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Vol. 31. Issue 3.
Pages 119-131 (May - June 2020)
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Vol. 31. Issue 3.
Pages 119-131 (May - June 2020)
Review article
DOI: 10.1016/j.neucie.2019.08.001
Stereotactic body radiation therapy and minimally invasive surgery in the management of spinal metastases: A change in the paradigm
Radioterapia estreotáxica corporal y cirugía mínimamente invasiva en el manejo de las metástasis espinales: un cambio de paradigma
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Pedro David Delgado-Lópeza,
Corresponding author
pedrodl@yahoo.com

Corresponding author.
, Héctor Roldán-Delgadob, Eva María Corrales-Garcíac
a Servicio de Neurocirugía, Hospital Universitario de Burgos, Burgos, Spain
b Servicio de Neurocirugía, Complejo Hospitalario Universitario de Canarias, Tenerife, Spain
c Servicio de Oncología Radioterápica, Hospital Universitario de Burgos, Burgos, Spain
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Table 1. SINS scale.
Abstract

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 2–3mm 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.

Keywords:
Spinal metastasis
Radiosurgery
Separation surgery
Stereotactic body radiation therapy
Minimally invasive surgery
Survival
Resumen

El objetivo principal del tratamiento en las metástasis espinales es el control local de la enfermedad, el alivio del dolor y el mantenimiento de la deambulación. Clásicamente, se ha recomendado una resección quirúrgica del tumor lo más amplia posible seguida de radioterapia o quimioterapia adyuvante. En la actualidad, la radioterapia estereotáxica corporal (SBRT) en dosis única o hipofraccionada proporciona tasas globales de control local al año superiores al 95% con mínima morbilidad, incluso en histologías que suelen considerarse radiorresistentes. Por otro lado, mediante cirugía de descompresión circunferencial posterolateral y estabilización de la columna es factible crear un espacio de 2-3mm entre el borde tumoral y la duramadre (separation surgery) suficiente para permitir administrar de forma segura SBRT a dosis ablativas. Dado que con frecuencia se trata de pacientes frágiles, dicha cirugía puede realizarse mediante técnicas mínimamente invasivas, que reducen la agresividad quirúrgica y ayudan a minimizar el retraso de eventuales tratamientos sistémicos.

Palabras clave:
Metástasis espinal
Radiocirugía
Separation surgery
Radioterapia estereotáxica corporal
Cirugía mínimamente invasiva
Supervivencia

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