title: Spine radiosurgery for the local treatment of spine metastases: Intensity-modulated radiotherapy, image guidance, clinical aspects and future directions.
abstract: Many cancer patients will develop spinal metastases. Local control is important for preventing neurologic compromise and to relieve pain. Stereotactic body radiotherapy or spinal radiosurgery is a new radiation therapy technique for spinal metastasis that can deliver a high dose of radiation to a tumor while minimizing the radiation delivered to healthy, neighboring tissues. This treatment is based on intensity-modulated radiotherapy, image guidance and rigid immobilization. Spinal radiosurgery is an increasingly utilized treatment method that improves local control and pain relief after delivering ablative doses of radiation. Here, we present a review highlighting the use of spinal radiosurgery for the treatment of metastatic tumors of the spine. The data used in the review were collected from both published studies and ongoing trials. We found that spinal radiosurgery is safe and provides excellent tumor control (up to 94% local control) and pain relief (up to 96%), independent of histology. Extensive data regarding clinical outcomes are available; however, this information has primarily been generated from retrospective and nonrandomized prospective series. Currently, two randomized trials are enrolling patients to study clinical applications of fractionation schedules spinal Radiosurgery. Additionally, a phase I clinical trial is being conducted to assess the safety of concurrent stereotactic body radiotherapy and ipilimumab for spinal metastases. Clinical trials to refine clinical indications and dose fractionation are ongoing. The concomitant use of targeted agents may produce better outcomes in the future.
authors.affiliation: Hospital Sírio-Libanês, Departamento de Radioterapia, São Paulo/, SP, Brasil.
authors.forename: Fabio Ynoe
authors.initials: FY
authors.lastname: de Moraes
authors.affiliation: Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York/NY, USA.
authors.forename: Neil Kanth
authors.initials: NK
authors.lastname: Taunk
authors.affiliation: Memorial Sloan Kettering Cancer Center, Department of Neurosurgery, New York/NY, USA.
authors.forename: Ilya
authors.initials: I
authors.lastname: Laufer
authors.affiliation: Hospital Sírio-Libanês, Departamento de Radioterapia, São Paulo/, SP, Brasil.
authors.forename: Wellington Furtado Pimenta
authors.initials: WF
authors.lastname: Neves-Junior
authors.affiliation: Hospital Sírio-Libanês, Departamento de Radioterapia, São Paulo/, SP, Brasil.
authors.forename: Samir Abdallah
authors.initials: SA
authors.lastname: Hanna
authors.affiliation: Hospital Sírio-Libanês, Departamento de Radioterapia, São Paulo/, SP, Brasil.
authors.forename: Heloisa de Andrade
authors.initials: Hde A
authors.lastname: Carvalho
authors.affiliation: Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York/NY, USA.
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Yamada
mesh_terms: D002986:Clinical Trials as Topic; D006801:Humans; D007103:Immobilization; D010146:Pain / Q000532:radiotherapy; D016634:Radiosurgery / Q000379:methods* / Q000639:trends; D061089:Radiotherapy, Image-Guided / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D013125:Spinal Neoplasms / Q000556:secondary / Q000601:surgery*