Radiation therapy and stereotactic radiosurgery for primary vertebral tumors

To formulate the most current, evidence-based recommendations for the role of radiation therapy and stereotactic radiosurgery for Primary Malignant Vertebral tumors. A systematic literature search in PubMed and Google Scholar databases was performed from 2013 to 2023 using the search terms, “radiosurgery”, “radiotherapy”, “radiation therapy”, “Ewing’s Sarcoma”, “Osteosarcoma”, “Chondrosarcoma”, and “Primary Spinal Sarcoma”. Standardized screening criteria resulted in a total of 28 articles that were analyzed, including 3 RCTs, 11 retrospective studies, 10 systematic reviews and 4 case series and reports. This up-to-date information was reviewed and presented at WFNS Spine Committee Spine Tumor consensus meeting. Two rounds of Delphi method were utilized to vote on the statements and arrive at a positive or negative consensus. The WFNS Spine Committee finalized nine recommendation guidelines on the role of different modalities of radiation therapy and stereotactic radiosurgery (SRS) for the primary vertebral tumors. In conclusion, the effective treatment of primary malignant spinal tumors relies on a combined approach, with radiation therapy crucial in challenging surgical cases. Patient survival depends on age, tumor size, dose, and surgery quality, especially in sarcoma cases. Advanced radiation techniques, such as SRS and IMPT/IMRT combination, show promise. CSI is effective for intraspinal Ewing Sarcoma, while charged-particle therapies offer comparable outcomes to surgery. As conventional radiotherapy is phased out, precision and reduced collateral damage are prioritized for better patient outcomes.