Robotic image-guided radiosurgery for the treatment of neoplastic vertebral pain

Abstract

Metastatic spinal lesions are a common event in cancer patients. Spinal metastases usually involve the vertebral bodies and are characterized by severe pain. Surgical treatment, as a consequence of its high invasivity, is rarely offered to patients with metastatic disease and expected limited life span. Spinal radiosurgery provides high rates of pain and local growth control in association with limited risk of neurological complications. The use of radiosurgery to treat spinal lesions has been strongly facilitated by the development of image-guided robotic radiosurgery, a technique able to deliver stereotactic irradiation to intra- and extracranial targets. Despite the exponential increase of treatments delivered to the spine using this novel approach and the growing number of papers reporting the outcomes of spine radiosurgery in terms of local growth control and analgesia following treatment of patients with metastatic and benign lesions of the spine, the awareness of the general medical public to the use of this technique remains limited. This paper aims to review the role of radiosurgery in the treatment of vertebral metastases and benign tumors and its efficacy in terms of pain and local growth control.