Patients' Guide to Spinal Cancer

Types of Radiation Therapy for Metastatic Spinal Tumors

Your doctor has many radiation options to treat your spine cancer.

If your doctor includes radiation therapy as part of your metastatic spine cancer treatment plan, he or she will choose from numerous delivery methods available today. Your doctor will consider the type, size, and severity of your spinal tumor when crafting your specific radiation regimen.

Radiation therapy uses radioactive energy to kill cancer cells, shrink tumors, and reduce symptoms caused by the cancer (such as spine pain). Radiation may be your only cancer treatment, or it may be used in combination with other modalities. In rare cases, your cancer may resist radiation, and surgery may be the only treatment option.

There are three broad categories of radiation to treat or control symptoms of metastatic spinal tumors: external radiation, internal radiation, and systemic radiation. Advancements to external radiation therapy, in particular, have made it the leading choice among radiation oncologists, and it is most popular for metastatic spinal cancer.
linear acceleratorExternal Radiation Therapy
External radiation therapy uses a device located outside of the body to send radiation to malignant cells within the body. This type of radiation therapy has benefited most from the latest advancements in the field.

Below are types of external radiation therapy that may be used to treat metastatic spinal cancer.

External beam radiation therapy (EBRT)
EBRT is a conventional and very common radiation delivery method for tumors that metastasize to the spine. Your doctor will aim two low-dose radiation beams at your tumor over the course of multiple sessions to destroy the cancerous cells.

Stereotactic radiosurgery
If your spinal tumors are not responding to EBRT, or if it is adjacent to sensitive tissues, your doctor may explore stereotactic radiosurgery. Stereotactic radiosurgery is a newer form of radiation therapy that is extremely successful at treating spinal tumors. This type of therapy uses advanced image-guided technology to deliver multiple low dose beams of radiation to the tumor when the combination of all the beams leads to a high dose of radiation being delivered to the tumor. Because the dose of radiation is intense, your doctor will carefully target it to a specific spot on your body to avoid nearby healthy tissues.

Because of the radiation intensity used in stereotactic radiosurgery, you won’t need as many sessions as conventional EBRT radiation to get optimal results.

Intensity-modulated radiation therapy (IMRT)
IMRT is another alternative when traditional EBRT isn’t the right option. This type of high-dose radiation uses cutting-edge software and imaging scans to replicate the exact size and shape of the spinal tumor. Then, the radiation beam is delivered to your body in that exact mold, making it incredibly precise while preserving nearby healthy tissue. IMRT can also account for movement of the body such as breathing.

Image-guided radiation therapy (IGRT)
Like stereotactic radiosurgery and IMRT, IGRT uses advanced technology to pinpoint high doses of radiation to a tumor. IGRT uses cone-beam computed tomography imaging to take three-dimensional images of the tumor before starting the radiation treatment. This allows your radiation oncologist to precisely target the tumor.

Internal Radiation Therapy
Internal forms of radiation use a catheter or other device to insert radioactive material directly into or near a tumor. High-dose rate brachytherapy is an example of this type of radiation.

High-dose rate brachytherapy
If your spinal tumor does not respond to external radiation, your doctor may recommend high-dose rate (HDR) brachytherapy. In this procedure, your doctor will briefly insert a high dose of radiation directly into your tumor.

Your doctor has the option to choose from multiple types of HDR brachytherapy. One type is called HDR brachytherapy plaques, which involves your doctor placing a thin piece of silicone covered with radioactive phosphorus on the cancer cells and removing it at the end of the procedure. Another option is called HDR brachytherapy catheters, where your doctor delivers radiation via catheters inserted into the tumor while you’re under general anesthesia.

Systemic Radiation Therapy
In some cases, radiation may be used to control symptoms rather than to treat the cancer itself. Systemic radiation therapy is used in this way with metastatic spinal cancer. While systemic radiation therapy may treat some types of cancer (namely thyroid cancer), it does not treat metastatic spinal tumors. However, systemic radiation therapy may be used to control the pain associated with spinal cancer.

Unlike external or internal radiation types that directly target a tumor, systemic radiation therapy involves the swallowing or injection of a radioactive substance that then travels to the tumor via the blood stream. Because the treatment works in the same fashion as a medication, your doctor may refer to it as a radiopharmaceutical.

Radiation Resistant: When Surgery Is Needed for Metastatic Spinal Tumors
While radiation is the most common therapy for people with metastatic spinal tumors, a small portion of patients have tumors that resist radiation (eg, tumors that originated in the gastrointestinal system and kidneys do not respond as well to radiation). In those cases, surgery may be the only possible treatment option.

Though radiation therapy may shrink your tumor and reduce cancer-related pain, you may still need spine surgery if your tumor is pressing on your spinal cord or if the cancer has caused the bones of your spine to become unstable. Your spine specialist is a key member of your clinical cancer team, and he or she will work with you, your medical oncologist, and your radiation oncologist to create a treatment plan that gives you the best chance of remission and recovery.

Updated on: 05/10/17
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