The use of stereotactic radiosurgery for the treatment of spinal axis tumors: A review

• Stereotactic radiosurgery (SRS) refers to the use of focused beams of radiation directed at a specific lesion within the body.
• Metastasis to the spine affects approximately 40% of patients with cancer.
• SRS has been used as first-line treatment for spinal metastases, with local control rates of approximately 90%.
• SRS has also been used following failure of conventional radiotherapy and separation surgery.
• Additionally, SRS has a potential role in the treatment of primary malignant spinal axis tumors such as chordomas and sarcomas.

As the prevalence of cancer in the general population increases, a greater proportion of patients will present with symptomatic metastatic lesions to the spine. While surgery has been historically considered the treatment of choice for spinal cord/nerve root compression, mechanical instability and intractable pain, radiation therapy – particularly stereotactic radiosurgery (SRS) – has been increasingly used as either a primary or adjuvant treatment modality. In this manuscript, the authors perform a review on the principles behind SRS and its use in the treatment of spinal tumors, specifically primary and secondary malignant tumors. In the last decades, numerous retrospective studies have shown the feasibility of SRS as both primary treatment for malignant tumors, as well as adjuvant treatment following surgical resection. Although local control rates may reach 90%, future studies are warranted to determine optimal doses, fractionation of therapy and the long-term implications of irradiation to neural structures.