Neurosurgeon Mark Bilsky on Stereotactic Radiosurgery for Spine Tumors

Pictured: Mark Bilsky

Mark Bilsky, director of the Spine Tumor Center

Stereotactic radiosurgery is an advanced type of external radiation therapy that delivers extremely precise, very intense doses of radiation to eliminate tumors. Physicians at Memorial Sloan Kettering’s Spine Tumor Center have pioneered the use of stereotactic radiosurgery as a key form of treatment for people with spine tumors. Their work has shown stereotactic radiosurgery to be highly effective at eliminating tumors while avoiding injury to the spinal cord.

In an interview, neurosurgeon Mark Bilsky, director of the Spine Tumor Center, explains how stereotactic surgery has changed spine tumor treatment at Memorial Sloan Kettering.

What is the Spine Tumor Center?

The Spine Tumor Center has evolved to become a highly specialized multidisciplinary team that works together closely on all problems related to spine cancer. Our team of more than 20 members includes neurosurgeons, radiation oncologists, neurologists, neuroradiologists, orthopaedic surgeons, pain management experts, rehabilitation specialists, and anesthesiologists who work only on spine procedures.

Nurses also play a critical role because they specialize in caring for people with spine tumors. Having a team focused just on spine tumors has enabled us to improve the care we provide in remarkable ways.

The Spine Tumor Center has grown dramatically over the past five to seven years. When I arrived at Memorial Sloan Kettering in 1995, we performed about 40 procedures on spine cancer patients each year. Last year we performed more than 800 procedures and cared for more than 1,500 patients.

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What are some of the most significant recent developments in spine tumor treatment?

Perhaps the greatest advance in the treatment of spine tumors has been the evolution of stereotactic radiosurgery and its integration into the treatment plan for many patients. Stereotactic radiosurgery is an incredibly precise form of radiation therapy that delivers very high doses of radiation to a tumor in just a few treatment sessions.

Most solid tumors, with the exception of breast cancer and prostate cancer, don’t respond well to conventional external beam radiation therapy, but they respond dramatically well to stereotactic radiosurgery. We’re now able to control about 95 percent of tumors in the spine for up to five years when we use stereotactic radiosurgery as a first treatment approach.

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When do you use traditional surgery to treat spine tumors?

Because stereotactic radiosurgery is so effective, only a small percentage of patients with spine tumors require traditional surgery. We typically perform surgery when a tumor is compressing the spinal cord or a patient has significant instability in the bones of the spine.

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How do neurosurgeons and radiation oncologists at Memorial Sloan Kettering work together to treat spine tumors?

In the past, when neurosurgeons performed major operations to remove spine tumors, many patients experienced a recurrence of cancer in the spine. Today, with neurosurgeons and radiation oncologists working together, we have every expectation that we will control the tumor using stereotactic radiosurgery.

Even when we use this approach after traditional surgery, we are typically able to control the tumor. As surgeons, our strategy has shifted. We now know that we don’t need to take out every bit of tumor surgically. What we really need to do is relieve the pressure that the tumor is placing on the spinal cord and stabilize the spine to make it possible to do radiosurgery.

Interventional radiologists can stabilize the spine using vertebroplasty and kyphoplasty, or surgeons can place specialized bone screws in minimally invasive ways through skin. Then, we can use stereotactic radiosurgery to treat the tumor.

We’ve looked at about 200 patients where we’ve used stereotactic radiosurgery following open surgery. The local rates of control are very similar to what we’re seeing when we use stereotactic radiosurgery as a primary treatment, with greater than 90 percent tumor control at one-year follow-up.

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In addition to the advanced treatment options, how does the multidisciplinary setting of the Spine Tumor Center benefit patients?

In our Spine Tumor Clinic, doctors specializing in neurosurgery, radiation oncology, and interventional radiology all work in the same clinic at the same time. This makes it easier and more efficient for us to take care of patients’ needs, rather than having them see one specialist one day and then asking them to come back several days later to see another doctor. It has been a dramatic improvement in patient care, both in terms of convenience and safety.

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Hi, I'm a 25 year old male in Australia. Three months ago a specialist spinal orthopaedic surgeon found a tumor in my C6 vertebrae, had taken over a fair bit of the vertebrae. On the 12th of September I had the tumor and C6 removed along with parts of my C7 and C5, which resulted in me having a multiple fusion from C3 to T2. It came unexpectedly and I never really got told what was involved so I never did any research and believed everything that was said to me, so now I'm left with big scars, muscle loss and a loss of motion which for a 25 year old male that was relatively active isn't ideal. Could this technology you are using also have helped my situation instead of a massive surgery leaving me restricted and depressed?

Tristan, unfortunately we are unable to answer specific medical questions about individual cases on our blog. If you would like to make an appointment with a Memorial Sloan-Kettering physician, please call our Physician Referral Service at 800-525-2225 or go to Thanks for your comment.

My dad has liver cancer for many years and finally metastasize to spine T11 12 in two years ago. He had radiation twice and surgery twice. At there the last surgery in NYU medical center, he cannot stand and have a lot of pain. Doctors in NYU said he has 're current tumors below the surgical site. They don't want to do any more surgery and no more radiation. Is there any way relieve pain and able to walk throughout your Radiation therapy? He is still in NYU hospital. We have United heath plan. Thanks.

Richard, if your father would like to come to MSK to learn about what treatment we may be able to offer, you can call 800-525-2225 or go to for more information about making an appointment. Our referral specialists will be able to discuss options with you and answer any questions you have about insurance. Thank you for your comment.

1.What causes a bladder contraction during stereotactic radiosurgery to the spine (L4,5; T11)? 2.What causes a tingly sensation in various parts of the body during stereotactic radiosurgery?

Thank you for reaching out. We consulted with MSK radiation oncologist Josh Yamada, who responds:

Stereotactic radiosurgery to T11, L4-L5 should not cause bladder contraction. Radiation can cause nerve irritation that can be experienced as tingling, but it should be limited to the spinal nerves that get irradiated. Tingling to various parts of the body not included in the area covered by the spinal nerves that are irradiated would not be expected from spine radiosurgery.

Would you recommend Stereotactic radio surgery on an intradural Schwannoma on the L3 level of the spine?

Thank you for reaching out. We suggest you discuss this question with the treating physician, as every patient’s case is different. If you would like to come to Memorial Sloan Kettering to learn about what treatment we may be able to offer, you can call 800-525-2225 or go to for more information about making an appointment.

1. What is the different between "Stereotactic Radiosurgery for Spine Tumors " v. "Radiofrequency ablation (RFA)"?

2. do you offer at the MSK the Radiofrequency ablation (RFA) treatment?

Dear Yoe, stereotactic radiosurgery is a type of radiation therapy that uses photon radiation to destroy tumors. Radiofrequency ablation uses radio waves (not radioactivity) to destroy tumors. MSK offers radiofrequency ablation for some types of tumors. If you are interested in learning more, you can go to… and…

If you would like to make an appointment for a consultation, you can call 800-525-2225 or go to for more information. Thank you for your comment.

Hi, I have had breast cancer 4 times in 4 years, first time I was 36. I had mastectomy then radiotherapy. 2 yrs later it returned under my arm so had lump removed then chemo (3xfec 3x T), followed by radiotherapy. A year later returned same place, had lump removed, but 2 wks later returned again and scan on my spine showed spots on spine to. Hospital pretty much given up on me, please could you help in any way? Many thanks, leeanne, Wales, uk.

Former patient of Dr Bilsky who operated on me for a schanoma tumor on my upper spine a few years ago. The tumor has growing back and causing constant pain in my left arm and hand. My left hand is completely useless and my fingers are swollen. I’m at my Florida home till May and surgeons here won’t touch me. They said I should return to Sloan Kettering and see Dr Bilsky. I’m afraid it might cause breathing problems...