Memorial Sloan Kettering is a proven innovator in radiation therapy for spine tumors. Our radiation oncology team pioneered several highly targeted techniques that allow us to deliver very effective doses of radiation to spine tumors while preventing injury to the nearby organs. These specialized techniques increase the chance of a cure for many spine tumors while reducing the risk of injury to the spinal cord and other tissues near the spine.
Radiation therapy is commonly included in the treatment plan for many patients with spine tumors. Because of its effectiveness, radiation therapy – given externally or internally – is often the treatment of choice for eliminating metastatic spine tumors and preventing tumors from returning after surgery. Radiation therapy is also frequently used before surgery to shrink tumors and make them easier to remove. Radiation therapy, alone or with surgery, is one of the most effective ways to relieve pain from spinal tumors. Radiation therapy by itself is a highly effective treatment for many spine tumors that do not require surgery.
The following sections explain the different types of radiation therapy used at Memorial Sloan Kettering. Your doctor will consider factors including but not limited to the size and location of the tumor to identify which approach would be best to treat your spine tumor.
External Radiation Therapy
In external radiation therapy, radiation is directed to spine tumors from a source located outside the body. Memorial Sloan Kettering’s radiation oncologists use a variety of methods to target spine tumors with exquisite precision and deliver the radiation dose that will be most effective. We use four types of external radiation therapy to treat spine tumors: conventional external-beam radiation therapy, intensity-modulated radiation therapy, image-guided radiation therapy, and stereotactic radiosurgery.
Conventional external-beam radiation therapy is the most common approach to irradiating spine tumors. In conventional EBRT, a pair of radiation beams is aimed precisely at the tumor from a machine that administers low doses of radiation over a number of treatment sessions. This approach is generally used to treat metastatic spine tumors. Spine metastases that are considered sensitive to radiation are very likely to benefit from this approach.
Intensity-modulated radiation therapy is the most advanced way to deliver high doses of radiation to spine tumors while reducing the amount of radiation given to nearby organs. IMRT uses highly sophisticated computer software and three-dimensional images from CT scans to mold radiation to the shape of a spine tumor. IMRT concentrates high doses of radiation to the tumor, even when it is located near important organs such as the spinal cord, esophagus, or kidneys. IMRT may be recommended to treat tumors that require a higher dose of radiation than is given with conventional external-beam radiation therapy.
Image-guided radiation therapy combines state-of-the-art cone-beam computed tomography (CBCT) imaging with IMRT. In IGRT, CBCT imaging is performed during each radiation treatment session to ensure that the intended radiation dose is delivered with pinpoint accuracy. IGRT is often used to treat patients with tumors that are resistant to standard doses of radiation, or for patients who have been previously treated with radiation.
Memorial Sloan Kettering’s radiation oncology team is advancing the use of an ultra-high-dose, highly precise form of IGRT called stereotactic radiosurgery. Stereotactic radiosurgery uses advanced imaging technologies, combined with a sophisticated computer guidance system, to deliver very high doses of intensity-modulated radiation directly to the tumor. With stereotactic radiosurgery, tumors can be treated in just a few sessions while sparing nearby organs. Stereotactic radiosurgery is often used to eliminate spine tumors that are resistant to conventional external-beam radiation, offering an important treatment option for patients who have previously had radiation therapy for their spine disease.
For some spine tumors, our radiation oncologists can use proton therapy, an advanced form of radiation therapy, to deliver high doses of radiation to tumors that may be resistant to conventional forms while minimizing exposure to the surrounding healthy tissues. Proton therapy directs its cancer-fighting energy to precise locations within the body, allowing our doctors to deliver the necessary dose to the tumor — maximizing the chance of destroying it — while simultaneously lowering the dose to normal tissues and thereby reducing the risk of treatment-related side effects. Currently, this cutting-edge technology is available at only 14 locations in the United States.
High-Dose-Rate (HDR) Brachytherapy
Radiation oncologists at Memorial Sloan Kettering are pioneers in the use of an internal form of radiation therapy called HDR brachytherapy for the treatment of spine tumors. In HDR brachytherapy, ultra-high doses of radiation are placed directly into the tumor for a short period of time to treat it from the inside out. This approach reduces the risk of radiation damage to other nearby tissues.
People with spine tumors that do not respond to external radiation therapy may be treated with one of the following brachytherapy techniques.
In this type of brachytherapy, doctors temporarily place a thin piece of silicone that is coated with a high-dose radioactive film directly on an area that contains tumor cells. The film is made of a radioactive form of phosphorus called P32. The plaque is put into place during surgery and removed before the operation is over. The radiation from the plaque is very strong at the surface where it is used, but within several millimeters the radiation dose weakens quickly. This allows delivery of high doses of radiation to the tumor cells while sparing the nearby normal tissues from radiation.
P32 has been used successfully for years as a local treatment for other types of tumors. Doctors at Memorial Sloan Kettering were instrumental in developing this technology and were the first to use it to treat spine tumors.
HDR brachytherapy can also be delivered to spine tumors using small catheters that are inserted into the tumor while you are under anesthesia. A computer-controlled treatment unit dispenses the prescribed amount of radiation through each catheter. At the end of treatment, the catheters are removed and the patient is able to go home the same day.
Reducing Radiation Side Effects
Our radiation oncology team strives to reduce the risk of side effects while offering you the best chance to cure or control your spine tumor. Medical physicists are present during your treatment to ensure that the correct dose of radiation is delivered precisely where it is needed. Our team has advanced the use of sophisticated technologies and imaging techniques that vastly improve our ability to focus therapy on your tumor while avoiding nearby tissues.
Side effects after radiation treatment of a spine tumor may vary, depending on which part of your spine is treated. Patients who are treated in the upper portion of the spine may temporarily experience a sore throat. Others may experience redness in the skin similar to a mild sunburn. Spinal cord injury after spine radiosurgery is extremely rare. Talk to your doctor about possible side effects before starting radiation therapy for your spine tumor.