RADIOSURGERY IN THE TREATMENT OF SPINAL METASTASES: TUMOR CONTROL, SURVIVAL, AND QUALITY OF LIFE AFTER HELICAL TOMOTHERAPY

OBJECTIVE: The effectiveness and limitations of spinal radiosurgery using a helical TomoTherapy system for the treatment of spinal metastases are reviewed in this article. METHODS: This is a retrospective review of patients who underwent stereotactic radiosurgery for spinal metastases between July 2004 and December 2007. Radiographic follow-up consisted of magnetic resonance imaging to assess tumor growth control as well as pre- and posttreatment x-rays, which were used to measure changes in segmental angulation and deformity. Clinical performance was assessed using the Karnofsky Performance Scale, Oswestry Disability Index, and visual analog scale. RESULTS: Forty patients were treated for 110 metastatic tumors (range, 1-6 tumors per patient). The mean age at the time of radiosurgical treatment was 67 years (age range, 35-81 years). Twenty-three patients (57.5%) had undergone previous surgical resection. Pain was the most common presenting symptom, seen in 32 patients (80%). The mean Oswestry Disability Index score at presentation was 43 (range, 20-90), and the mean visual analog scale score was 6.2 (range, 0-10). The mean radiosurgical dose to the tumor was 17.3 Gy (range, 10-24 Gy). At a mean follow-up duration of 12.7 months (range, 4-32 months), decreased or stable tumor volume was seen in 90 (82%) of the tumors treated. There was improvement in pain in 34 patients (850%). The mean postradiosurgical Oswestry Disability Index score was 25 (range, 10-90), whereas the postradiosurgical visual analog scale score was 3.2 (range, 0-9). Progression of kyphosis was the most common radiographic sequela, experienced by 73% of patients alive at 12 months, with a mean change in angulation of 7.3 +/- 4.5 degrees. CONCLUSION: Radiosurgery is effective as either primary or adjunctive treatment of metastatic tumors of the spine.