Gerszten PC, Ryu S, eds. Spine Radiosurgery. 2nd ed. Thieme; 2015; 220 pp; 150 ill; $179.99
Over several decades, stereotactic radiosurgery directed at targets in the head has become an accepted and widely available treatment modality. The expansion of radiosurgery to the spine is a more recent innovation, involving different challenges with regard to immobilization and localization techniques, radiation dose planning, risks, and patient selection. The volume of overall experience with spine radiosurgery is far less than with cranial radiosurgery, and thus, the optimal radiation doses and methods are less certain. This second edition brings together the work of many contributors, in order to collect sufficient data from which to draw worthwhile guidance. Two forewords, along with the editors’ preface, provide nice introductions and perspectives on the topic.
The first section covers radiobiology, including chapters on both experimental and clinical aspects of spinal cord and spinal nerve radiobiology. The first chapter is an introduction to radiobiology, particularly showing the relationships between basic radiobiology and radiosurgery. The next chapter covers animal models of irradiation of spinal cord and spinal nerves. This chapter presents a nice summary of the available experimental literature and discusses the limitations in extrapolating to human treatment. Next is an extensive chapter on clinical spinal cord tolerance to radiosurgery. Published experience is discussed and nicely compiled in tables. Spinal cord tolerances of conventionally fractionated radiation, hypofractionated radiation, single dose radiation, and re-irradiation are discussed, including dose levels, anatomic considerations, and technical factors. Logically, the next chapter is on management of spinal cord toxicity. The last chapter of the section describes the histopathology of spinal tumors, bone, and paraspinal tissues removed in a series of patients that required surgery after spinal radiosurgery had been performed.
The next section is composed of 4 chapters on the physics and techniques of spine radiosurgery. The first chapter reviews image guidance and immobilization, problems that are very different in spine radiosurgery as compared to intracranial radiosurgery. The next chapter is a thorough overview of treatment planning for spine radiosurgery, including discussion of the relations of different types of radiation delivery devices to treatment planning. Quality assurance is covered in the next chapter. The final chapter of the section provides detailed descriptions of several contemporary, commercially available radiation systems capable of spinal radiosurgery.
The next section consists of 9 chapters covering spine metastases, the most frequent pathology considered for spinal radiosurgery. The first of these chapters is on imaging, targeting, and dose prescription. The other chapters cover a variety of general and specific topics and situations, in a not particularly logical order. Importantly, two of the chapters focus specifically on clinical outcomes, including pain and quality of life. Two chapters cover treatment in the setting of spinal canal compromise and spinal cord compression. One chapter looks at retreatment of progressive spine metastases. Two chapters cover the use of radiosurgery in association with minimally invasive surgical techniques and percutaneous cement spine augmentation. One chapter covers treatment failure, complications, and their management.
The next section consists of 4 chapters covering benign extramedullary tumors, primary malignant spine and spinal cord tumors, and arteriovenous malformations. These chapters review the topics and the available clinical data, but these indications have been treated with radiosurgery in far smaller numbers than have spine metastases. Thus, it is still difficult to be sure of where radiosurgery should fit in the general scheme of treating these lesions, which offer both different pathologies and different anatomic challenges with regard to spinal cord radioprotection than do spinal metastases.
The final section is a single chapter describing collaborative multidisciplinary evaluation and treatment of metastatic spinal tumors. In this chapter, the disciplines involved are the surgeon and the radiation oncologist, after the patient has been referred by the medical oncologist. The discussion covers the options of surgery, fractionated radiotherapy, and radiosurgery.
Overall, this book is a useful update on the status of this developing field. In addition to its obvious utility for the neurosurgeon and the radiation oncologist, it will be of interest to the neuroradiologist, because all of this type of treatment is dependent on modern neuroimaging. Most of the chapters are well-illustrated and well-referenced. A few chapters are very brief and less helpful, but this volume is a significant expansion and improvement on the first edition, published in 2009, and it will be helpful for anyone interested in spine radiosurgery.
