Advanced Radiotherapy for Metastatic Disease of the Cervical Spine

Optimal management of cervical spine metastases requires the combined expertise of a multidisciplinary team. Stereotactic body radiation therapy (SBRT), which incorporates advances in imaging technology and high conformal treatment planning technology to safely deliver precision radiation therapy in high doses per fraction, is able to provide durable tumor control for even radioresistant tumors with limited severe toxicity. Mechanisms of response within the tumor, such as higher efficiency DNA double strand breaks, endothelial apoptosis, and pro-immunologic effects, which are unique to high dose per fraction treatment are thought to result in greater tumor cell kill and ultimately ablative therapy when radiation is administered with a hypofractionated schedule. Because SBRT spares surrounding normal tissues from the high radiation dose given to the tumor, toxicity profiles of SBRT are low. Thus, SRT is an ideal radiotherapeutic treatment modality for the complicated anatomy of the cervical spine.