Radiotherapy in Metastatic Spinal Disease

Metastases to the spine represent a challenging problem in oncology. Treatment decisions require multidisciplinary review. Radiation therapy remains a primary treatment modality for metastatic spinal tumors, but advances in radiation therapy, chemotherapy, and surgery have changed the roles of each and led to improved patient outcomes. Diagnosis and treatment before the development of significant neurologic and functional deficits improve outcomes. Physician awareness and appropriate imaging greatly enhance the early detection of tumor. The treatment of vertebral column tumors has undergone significant transformation over the past several decades. Advances in surgical techniques, chemotherapy, and radiation therapy have led to an overall shift in the management of patients with spine tumors, all with the goal of improving tumor control while minimizing treatment-related morbidity in these patients who are now expected to have prolonged survival. Perhaps the most significant changes have been the recent advances in spinal radiosurgery.