Stereotactic Radiosurgery (SRS) for spinal tumors: the Philippines experience

Introduction: Delivery of a single high dose or a few fractionated radiation treatments for spinal tumors through stereotactic radiosurgery (SRS) is now available in the Philippines. A retrospective review was performed to determine the rate of pain relief, toxicity, and neurologic outcomes of patients treated with this modality.

Methodology: From 2012-2015, 24 patients were identified who underwent spine SRS in this institution. Patients were eligible for SRS based on the RTOG 0631 eligibility checklist. Pain outcome was measured using the numerical rating pain scale. Neurologic examination was done by the attending neurosurgeon and the radiation oncologist. Acute effects were scored according to the CTC v3. Dose was determined by tumor histology, proximity to nearby structures, as well as computed tumor volume. The mean age of patients was 58 ± 16.06 years. Patients were treated to a median dose of 16Gy (range 12-25Gy), given in 1-5 fractions.

Results: Spine SRS was performed in a total of 30 spinal tumors from 24 patients (7 primary, 23 metastatic). The most common tumor site was the thoracic spine. Pain was present in 18 of the patients pre-SRS, with 83% documenting complete pain relief, one month after SRS. Only one patient experienced pain flare which resolved with steroids, and one patient developed vertebral compression fracture two months after treatment. Of the 10 patients who had motor deficits pre-SRS, 3 had complete recovery of motor function, while 7 had partial improvement.

Conclusions: SRS for spinal tumors is well-tolerated, safe, and effective treatment option. The results of our institution appear comparable to other institution reports investigating outcomes of spine SRS.