Nonsurgical options are considered first-line treatment for many metastatic spinal tumor symptoms and tumor management. Nonsurgical options vary from medications to radiation therapy.

Spine Tumor Symptom Management

Pain medications are typically prescribed at the onset of back pain. Other medications may be prescribed to treat other side effects of metastatic spine tumors.

    Medications
    Medications, such as nonsteroidal anti-inflammatory drugs, may be used to reduce pain. Narcotics (opioids) may be used for short term pain management.

    Other medications that may be prescribed include:

    • Corticosteroids - to treat inflammation, or possibly fluid build-up, around the nerves or spinal cord
    • RANKL inhibitors and bisphosphonates - to strengthen the patient’s bone and minimize the chance of vertebral fracture

    Back Braces
    Braces may be used for symptom relief when mechanical pain develops as a result of spinal instability. Braces are generally used in combination with other treatments.

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Tumor Management of Metastatic Spinal Tumors

Certain medication, radiation, ablation, and chemotherapy treatments all aim to shrink and/or destroy tumor cells for pain relief.

    Medications
    Hormonal treatments may be used for metastases that are sensitive to hormones, such as breast and prostate cancer.

    Radiation Therapy
    Radiation therapy has proven effective in shrinking tumors and is often the treatment of choice for alleviating pain associated with metastatic spine tumors. High levels of radiation energy directed at the tumor can shrink tumor cells, relieving pressure on nerve roots and/or the spinal cord. Studies have indicated a success rate of 70% in alleviating pain.7 However, it can take up to 2 weeks to feel pain relief.

    There are a variety of methods of radiation delivery. For spinal tumors, external radiation therapy methods are used - a machine outside the body delivers radiation to the tumor.

    Stereotactic radiosurgery uses imaging to target the tumor so that higher doses of radiation can be given with less risk of damage to healthy tissue.

    Ablation
    Ablation refers to an energy source that is transmitted locally to the tumor through a needle. Ablation is designed to target and destroy unhealthy tissue (the tumor) while sparing healthy tissue. The goal of treatment is to shrink the tumor to relieve pain associated with pressure on the nerve roots and/or spinal cord.

    • Radiofrequency ablation – designed to target and destroy the tumor tissue with heat (radiofrequency energy)
    • Cryoablation - designed to use cold gas to freeze and destroy tumor cells.

    Primary cancer treatments do not have to be stopped for ablation procedures, and pain relief is often felt in hours/days.

    Chemotherapy
    Studies indicate that chemotherapy may have benefit for some types of spinal cancer.3 For chemotherapy, chemicals are introduced into the blood stream to shrink tumors either for pain relief or prior to surgical removal.

    Chemotherapy may also be used to kill tumors cells that may remain after surgical removal of the tumor.

    At times, surgery to remove the tumor or to help lessen the symptoms from the tumor may be considered.

    References

    1. Constans JP et al. Spinal metastases with neurological manifestations: review of 600 cases. Journal of Neurosurgery. 1983;59:111-118.
    1. Muir, Cameron J. Management of Tumors. Journal of the Spinal Research Foundation. 2011; 6(2):25-29.
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Written by David DeWitt, MD