Advances in the treatment of metastatic spine tumors: the future is not what it used to be

Abstract

An improved understanding of tumor biology, the ability to target tumor drivers, and the ability to harness the immune system have dramatically improved the expected survival of patients diagnosed with cancer. However, many patients continue to develop spine metastases that require local treatment with radiotherapy and surgery. Fortunately, the evolution of radiation delivery and operative techniques permits durable tumor control with a decreased risk of treatment-related toxicity and a greater emphasis on restoration of quality of life and daily function. Stereotactic body radiotherapy allows delivery of ablative radiation doses to the majority of spine tumors, reducing the need for surgery. Among patients who still require surgery for decompression of the spinal cord or spinal column stabilization, minimal access approaches and targeted tumor excision and ablation techniques minimize the surgical risk and facilitate postoperative recovery. Growing interdisciplinary collaboration among scientists and clinicians will further elucidate the synergistic possibilities among systemic, radiation, and surgical interventions for patients with spinal tumors and will bring many closer to curative therapies.

Keywords: Dmax = maximum dose; ESCC = epidural spinal cord compression; HRQOL = health-related quality of life; LITT = laser interstitial thermal therapy; MAS = minimal access surgery; NOMS; NOMS = neurologic, oncologic, mechanical stability, and systemic disease; PMMA = polymethylmethacrylate; SBRT; SBRT = stereotactic body radiotherapy; SINS = Spinal Instability Neoplastic Score; TKI-VEGF = tyrosine kinase inhibitor–vascular endothelial growth factor; and systemic disease; cEBRT = conventional external-beam radiation therapy; mechanical stability; neurologic; oncologic; oncology; spine tumor; stereotactic body radiotherapy.