic locations; surgical procedures are risky as it can affect other neurological functions (limb movement, bowel and bladder control, etc.).
Further studies have shown that only 15% of these tumors are candidates for en bloc resections. With this in mind other treatment options must be explored to manage cases where resection is not possible. SRSS is seen to aid patients with the stated conditions. This treatment is also used as an adjuvant treatment for patients who have undergone surgery.
Spinal cancer patients treated with SRSS demonstrated up to 98% control rate during their first year, 84% at their 3rd year and 78% at the 5th year. SRSS using single fraction radiation is also shown to be effective in treating primary spinal tumors. This is evidenced by a case of a patient treated with SRSS demonstrating almost 99% tumor death.
Side Effects of SRSS
Side effects associated with SRSS include mild esophagitis, dysphagia, mucositis, paresthesia, laryngitis, radiculitis, and diarrhea. The side effects are considered self-limiting and are easily managed. According to research, spinal cord injury from SRS treatment is extremely rare and only a few cases have been reported. The risk for spinal cord toxicity was very minimal and was even not reported in some of the cases.
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