Primary Spine Tumors: Diagnosis and Treatment

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


Cancer Control. 2014;21(2):114-123. 

In This Article

Moderately Responsive Tumors

Another group of tumors are those with an incomplete response to adjuvant therapy in which preoperative chemotherapy or radiation may be employed. Although it is preferable to preoperatively avoid cytotoxic therapies to reduce infection and optimize healing, a subset of patients exists in whom delaying surgical intervention might improve outcome.

The most important of this tumor group is Ewing sarcoma, which is also the most common primary spinal column tumor in children.[13] The lesion is so responsive to chemotherapeutic and radiation options that surgical treatment is reserved for issues of stability and neurological compromise. Surgical treatment has not been shown to improve local control.[13,14] Although survival gains have been made, Ewing sarcoma is an aggressive lesion, with a 5-year survival rate of less than 50% in certain subsets of patients.[15,16]

Sarcomas may benefit from preoperative chemotherapeutics. Osteosarcoma and, in particular, angiosarcoma are aggressive lesions that benefit from upfront chemotherapy followed by en bloc resection and postoperative radiation. Despite such aggressive therapy, prognosis remains poor.