Primary Spine Tumors: Diagnosis and Treatment

Michelle J. Clarke, MD; Ehud Mendel, MD; Frank D. Vrionis, MD, PhD

Disclosures

Cancer Control. 2014;21(2):114-123. 

In This Article

Postoperative Adjuvant Therapy

Following optimal surgical debulking, patients should be considered for adjuvant chemotherapy and radiation. If a patient has undergone successful en bloc resection (with marginal margins in a benign lesion or clean wide margins in a low-grade malignant lesion), then the patient should be observed for signs of distant metastases or local recurrence. Adjuvant therapy should be timed to allow adequate wound healing and to decrease the risk of infection.

Local control is achieved with radiation. Primary tumors are often considered for proton beam radiotherapy (PBR) alone or in combination with intensity-modulated radiotherapy (IMRT). The advantage of PBR is the steep Bragg peak, allowing high-dose radiation delivery near critical structures. Although IMRT is conformal, it does not have the same steep drop in dose, thus it effectively delivers a through-and-through dose of radiation. However, PBR is geographically limited and expensive, so combination PRB/IMRT has been employed to achieve a similar effect.[28]

Chemotherapeutics also play an important role, particularly in sarcomas and hematologic malignancies. In other cases, such as giant cell tumors, experimental chemotherapeutics have been attempted with reasonable effect in patients with inoperable tumors or recurrences.

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