Spinal Tumor Treatment Options

A range of treatment options are available for patients with metastatic spinal tumors, including radiation therapy and radiosurgery, surgery, and minimally invasive spine procedures, such as cryotherapy and radiofrequency ablation.

Radiation Therapy and Radiosurgery

The use of radiation therapy remains the current standard of care for metastatic spinal tumors.  Two principle modalities exist: external beam radiotherapy, most commonly offered in fractionated treatments over days or weeks, and stereotactic radiosurgery, which is often delivered over a shorter treatment timeline.

Whether choosing stereotactic radiosurgery or fractionated external beam radiation therapy, meaningful pain relief may not be realized for several weeks or months.

It is important to consider the etiology of the tumor when weighing treatment options as the effectiveness of radiotherapy on spinal metastases depends on the sensitivity of the tumor to ionizing radiation.  Metastatic lesions resulting from breast, lung, kidney, thyroid, and prostate cancer are often sensitive to radiotherapy, while those secondary to most melanomas, carcinomas, and sarcomas are found to be more resistant.

Additional factors to be considered may include the need to discontinue primary cancer chemotherapy to avoid risks of cumulative toxicity, increased risk of post-radiation vertebral collapse, and local symptomatic recurrence of previously radiated metastatic spinal tumors.

Surgery

Invasive surgical procedures for the treatment of spine tumors, such as laminectomy, corpectomy, spine fusion, and vertebral reconstruction, are considered options for patients with neurological deficits, significant spinal instability, and/or longer life expectancy. Given the disease state of many patients with metastatic spine tumor and the palliative and local control goals for chosen treatments, invasive surgical procedures are often less desirable.

Ablation

Ablation is commonly used to treat cancer in soft tissue organs throughout the body using hypothermia (cryoablation or cryotherapy) or hyperthermia (heat-based ablation) via laser, microwave, ultrasound, or radiofrequency (RF) energy. Recent advances in the targeted delivery of RF energy make ablation a viable option for treating metastatic bone tumors in vertebra.

For localized bone pain, such as that associated with painful metastatic spinal tumors, the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines indicate that radiofrequency ablation (RFA) should be considered a treatment option.

Clinical Practice Guidelines indicate that radiofrequency ablation (RFA) should be a considered treatment option. 1

When used in combination with other treatments, RFA offers acute pain relief and meaningful quality of life improvements for cancer patients.2,3 RFA procedures are localized and performed in a single non-toxic treatment that is easily tolerated by patients.

In addition, RFA  potentially allows for the concomitant initiation and/or continuation of chemotherapy, reduced-dosage radiation therapy, and lower cumulative toxicity levels in patients. Such treatments may offer an effective option to patients who are not candidates for other standard therapies.

References

1.    National Comprehensive Cancer Network.  Adult Cancer Pain (Version 2.2014).
2.    Kurup AN and Callstrom MR. “Ablation of skeletal metastases: Current status” .J Vasc Interv Radiol. 2010; 21:S242-S250.
3.    Dupuy DE, Dawei L, Hartfeil D, Hanna L, Blume JD, Ahrar K, Lopez R, Safran H and DiPetrillo T. “Percutaneous Radiofrequency Ablation of Painful Osseous Metastases”, Cancer. 2009; 116(4):989-997.