Spinal Tumor Treatment Options
A range of treatment options is available for patients with metastatic spinal tumors, including chemotherapy, radiation therapy and radiosurgery, hormonal therapy, antiresorptive therapy, general surgery, and minimally invasive spine procedures, such as cryoablation and radiofrequency ablation.
Chemotherapy is rarely considered as an option for treating metastatic spinal tumors due to its systemic nature and extended time to pain relief. Despite its gradual impact, when successful, chemotherapy can shrink tumors and ease pain. Introducing an additional therapy focused on metastatic spinal tumors must ensure minimal interference with the standard chemotherapy usually prescribed to treat the primary cancer.
The use of radiotherapy remains the current standard of care for metastatic spinal tumors, even as new developments in surgery and medical oncology have become available. Within this standard of care, two principle modalities exist: external beam radiotherapy, most commonly offered in fractionated treatments over days or weeks, and stereotactic radiosurgery.
Although stereotactic radiosurgery has a shorter treatment timeline than that often associated with fractionated external beam radiation therapy, other factors have made external beam radiotherapy the more common of the two modalities. Both, however, may not offer significant pain relief until after treatment has been initiated 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 melanoma, renal cell carcinoma, and osteosarcoma 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 recurrence of radiated spinal metastatic tumors.
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 palliative nature of metastatic spine tumor treatments, more invasive surgical procedures are often avoided.
Ablation is commonly used to treat cancer in soft tissue organs throughout the body using hypothermia (cryoablation) or hyperthermia (heat-based ablation) via laser, microwave, ultrasound, or radiofrequency (RF) energy. Recent technological advances in targeted delivery of RF energy make ablation a viable option for treating metastatic bone tumors in vertebra.
Used in combination with other treatments, radiofrequency ablation technology offers acute pain relief and other quality of life improvements for cancer patients.1,2 Because radiofrequency ablation is localized and performed in a single treatment, it can allow for the concomitant initiation and/or continuation of chemotherapy, potentially reduced-dosage radiation therapy, and lower cumulative toxicity levels in patients. Radiofrequency ablation may also offer an important treatment option for patients who are especially sensitive to radiation or those with radiation resistant tumors.
References
- Kurup AN and Callstrom MR. “Ablation of skeletal metastases: Current status.” J Vasc Interv Radiol. 2010;21:S242-S250.
- 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.