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

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.