Radiosurgery and Radiotherapy for Sacral Tumors
Radiosurgery and Radiotherapy for Sacral Tumors
Sacral tumors represent a small subset of spinal lesions and typically include chordomas, metastases, other primary bone tumors, and benign schwannomas. Resection is the standard treatment for many sacral tumors, but many types of sacral lesions have the potential for recurrence after excision. In these cases, adjuvant radiotherapy is often beneficial. Although conventional radiotherapy plays an important role in the management of spinal lesions, the radiation doses required for adequate local control of many sacral lesions generally exceed the tolerance doses of normal tissues, thus limiting its definitive role in the management of sacral tumors. Recent advances in the field of stereotactic radio-surgery have allowed precise targeting of the sacrum. In this report the authors review the use of these two forms of radiation treatment and their role in managing sacral tumors.
Sacral neoplasms are relatively rare. Those involving the sacrum fall into three major categories: primary benign or malignant lesions, metastatic lesions, or lesions that secondarily involve the sacrum by local extension. The majority are benign, with giant cell tumor of the sacrum representing 70% of all sacral tumors. Although the majority of malignant sacral tumors involve metastatic spread from nearby pelvic sites or distant sites, primary malignant tumors comprise a wide range of histologies including chordoma, osteosarcoma, chondrosarcoma, myeloma, lymphoma, and Ewing sarcoma. Chordoma is the most common primary malignant sacral tumor. Tumors secondarily involving the sacrum by local extension are predominantly of neural precursor, connective tissue, or supportive tissue origin. This group includes neurofibroma, schwannoma, ependymoma, epidermoid, and teratoma. We limit our discussion to the role of radiotherapy and radiosurgery in the management of the most common sacral tumors.
Sacral tumors represent a small subset of spinal lesions and typically include chordomas, metastases, other primary bone tumors, and benign schwannomas. Resection is the standard treatment for many sacral tumors, but many types of sacral lesions have the potential for recurrence after excision. In these cases, adjuvant radiotherapy is often beneficial. Although conventional radiotherapy plays an important role in the management of spinal lesions, the radiation doses required for adequate local control of many sacral lesions generally exceed the tolerance doses of normal tissues, thus limiting its definitive role in the management of sacral tumors. Recent advances in the field of stereotactic radio-surgery have allowed precise targeting of the sacrum. In this report the authors review the use of these two forms of radiation treatment and their role in managing sacral tumors.
Sacral neoplasms are relatively rare. Those involving the sacrum fall into three major categories: primary benign or malignant lesions, metastatic lesions, or lesions that secondarily involve the sacrum by local extension. The majority are benign, with giant cell tumor of the sacrum representing 70% of all sacral tumors. Although the majority of malignant sacral tumors involve metastatic spread from nearby pelvic sites or distant sites, primary malignant tumors comprise a wide range of histologies including chordoma, osteosarcoma, chondrosarcoma, myeloma, lymphoma, and Ewing sarcoma. Chordoma is the most common primary malignant sacral tumor. Tumors secondarily involving the sacrum by local extension are predominantly of neural precursor, connective tissue, or supportive tissue origin. This group includes neurofibroma, schwannoma, ependymoma, epidermoid, and teratoma. We limit our discussion to the role of radiotherapy and radiosurgery in the management of the most common sacral tumors.
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