Nonsurgical options are considered first-line treatment for many metastatic spinal tumor symptoms and tumor management. Nonsurgical treatments vary from medications to radiation therapy.
Most treatment plans for metastatic spinal tumors involve radiation therapy. A couple of common types include:
- Conventional external beam radiation therapy (cEBRT). Conventional EBRT uses a machine to send a single beam of radiation into the body that targets the tumor. This type of radiation therapy may not be an option for tumors that are too close to sensitive organs, which would not be able to handle radiation exposure.
- Stereotactic radiosurgery (SRS). SRS sends multiple low-dose radiation beams at the tumor from multiple angles. The goal is to maximize the amount of therapeutic radiation that reaches the tumor while minimizing exposure to nearby healthy tissues. Due to advances in SRS, more metastatic spinal tumors can be treated without the need for more invasive surgery.
Various types of medications may be considered when treating metastatic spinal tumors and/or their related symptoms.
- Pain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or opioids on a short-term basis, may help reduce pain.
- Corticosteroids aim to lower inflammation and, in some cases, reduce the size of the tumor.
- Chemotherapy drugs may be given orally or intravenously. Chemotherapy attacks cancer cells throughout the body, rather than just in the spine.
- Bone-strengthening medications, such as biphosphates and RANKL inhibitors, help maintain bone density. These medications may help to prevent or reduce skeletal-related events (SREs), such as vertebral fractures.
Other types of medications may be considered, such as immunotherapy drugs, which aim to stimulate the immune system into fighting cancer cells. While some studies have suggested that immunotherapy may be beneficial in treating some types of metastatic spinal tumors, more research is needed.
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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 targets and destroys the tumor tissue with heat (radiofrequency energy)
- Cryoablation uses cold gas to freeze and destroy tumor cells.
Primary cancer treatments do not have to be stopped for ablation procedures. Also, ablation may be used in combination with other treatments, such as surgery or chemotherapy.
Braces may be used for symptom relief when mechanical pain develops as a result of spinal instability. By helping to stabilize the spine, the back brace may prevent excessive motion and pain. Braces are generally used in combination with other treatments.
At times, surgery to remove the tumor or to help lessen the symptoms from the tumor may be considered.