Given the success of radiosurgery to treat a variety of both malignant as well as benign intracranial tumors, there has been an increased interest in the use of high doses of conformal radiation to treat spinal lesions in this minimally invasive fashion. Stereotactic spine radiosurgery involves the precise delivery of high doses of ionizing radiation to tumors of the spine and spinal cord that limits the radiation exposure to normal surrounding structures. Its use for the treatment of spinal lesions had been limited by the availability of effective target localization technologies.

The Synergy S spine radiosurgery unit at UPMC Presbyterian is a close collaborative effort between the Departments of Neurosurgery, Radiation Oncology and Medical Physics. The unit represents the latest technological advancement in image-guided, stereotactic body radiosurgery.

Spine radiosurgery is used to treat benign or malignant lesions of the spine, including primary tumors, metastases, meningiomas, neurofibromas, schwannomas, and vascular malformations. Since 2001, members of the Department of Neurological Surgery have collaborated with members of the Department of Radiation Oncology to develop the largest clinical experience in the world with spine radiosurgery; over 1,000 patients have been successfully treated to date. The CyberKnife Robotic Radiosurgery System, located on our Shadyside campus, was the first extracranial radiosurgery technology at UPMC and only the third such system in the world.

The Elekta Synergy S linear accelerator, successfully installed in 2007, was acquired to further develop the spine radiosurgery program, and its installation represents a close collaborative effort between the Departments of Neurosurgery, Radiation Oncology, and Medical Physics. The machine represents the latest technological advancement in image-guided stereotactic body radiosurgery.

The Synergy S has a built in computed tomography unit mounted on the same gantry as its linear accelerator utilizing a technique called “cone beam imaging.” By making a full gantry rotation, the kilovolt system acquires several hundred projection images. These are converted into CT-like axial slices in a process similar to the reconstruction used by conventional CT scanners. The cone beam scans provide extremely high spatial resolution of both bony and soft tissue structures, making possible the setup of sites with submillimeter targeting precision. The Synergy S has the ability to acquire a high definition three dimensional volume image that allows for the target to be visualized at the precise time of treatment with the patient lying comfortably on a treatment couch. An extremely accurate robotic couch automatically makes any necessary adjustments in the patient’s position to ensure that the radiation is directed precisely to the target.

Research from the University of Pittsburgh has demonstrated high rates of durable pain control as well as radiographic tumor control in patients following spine radiosurgery. Long-term pain improvement occurred in 86% of patients with spine metastases treated with radiosurgery. Long-term tumor control was demonstrated in 90% of lesions treated with radiosurgery as a primary treatment modality and in 88% of lesions treated for radiographic tumor progression. Spine radiosurgery has now become an important part of our multidisciplinary treatment of patients with spine tumors. The work done at the University of Pittsburgh has helped to pave the way for widespread use of this treatment modality throughout the world.

Spine radiosurgery using the new Synergy S is safe and clinically effective for the treatment of a wide variety of spinal tumors. Spine radiosurgery represents a logical extension of the current state-of-the-art radiation therapy. It has the potential to significantly improve local control of cancer of the spine, which could translate into better palliation. The major potential benefits of radiosurgical ablation of spinal lesions are the relatively short treatment times in an outpatient setting combined with potentially better local control of the tumor with minimal risk of side effects.

Spine radiosurgery offers a new and important alternative therapeutic modality for the treatment of spine tumors in patients who are medically inoperable or who are poor surgical candidates, have had prior irradiation, have lesions not amenable to open surgical techniques, or as an adjunct to surgery. Spine radiosurgery is allowing many patients to avoid open surgery with even better clinical outcomes.

For more information regarding the spine radiosurgery program, you may contact Peter Gerszten, MD, directly, or contact Carol Kennedy, RN, nurse coordinator, at (412) 647-9786.