Abstract
Radiosurgery is the delivery, in a single or a few fractions, of a concentrated dose of radiation to diseased tissue with a steep dose fall-off outside the treatment volume. Traditionally, radiosurgery is delivered to intracranial targets using a rigid frame to immobilize the target and provide external reference points for target localization. The development of image-guided radiosurgery has allowed the principles of radiosurgery to be applied to the treatment of extracranial pathologies including spinal lesions. Image guidance is the use of imaging to locate the tumor before and during a treatment session and redirect the radiation source or reposition the patient based on these measurements. In this manner dose delivery accuracy comparable to frame-based radiosurgery can be achieved. Furthermore, frameless stereotactic radiosurgery allows treatments to be delivered in more than one fraction, which has the potential to reduce toxicity to healthy tissue and organs at risk such as the spinal cord, an organ that is among the most sensitive to radiation.
Spinal radiosurgery has resulted in excellent rates of tumor control with a relatively low risk of radiation-induced myelopathy. Here we review currently available image-guided stereotactic radiosurgery devices that can be used to treat the spine, summarize clinical data showing the efficacy of these systems, and discuss dose and volume limits to avoid radiation toxicity induced by spinal radiosurgery for malignant and benign pathologies.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Adler JR, Chang SD, Murphy MJ, Doty J, Geis P, Hancock SL (1997) The Cyberknife: a frameless robotic system for radiosurgery. Stereotact Funct Neurosurg 69:124–128
Bilsky M, Hamada Y, Yenice KM, Lovelock M, Hunt M, Gutin PH, Leibel SA (2004) Intensity-modulated stereotactic radiotherapy of paraspinal tumors: a preliminary report. Neurosurgery 54:823–830
Chang UK, Rhee CH, Youn SM, Lee DH, Park SQ (2011) Radiosurgery using the Cyberknife for benign spinal tumors: Korea cancer center hospital experience. J Neurooncol 101:91–99
Colombo F, Cavedon C, Casentini L, Francescon P, Causin F, Pinna V (2009) Early results of CyberKnife radiosurgery for arteriovenous malformations. J Neurosurg 111:807–819
Daly ME, Luxton G, Choi CY, Gibbs IC, Chang SD, Adler JR, Soltys SG (2012) Normal tissue complication probability estimation by the Lyman-Kutcher-Burman method does not accurately predict spinal cord tolerance to stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 82:2025–2032
De Salles AA, Pedroso AG, Medin P, Agazaryan N, Solberg T, Cabatan-Awang C, Espinosa DM, Ford J, Selch MT (2004) Spinal lesions treated with Novalis shaped beam intensity-modulated radiosurgery and stereotactic radiotherapy. J Neurosurg 101(Suppl 3):S435–S440
Degen JW, Gagnon GJ, Voyadzis JM, McRae DA, Lunsden M, Dieterich S, Molzahn I, Henderson FC (2005) CyberKnife stereotactic radiosurgical treatment of spinal tumors for pain control and quality of life. J Neurosurg Spine 2:540–549
Dodd RL, Ryu MR, Kamnerdsupaphon P, Gibbs IC, Chang SD Jr, Adler JR Jr (2006) CyberKnife radiosurgery for benign intradural extramedullary spinal tumors. Neurosurgery 58:674–685
Emami B, Lyman J, Brown A, Coia L, Goitein M, Munzenrider JE, Shank B, Solin LJ, Wesson M (1991) Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 21:109–122
Gagnon GJ, Nasr NM, Liao JJ, Molzahn I, Marsh D, McRae D, Henderson FC Sr (2009) Treatment of spinal tumors using cyberknife fractionated stereotactic radiosurgery: pain and quality-of-life assessment after treatment in 200 patients. Neurosurgery 64:297–306
Gerszten PC, Ozhasoglu C, Burton SA, Vogel WJ, Atkins BA, Kalnicki S, Welch WC (2004) CyberKnife frameless stereotactic radiosurgery for spinal lesions: clinical experience in 125 cases. Neurosurgery 55:89–98
Gerszten PC, Burton SA, Ozhasoglu C, Vogel WJ, Welch WC, Baar J, Friedland DM (2005a) Stereotactic radiosurgery for spinal metastases from renal cell carcinoma. J Neurosurg Spine 3:288–295
Gerszten PC, Germanwala A, Burton SA, Welch WC, Ozhasoglu C, Vogel WJ (2005b) Combination kyphoplasty and spinal radiosurgery: a new treatment paradigm for pathological fractures. J Neurosurg Spine 3:296–301
Gerszten PC, Burton SA, Quinn AE, Agarwala SS, Kirkwood JM (2006) Radiosurgery for the treatment of spinal melanoma metastases. Stereotact Funct Neurosurg 83:213–221
Gerszten PC, Burton SA, Ozhasoglu C, Welch WC (2007) Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution. Spine 32:193–199
Gerszten PC, Burton SA, Ozhasoglu C, McCue KJ, Quinn AE (2008) Radiosurgery for benign intradural spinal tumors. Neurosurgery 62:887–895
Gibbs IC, Kamnerdsupaphon P, Ryu MR, Dodd R, Kiernan M, Chang SD, Adler JR Jr (2007) Image-guided robotic radiosurgery for spinal metastases. Radiother Oncol 82:185–190
Gibbs IC, Patil C, Gerszten PC, Adler JR Jr, Burton SA (2009) Delayed radiation-induced myelopathy after spinal radiosurgery. Neurosurgery 64:A67–A72
Hamilton AJ, Lulu BA, Fosmire H, Stea B, Cassady JR (1995) Preliminary clinical experience with linear accelerator-based spinal stereotactic radiosurgery. Neurosurgery 36:311–319
Heron DE, Rajagopalan MS, Stone B, Burton S, Gerszten PC, Dong X, Gagnon GJ, Quinn A, Henderson F (2012) Single-session and multisession CyberKnife radiosurgery for spine metastases-University of Pittsburgh and Georgetown University experience. J Neurosurg Spine. May 11. [Epub ahead of print]
Ho AK, Fu D, Cotrutz C, Hancock SL, Chang SD, Gibbs IC, Maurer CR Jr, Adler JR Jr (2007) A study of the accuracy of Cyberknife spinal radiosurgery using skeletal structure tracking. Neurosurgery 60:147–156
Jin JY, Chen Q, Jin R, Rock J, Anderson J, Li S, Movsas B, Ryu S (2007) Technical and clinical experience with spine radiosurgery: a new technology for management of localized spine metastases. Technol Cancer Res Treat 6:127–133
Kirkpatrick JP, van der Kogel AJ, Schultheiss TE (2010) Radiation dose-volume effects in the spinal cord. Int J Radiat Oncol Biol Phys 76(3 Suppl):S42–S49
Kutcher GJ, Burman C (1989) Calculation of complication probability factors for non-uniform normal tissue irradiation: the effective volume method. Int J Radiat Oncol Biol Phys 16:1623–1630
Leksell L (1951) The stereotaxic method and radiosurgery of the brain. Acta Chir Scand 102:316–319
Murphy MJ, Adler JR Jr, Bodduluri M, Dooley J, Forster K, Hai J, Le Q, Luxton G, Martin D, Poen J (2000) Image-guided radiosurgery for the spine and pancreas. Comput Aided Surg 5:278–288
Patel VB, Wegner RE, Heron DE, Flickinger JC, Gerszten P, Burton SA (2012) Comparison of whole versus partial vertebral body stereotactic body radiation therapy for spinal metastases. Technol Cancer Res Treat 11:105–115
Romanelli P, Adler JR (2008) Technology insight: image-guided robotic radiosurgery–a new approach for noninvasive ablation of spinal lesions. Nat Clin Pract Oncol 5:405–414
Romanelli P, Schaal DW, Adler JR (2006) Image-guided radiosurgical ablation of intra- and extra-cranial lesions. Technol Cancer Res Treat 5:421–428
Ryu SI, Chang SD, Kim DH, Murphy MJ, Le QT, Martin DP, Adler JR Jr (2001) Image-guided hypo-fractionated stereotactic radiosurgery to spinal lesions. Neurosurgery 49:838–846
Ryu S, Fang YF, Rock J, Zhu J, Chu A, Kagan E, Rogers L, Ajlouni M, Rosenblum M, Kim JH (2003) Image-guided and intensity-modulated radiosurgery for patients with spinal metastasis. Cancer 97:2013–2018
Ryu S, Rock J, Rosenblum M, Kim JH (2004) Patterns of failure after single-dose radiosurgery for spinal metastasis. J Neurosurg 101(Suppl 3):402–405
Ryu S, Jin JY, Jin R, Rock J, Ajlouni M, Movsas B, Rosenblum M, Kim JH (2007) Partial volume tolerance of the spinal cord and complications of single-dose radiosurgery. Cancer 109:628–636
Sachdev S, Dodd RL, Chang SD, Soltys SG, Adler JR, Luxton G, Choi CY, Tupper L, Gibbs IC (2011) Stereotactic radiosurgery yields long-term control for benign intradural, extramedullary spinal tumors. Neurosurgery 69:533–539
Schultheiss TE (2008) The radiation dose–response of the human spinal cord. Int J Radiat Oncol Biol Phys 71:1455–1459
Sinclair J, Chang SD, Gibbs IC, Adler JR Jr (2006) Multisession CyberKnife radiosurgery for intramedullary spinal cord arteriovenous malformations. Neurosurgery 58:1081–1089
Yamada Y, Lovelock DM, Yenice KM, Bilsky MH, Hunt MA, Zatcky J, Leibel SA (2005) Multifractionated image-guided and stereotactic intensity-modulated radiotherapy of paraspinal tumors: a preliminary report. Int J Radiat Oncol Biol Phys 62:53–61
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2014 Springer Science+Business Media Dordrecht
About this chapter
Cite this chapter
Romanelli, P., Conti, A. (2014). Image-Guided Stereotactic Radiosurgery for Spinal Pathology. In: Hayat, M. (eds) Tumors of the Central Nervous System, Volume 12. Tumors of the Central Nervous System, vol 12. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-7217-5_28
Download citation
DOI: https://doi.org/10.1007/978-94-007-7217-5_28
Published:
Publisher Name: Springer, Dordrecht
Print ISBN: 978-94-007-7216-8
Online ISBN: 978-94-007-7217-5
eBook Packages: MedicineMedicine (R0)