Stereotactic radiosurgery has advanced the treatment of metastatic spine disease

SAN DIEGO — Radiosurgery is a revolutionary and meaningful advance that has helped improve the outcomes of metastatic spine disease and how it is treated, according to a presentation by Mark H. Bilsky, MD.

“Twenty percent of cancer patients will develop spinal metastases over the course of their illness,” he said at the Congress of Neurological Surgeons Annual Meeting, noting there is an immense need for more effective treatments.

Stereotactic radiosurgery (SRS) and its related technological developments now enable spine surgeons to safely deliver high doses of radiation to within millimeters of the spinal cord in patients with spinal metastases. Its use is also associated with improved outcomes with separation surgery, some of which is done through minimally invasive surgery by pioneers in the field, Bilsky said.

“The goals of metastatic disease treatment are palliative: to improve or maintain function; achieve local tumor control; mechanical stability; pain relief; and improve quality of life. Far and away the single greatest advance in the treatment of metastatic spine disease is stereotactic radiosurgery,” he said.

According to Bilsky, some key advantages of SRS over conventional external beam radiation are a shorter treatment time and quicker return of patients to systemic therapy.

“But,” he said, “the great advance is the ability to give a cytotoxic tumoral dose that is ablative, and this has fundamentally changed our treatment paradigms, including indications for any type of surgery that we do.”

Bilsky, who is vice chairman for Clinical Affairs in Neurosurgery at Memorial Sloan Kettering Cancer Center in New York City, said researchers are learning more about the effects of the dose of radiation on tumor outcomes. He also mentioned the future directions for SRS in spinal metastases he feels are critical.

“We need to standardize dose reporting for the literature. We have contouring guidelines for the upfront setting, but need to establish those for the postoperative setting, as well. Tumor responses are based on the spinal criteria. We look at standard [magnetic resonance] MR imaging, but there is always radiographic residual in the bone and it is unclear whether there is viable tumor there or treated. Now, using [dynamic contrast-enhanced] DCE MR, particularly looking at plasma volume, we have reliable indicators of whether there is a residual or a recurrent tumor long before standard MR imaging changes,” he said. – by Susan M. Rapp

Reference:

Bilsky MH. Stereotactic radiosurgery: The revolutionary advance in the treatment of spine metastases. Presented at: Congress of Neurological Surgeons Annual Meeting; Sept. 24-28, 2016; San Diego.

Disclosure: Bilsky reports no relevant financial disclosures.