General Editor: Luiz Vialle

Authors: Ilya Laufer, JJ Verlaan (on behalf of AOSpine Knowledge Forum Tumor)

Metastatic tumors Occipitocervical, stable, low ESCC

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Glossary

General considerations

Patients with low grade ESCC without mechanical instability do not require surgery.

Conventional radiotherapy
Main indication Skill Equipment
Nonmechanical pain, tumor progression Basic surgical experience, no specialized skills Basic equipment only

CRT is recommended to reduce pain and maintain ambulation in patients with radiosensitive (i.e. lymphoma, myeloma, and seminoma) and intermediate sensitive metastatic disease of the spine without instability.

CRT relative contraindications include, but are not limited to:

  • spinal instability,
  • mechanical pain
  • prior irradiation,
  • redioresistant histology,
  • high-grade spinal cord compression in intermediate and radioresistant tumors.
Stereotactic body radiotherapy
Main indication Skill Equipment
Nonmechanical pain, tumor progression in patients with radioresistant tumors and relatively good life expectancy Basic surgical experience, no specialized skills Basic equipment only

SBRT is recommended to reduce pain and maintain ambulation and local control in patients with intermediate and radioresistant metastatic disease of the spine without instability.

SBRT relative contraindications include, but are not limited to:

  • spinal instability,
  • mechanical pain
  • high-grade spinal cord compression
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

V1.0 2019.01.06