What are the indications for radiation therapy as the primary form of treatment for metastatic spinal lesions

Radiation therapy plays a role in the treatment of malignancies by promoting reossification of the vertebral body and reducing tumor load. Pain relief has been reported in up to 80% of patients receiving radiation. Use of a spinal orthosis for 3 months following radiation therapy is recommended to prevent development of spinal fracture and instability. Tumors that are sensitive to radiation therapy include lung, breast, and prostate cancer, as well as lymphoma and myeloma. Radioresistant tumors include GI adenocarcinoma, metastatic melanoma, thyroid carcinoma, and renal cell carcinoma. Potential indications for radiation therapy as the primary form of treatment for metastatic spinal lesions include radiosensitive tumors with stable or slowly progressive neurologic symptoms, spinal canal compromise secondary to soft tissue tumor lesions, and patients who are not candidates for surgery due to medical comorbidities.

Radiation therapy is not indicated for patients with spinal canal compromise secondary to bone or for patients with spinal instability due to metastatic spinal disease. Patients with metastatic disease and epidural compression who are surgically treated with spinal cord decompression and reconstruction followed by radiation have been shown to have more favorable outcomes (improved neurologic function and pain relief) than patients treated with radiation alone.

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