Stereotactic body radiation therapy and minimally invasive surgery in the management of spinal metastases: a change in the paradigm.
The main goal of treatment in spinal metastatic patients is local control of the disease, pain relief and the maintenance of ambulation. Traditionally, wide surgical resection of the tumour followed by adjuvant radiation and/or chemotherapy has been recommended. Currently, single-fraction or hypofractionated stereotactic body radiation therapy (SBRT) yields a one-year local control rate of over 95% with minimum morbidity, even for tumours previously considered radioresistant. In addition, by posterolateral and circumferential decompression and stabilisation of the spinal cord, it is feasible to create a 2 to 3 mm epidural margin between the dura mater and the tumour (separation surgery), enough to deliver safe and ablative doses of SBRT to the vertebrae. As these patients tend to be frail, such interventions should ideally be minimally invasive, thereby reducing surgical aggressiveness and helping to minimise the delay of any systemic therapies.
['Delgado-López|Pedro David|PD|', 'Roldán-Delgado|Héctor|H|', 'Corrales-García|Eva María|EM|']
D006801:Humans D019060:Minimally Invasive Surgical Procedures D016634:Radiosurgery D018714:Radiotherapy, Adjuvant D013125:Spinal Neoplasms D016896:Treatment Outcome
Stereotactic Body Radiation Therapy Minimally Invasive Surgery Separation surgery Cirugía mínimamente invasiva Metástasis espinal Radiocirugía Radiosurgery Radioterapia estereotáxica corporal Spinal metastasis Supervivencia Survival