"A spine metastasis causes a lot of pain," Szerlip says. "People can live with metastases in other areas of the body without much discomfort, but bone pain hurts a lot, and the ability to treat a tumor near the spinal cord is less. Surgeries on other bones are much easier than surgeries on the spine, and less morbid."

Popular treatment paths address both the neurologic benefit and the oncologic benefit. That might mean a surgical decompression of the tumor, followed by radiation to attempt to control the cancer. Spratt is particularly excited about offering spine stereotactic body radiotherapy (SBRT), a form of high-dose radiation that requires just one to three treatments. Conventional radiation results in only about a 50 percent reduction in pain three months after treatment, and the cancer is eliminated for only a short time. Spratt says spine SBRT is a game changer, showing greater than 90 percent pain reduction and more effectively controlling tumor growth beyond one year post-treatment.


"With this technique, you've basically spared the spinal cord so you can give a much higher dose just millimeters away," he says.

Patients are living longer

Most patients who present with metastatic spine cancer know they have cancer and have had it for some time, Szerlip says. The cancers that most often lead to spine metastasis tend to be renal cell, breast, prostate, sarcoma and lung, the researchers say.

But not all patients who could benefit from a spine oncology clinic will set foot inside one. Szerlip and Spratt say their algorithm will also raise awareness for doctors who care for people with metastatic spine cancer.

"If you look back 10 or 20 years, you'd see people with spine metastasis lived in the order of months," Spratt says. "Now, with new systemic therapies, targeted therapies and immunotherapies, it may be years."

That means there is more opportunity to treat the cancer, to manage the patient's comfort and to prevent painful and debilitating compression that can result after a period of living with a tumor pressing on your spinal cord.

Szerlip says not long ago, physicians were much less likely to send a spinal metastasis patient to a neurosurgeon because of the high morbidity of surgeries. Now, he says, spine oncology clinics can offer additional options and surgical procedures with less morbidity than in the past. However, these huge surgeries are still highly morbid.

A long-term project

The algorithm that leads to these treatment decisions takes the user through a series of steps starting with an assessment of life expectancy. Then, the systemic burden of the disease is considered, followed by a calculation of how controlled the disease is, and then a consideration of systemic treatment options. It's the result of combing through 243 studies and learning about what other spine oncology clinics' practices look like.

Rad Oncology Homepage