Onkológia 5/2022

Stereotactic radiotherapy has transformed the treatment of metastases in the spine

radiotherapy has been the only radical treatment option for long. Radiotherapy as a single modality has resorted in palliation only, providing insufficient long-term control in radioresistant tumours, as the standard dose has been limited by the tolerance of a spinal cord. Stereotactic radiotherapy offers spinal cord protection by conformal dose shaping with a steep dose gradient and precise patient positioning utilizing imaging before and during irradiation. A high dose of irradiation with ablative potential can be delivered to metastatic spine involvement by the means of this safe and non-invasive technology allowing high probability of a local control also in radioresistant tumours. Spinal stereotactic radiotherapy has changed several paradigms in spinal metastases management, enabling non-invasive radical treatment of oligometastatic involvement of a spine, improving long-term pain control in radioresistant tumours and altering the management of epidural spinal cord compression. Optimal indication of conventional or stereotactic radiotherapy and various types of surgical interventions should be based on the NOMS (Neurologic, Oncologic, Mechanical and Systemic Criteria) framework and individual patient evaluation by a dedicated spinal oncology multidisciplinary team.

Keywords: spinal metastases, epidural spinal cord compression, stereotactic body radiotherapy