INTRODUCTION
Stereotactic radiosurgery (SRS), initially developed for intracranial lesions, has evolved into a highly precise treatment modality for spinal tumors, aided by advancements in imaging technologies and computer-assisted planning. Commonly employed SRS technologies include CyberKnife (Accuray Inc.), Novalis (BrainLAB), and Synergy S (Elekta) [1]. By delivering targeted radiation with minimal impact on surrounding healthy tissues, SRS has demonstrated its effectiveness in managing various benign lesions, including arteriovenous malformations, pituitary adenomas, and acoustic neuromas [2]. Its application to spinal tumors, however, has primarily focused on vertebral malignancies, with limited use for benign intradural extramedullary tumors such as meningiomas, neurofibromas, and schwannomas [1]. These tumors, which constitute 55-76% of primary spinal tumors, can cause significant morbidity through compressive myelopathy or radiculopathy, leading to pain, motor and sensory deficits, and bladder or bowel dysfunction [3,4]. While surgical resection remains the gold standard due to its proven safety and efficacy, certain patient populations—such as the elderly, those with comorbidities, or individuals with familial conditions like neurofibromatosis—may not be suitable candidates for surgery. In such cases, SRS presents a promising alternative, offering precise tumor control with minimal invasiveness [1]. Importantly, the ability to deliver high radiation doses near sensitive structures, such as the spinal cord, without exceeding its low radiation tolerance is crucial for treating benign spinal tumors, especially given the longer life expectancy of these patients compared to those with metastatic lesions [2]. However, the precision required to achieve therapeutic efficacy while avoiding complications, such as radiation-induced myelopathy and secondary neoplasia, underscores the need for further investigation [1]. As technology advances and clinical experience grows, SRS represents a powerful tool in the management of benign spinal tumors, offering precise tumor control with minimal invasiveness. This narrative review article seeks to summarize the recent trends and provide valuable data on efficacy, safety, and outcomes associated with the SRS for benign extramedullary intradural spinal tumors.
METHODS
A literature search was conducted across PubMed, EMBASE, and Web of Science databases to identify English-language articles on applying SRS for benign spinal tumors. We used search terms including “stereotactic radiosurgery,” “benign spinal tumors,” “intradural tumors,” “spinal schwannoma,” and “spinal meningioma,” focusing on literature published between July 2013 and July 2023. Non-original publications such as reviews, case reports, conference abstracts, editorials, and irrelevant articles were excluded. The final analysis included 15 articles, with data collection focusing on variables such as article details, patient and lesion characteristics, diagnosis, symptoms, tumor location, gross tumor volume, dose and fractionation, dosimetry indices, SRS results, complications, previous treatments, and outcomes of SRS. Fig. 1 illustrates the flow of information through the review process.
RESULTS
The analysis of 15 studies involving 616 patients and 707 lesions provides a comprehensive insight into the application of SRS for benign spine tumors. The patients in these studies represent a diverse cohort, with a variety of tumor types and anatomical locations, reflecting the broad utility of SRS in managing spinal neoplasms (Table 1) [2-16].
Indications of stereotactic radiosurgery for benign spinal tumors and tumor characteristics
The exact numbers or percentages of indications of SRS for benign spinal tumors were not consistently reported in 15 studies. The primary treatment indications, specifically the presence of underlying neurofibromatosis and primary treatment, were more thoroughly reported in some studies compared to others. The presence of underlying neurofibromatosis was documented with precise patient numbers in 12 studies, with an average indication percentage of 46.6%, while primary treatment was reported in five studies, with an average indication percentage of 47.3%. Other indications, such as post-surgery tumor remnants, recurrences, and patient preferences, were mentioned qualitatively across various studies but lacked consistent quantitative data. The breakdown of diagnoses showed that 37% of cases were schwannoma, 27.8% were meningiomas, 22.3% were neurofibroma, and 12.5% were other types of tumors including 10 cases of chordoma reported in two separate studies. This indicates a slightly higher prevalence of schwannomas, followed by meningiomas and neurofibromas. The tumors were located across various spinal regions, with the cervical spine being the most common site (46%), followed by the lumbar (24%), thoracic (21.2%), sacral (6.6%), and cauda equina (0.8%) regions. The cervical spine’s higher incidence correlates with its complex anatomy and critical nerve structures [17]. The average of the median tumor volume was reported as 4.9±3 cm3. The SRS dose ranges for the treatment of benign spinal tumors across 15 studies show considerable variation in both minimum and maximum doses, as well as fractionation schemes. Minimum doses range from 10 to 16 Gy, while maximum doses span from 15 to 33 Gy. Most studies report dose minima between 12 and 15 Gy, with maxima generally clustering around 24 to 30 Gy. Based on the data from eight studies, there was no significant difference in the mean single SRS dose among the three common pathologies (p=0.968) (Table 2) [2-5,8,12,13,16]. Most studies report fractionation schedules of 1 to 5 fractions, with a few extending to 6 fractions. Additionally, a significant proportion of patients had undergone previous surgery (0-77.7%) or radiotherapy (0-85%) before receiving SRS, highlighting SRS’s role as a secondary option for managing persistent or recurrent tumors. Clinically, these findings underscore SRS’s effectiveness and versatility, particularly in treating well-defined, smaller tumors and as a valuable adjunct to previous interventions, reinforcing its role in providing precise, targeted treatment for benign spinal tumors while minimizing additional patient burden.
Clinical outcomes of stereotactic radiosurgery for benign spinal tumors
The clinical outcomes following SRS for benign spinal tumors were generally favorable, demonstrating its efficacy and safety. Specifically, the average local tumor control rate ranged from 75-100%, indicating that most tumors either decreased in size or remained stable during follow-up periods ranging from 15 to 49 months. Pain improvement was reported in 12-100% of cases, while pain remained unchanged in 0-88%, and pain worsened in 0-23%. These findings highlight the potential of SRS not only to control tumor progression but also to address pain, a common symptom of spinal tumors. Furthermore, a significant proportion of patients had undergone previous surgery (0-77.7%) or radiotherapy (0-85%) before receiving SRS. This underscores the role of SRS as a secondary treatment option for patients who are not candidates for surgery or for whom other treatments have failed. Across the 15 reviewed studies, SRS and stereotactic body radiation therapy (SBRT) emerged as effective non-surgical options for managing benign spinal tumors such as meningiomas, schwannomas, and neurofibromas. Local tumor control rates frequently exceeded 90%, with minimal adverse effects, including rare cases of mild complications or myelopathy. Both single-fraction and multi-fraction approaches using systems like CyberKnife and linear accelerators showed similar efficacy. These therapies offer viable alternatives, particularly for patients who are not candidates for surgery or have previously undergone radiation. Long-term follow-up data support their use as effective options for managing benign spinal tumors, with ongoing monitoring recommended for potential late effects.
Safety and efficacy of stereotactic radiosurgery for benign spinal tumors
SRS is generally well-tolerated, with a relatively low incidence of side effects. Out of 15 reviewed studies, six reported nine cases (1.4%) of radiotherapy-induced spinal complications, including four cases of myelopathy, two cases of myelitis, one case of peripheral neuropathy, one case of pain flare, and one unspecified type of complication. These findings highlight the importance of monitoring potential adverse effects when utilizing SRS for benign spinal tumors. The pathology of the complicated cases included three cases of meningiomas and two cases of schwannomas (Table 3) [3,7,8,11,13,16]. In three out of nine patients with complications, there was an absence of spinal cord compression. However, the lack of data in six cases makes it difficult to conclude that tumor-induced cord compression is not a significant cause of complications. The mean follow-up period ranged between 15.5 and 54 months, providing an extended timeframe to assess long-term outcomes. Tumor volume was reported in five cases, with a range of volume of 1.2-7.5 cm3. Regarding previous treatments, four patients did not receive radiotherapy, while one (11.1%) did, and two cases had no data on this aspect. Surgical history was more frequently reported, with five patients having undergone surgery and four cases lacking this information. Prior radiotherapy was reported in only one patient, with a high cumulative dose (60 Gy in 30 fractions, biological equivalent dose [BED]: 37,800), raising concerns about cumulative radiation exposure and its impact on subsequent SRS outcomes. SRS dosage was provided for six cases, with a dose range of 16-24 Gy (BED: 101-648), and fractionation details revealed that four patients received a single fraction and two received three fractions. The spinal cord volume receiving more than 8 Gy was noted in five cases, with a significant variation from <0.02 to 4.7 cm3. The interval between prior radiotherapy and SRS was 3 months in the single reported case, while the interval from SRS to the onset of complications ranged from 3 to 13 months in six cases. Tumor location was most common in the cervical spine (44.4%), followed by the cervicothoracic region (22.2%), and lumbar and sacral regions each accounted for 11.1%. The paired t-test analysis of studies comparing those that reported spinal cord complications (6 studies) versus those that did not (9 studies) after SRS for benign spinal tumors shows no statistically significant differences in several key parameters. Specifically, there was no significant difference in tumor volume (p=0.152), biologically effective dose for multi-fraction SRS (p=0.457), BED for single-fraction SRS (p=0.726), or the maximum dose to the spinal cord (p=0.969) between the two groups. These results suggest that these factors may not be the primary determinants of spinal cord complications in these patients.
In terms of recurrence, the studies indicated a recurrence rate of 1.4%, which underscores the effectiveness of SRS in achieving durable tumor control. Additionally, the correlation analysis revealed a Spearman correlation coefficient of 0.2638 and a Pearson correlation coefficient of 0.09944 between gross tumor volume and SRS dose, with an R squared value of 0.009888, indicating a weak correlation.
Overall, this analysis underscores the complexity of managing benign spinal tumors with SRS and the importance of personalized care strategies. It also highlights the need for more detailed and standardized reporting in clinical practice to better understand the risks and optimize treatment protocols for these patients. Further research and clinical trials are essential to refine SRS techniques, improve patient selection, and reduce the incidence of treatment-related toxicities.
DISCUSSION
In this discussion, we will explain three benign spinal tumors: meningioma, schwannoma, and neurofibroma. Additionally, we will explore the indications of SRS in benign spinal tumors and tumor characteristics, the safety and efficacy of SRS for benign spinal, clinical outcomes and dose response in SRS for benign spinal tumors, and current trends in dose fractionation, and conclude with a summary based on the results of this review.
Benign spinal tumors
Meningioma
Spinal meningiomas are benign, slow-growing, well-delineated, extramedullary tumors with a tendency for lateral spread in the subarachnoid space [18]. They comprise 1.2-12% of all meningiomas and account for 25-45% of all intradural spine tumors [19]. These tumors originate from the arachnoid cap cells surrounding the brain and spinal cord, with meningiomas typically forming in the dura mater [19]. Histologically, meningiomas are characterized by a variety of growth patterns, including meningothelial, fibrous, and transitional types. They often exhibit a whorled pattern of cell arrangement and may contain calcifications [20]. Classified by the World Health Organization (WHO) into three grades based on histopathology, most spinal meningiomas (96-99%) are benign Grade I tumors, with subtypes like meningothelial being the most common [19]. Genetic studies reveal frequent deletions on chromosome 22q, particularly involving the neurofibromatosis 2 (NF2) gene, with additional losses and gains in other chromosomes noted in atypical and anaplastic subtypes [20]. Tumors most commonly occur in the thoracic spine but can develop along the entire spinal dura [20]. Genetic predisposition NF2 and prior exposure to ionizing radiation are the only definite risk factors [21]. Meningiomas are generally slow-growing tumors, often asymptomatic until they reach a significant size. Depending on their location, they can cause symptoms through mass effect, leading to neurological deficits [19]. Radiotherapy may be considered for subtotal resection or tumor recurrence, particularly for WHO Grade III meningiomas and recurrent or subtotally resected WHO Grade II tumors. However, WHO Grade II spinal meningiomas might not require adjuvant radiotherapy after complete surgical resection, as surgery alone may suffice for short-term tumor control. Radiotherapy may also be an alternative primary treatment when surgery poses high risks due to the tumor’s location or patient comorbidities, though it is generally reserved for those unable to undergo surgery or with recurrent tumors not compressing neural elements [20]. Despite the favorable prognosis due to their slow growth, about 20% of benign tumors may recur, highlighting the importance of careful surgical intervention [18].
Schwannomas
Schwannomas are benign nerve sheath tumors primarily affecting the dorsal nerve root, with an annual incidence of 0.3-0.7 per 100,000 [22,23]. They represent about 30% of all spinal tumors and are also more prevalent in females. The incidence is highest in individuals aged 40 to 60 years [21]. The majority of tumors have an intradural occurrence, however, they also grow extradurally (10%) or combined intra-extradurally (10-15%) [23]. Schwannomatosis and NF2 are significant risk factors that have an elevated risk of malignant transformation. The majority of schwannomas are sporadic, but those associated with NF2 are linked to mutations in the NF2 gene, which encodes the protein merlin, a tumor suppressor [21]. Genetic predisposition plays a role, particularly in patients with NF2 [22]. Schwannomas originate from Schwann cells, which are responsible for myelination in the peripheral nervous system [21]. They are often encapsulated and can cause local compression of the spinal cord or nerve roots [23]. Clinical manifestations can include localized pain, sensory changes, and motor weakness. The symptoms are often gradual and can be mistaken for other conditions. In some cases, patients may be asymptomatic until the tumor grows large enough to cause significant compression [22]. Surgery remains the treatment of choice for most symptomatic spinal schwannomas [23]. Furthermore, SRS is increasingly used for the treatment of spinal meningiomas, schwannomas, and neurofibromas, particularly in patients who are not surgical candidates or when the tumors are small and asymptomatic. SRS delivers high doses of radiation precisely to the tumor, leading to tumor control while sparing surrounding healthy tissue [5].
Neurofibromas
Neurofibromas are benign, heterogeneous peripheral nerve sheath tumors stemming from the connective tissue of peripheral nerve sheaths, especially the endoneurium [22]. These tumors can occur sporadically or as part of NF1. Spinal neurofibromas are less common than schwannomas and meningiomas, but they can be more aggressive. The incidence of NF1 is approximately one in 3,000-4,000 people worldwide females of all races equally [24]. The primary risk factor for developing spinal neurofibroma is the presence of NF1 [22]. A mutation in gene NF1, which encodes neurofibromin 1 and is located on chromosome 17q11.2, can be the cause of NF1 [24]. Neurofibromas arise from a mixture of Schwann cells, fibroblasts, and other cell types within the nerve sheath. They can be solitary or multiple, particularly in the context of NF1 [22]. While more than one-third of patients are asymptomatic, symptoms can vary widely depending on the tumor’s location. Patients may experience pain, neurological deficits, or signs of spinal cord compression [22]. In NF1 patients, neurofibromas can be multiple and may lead to complications such as scoliosis or other deformities. Surgical intervention remains a primary treatment for symptomatic tumors, especially when there is significant spinal cord compression. SRS is increasingly used for the treatment of spinal neurofibromas, particularly in patients who are not surgical candidates [3,22]. The most common pathologies in this review were schwannomas (37.1%), followed by meningiomas (27.8%), and neurofibromas (22.3%). These percentages are consistent with the known prevalence of these benign spinal tumors, with schwannomas and meningiomas being the most frequently encountered.
Indications of stereotactic radiosurgery for benign spinal tumors and tumor characteristics
The studies reviewed exhibit inconsistencies in reporting quantitatively the specific indications for SRS in treating benign spinal tumors. While some studies thoroughly documented primary treatment indications and the presence of underlying neurofibromatosis, others did not provide consistent data. For instance, the presence of neurofibromatosis was reported with precise numbers in 12 studies, showing an average indication percentage of 46.6%. Similarly, primary treatment was detailed in only five studies, with an average indication of 47.3%. In contrast, other factors like post-surgical tumor remnants, recurrences, and patient preferences were qualitatively mentioned but lacked comprehensive quantitative data across the studies. As reported in a previous review study, spinal SRS has been generally reserved for cases where surgery is not feasible, such as patients with comorbidities preventing general anesthesia, postoperative treatment of residual or recurrent tumors, high-grade tumors, or tumors in challenging locations like the ventral spinal cord [25]. The breakdown of tumor types revealed that schwannomas were the most prevalent at 37%, followed by meningiomas at 27.7%, and neurofibromas at 22.3%. This is consistent with literature reporting that the most common benign tumors include meningiomas and nerve sheath tumors (schwannomas and neurofibromas), which comprise 25% and 25-30% of spinal tumors, respectively [26]. The average median tumor volume treated with SRS was 4.9±3 cm3. The SRS dose ranges for benign spinal tumors, as reported in 15 studies, exhibit considerable variability, reflecting differences in clinical practice and patient-specific factors. Minimum doses range from 10 to 16 Gy, while maximum doses span from 15 to 33 Gy, typically administered in 1 to 6 fractions. Fractionation also varies, with some studies using single-dose treatments and others extending up to 5 or 6 fractions, indicating that the choice of dose and fractionation likely depends on tumor size, location, and proximity to critical structures. These findings suggest a trend toward hypofractionation to reduce exposure to surrounding tissues while maintaining treatment efficacy. This could reflect an evolving understanding of dose-response relationships or a focus on minimizing complications while maintaining efficacy [27]. The overall variability in BED across the years suggests that the dosing strategies for SRS in benign spinal tumors have been influenced by various factors, including technological advancements, better patient selection, and a growing emphasis on safety. There is no established optimal fractionation schedule for spine SRS, with both single and multiple fraction regimens being widely used. Fractionation takes advantage of the different radiosensitivities between tumors and the spinal cord, allowing for high doses to be delivered safely to lesions, particularly in the epidural space, which is prone to recurrences after conventional radiotherapy. Single-fraction treatments exceeding 15 Gy may enhance cell death through apoptosis. However, current data do not definitively favor one method over the other in terms of local control, though fractionated SBRT might reduce certain toxicities such as vertebral compression fractures, pain flare, and radiation myelopathy, and may be more suitable for larger treatment volumes or postoperative and re-irradiation cases [28]. Heron et al. [29] compared single-session (SS) and multi-session (MS) SRS for spinal metastases, analyzing 348 lesions from 228 patients. SS treatment provided superior early pain relief, while MS treatment resulted in better long-term tumor control, reduced need for retreatment, and higher 1-year survival rates. Both approaches were found effective, with SS offering better early outcomes and MS better long-term outcomes [29]. However, for radioresistant tumors, single-fraction treatments of 24 Gy have shown better local control than multifraction regimens, possibly due to the higher biologically equivalent doses used in single-fraction approaches. Further prospective research is required to establish the most effective dose and fractionation strategy [28]. In an animal model, Perdomo-Pantoja et al. [30] evaluated the effects of high-dose localized radiation on vertebral microstructure and mechanical integrity, testing the hypothesis that fractionated dosing may mitigate the harmful impacts of radiation on the spine. Single-dose radiation had more severe negative effects on vertebral microarchitecture, cellularity, and biomechanics compared to fractionated doses. The study’s animal model proved effective in simulating radiation-induced vertebral fractures, offering the potential for future research on preventative strategies [30]. Further prospective studies are needed to determine the optimal dose and fractionation schedule.
Additionally, SRS was often employed as a secondary treatment option, as indicated by the of patients who had prior surgery (0-77.7%) and who had previous radiotherapy (0-85%). Clinically, these findings highlight the versatility and precision of SRS in treating benign spinal tumors, particularly for smaller, well-defined tumors, and underscore its role as an adjunct to previous interventions. In a retrospective study of 16 patients with 19 benign spinal tumors, Sahgal et al. [6] employed SRS as adjuvant to subtotal resection for 26% of their patients.
Clinical outcomes of stereotactic radiosurgery for benign spinal tumors
The clinical outcomes following SRS for benign spinal tumors are overwhelmingly favorable, with an average local tumor control rate ranging from 75-100%, consistent with reports of previous reviews as 76% and 100% of the cases [25,28]. This high efficacy rate underscores the effectiveness of SRS in managing these tumors. SRS demonstrates a wide range of effects on pain management in patients with benign intradural extramedullary spinal tumors. Pain improvement was reported in 12-100% of cases, while pain remained unchanged in 0-88%, and pain worsened in 0-23%. The significant variation in these outcomes could be attributed to the heterogeneous nature of the studies, including differences in patient populations, tumor types, and SRS protocols. However, the majority of patients experienced pain improvement, highlighting SRS as an effective modality for symptom management in benign spinal tumors [27]. A significant proportion of patients had undergone previous treatments before receiving SRS, with having had prior surgery (0-77.7%) and having received radiotherapy (0-85%). This indicates that SRS is frequently used as a secondary treatment option, particularly in cases where other treatments have failed or are not feasible [3]. The BED for SS SRS in meningiomas, schwannomas, and neurofibromas was approximately 93.96±27.03 Gy, 91.71±21.53 Gy, and 95.40±29.92 Gy, respectively. These values reflect the high-dose, targeted approach of SRS aimed at achieving maximum tumor control with minimal complications. Additionally, the data on dose distribution indicates careful planning to limit spinal cord exposure, crucial in preventing radiation-induced myelopathy and other complications. Overall, these results affirm the role of SRS as an effective, secondary treatment modality for benign spinal tumors, providing high rates of local control and pain relief while accommodating varying patient needs through tailored dosing strategies [27]. Kalash et al. [7], evaluated whether lower SBRT doses could be as effective as higher doses while reducing complications. A cohort of 38 patients with 47 benign spinal tumors treated between 2004 and 2016 was analyzed, comparing low-dose and high-dose SBRT, using a cutoff biologically effective dose (10 Gy) of 30 Gy. The 5-year local control rate was 76%, with no significant differences in outcomes between the dose groups. Pain flare occurred in 16% of patients, but no severe complications were reported. The study concludes that long-term control of benign spinal tumors with SBRT is achievable with both low and high doses, without significant differences in efficacy or complications [7].
Collectively, these studies underscore the promise of SRS and SBRT as effective treatment modalities for benign spinal tumors, offering favorable long-term control rates, symptom relief, and minimal complications. Whether comparing different dose regimens or evaluating outcomes such as tumor control and neurological improvement, the evidence supports the use of these advanced radiation techniques, especially for patients who are not suitable candidates for surgery. These findings contribute to the growing body of evidence advocating for the expanded use of SRS and SBRT in managing benign spinal tumors.
Safety and efficacy of stereotactic radiosurgery for benign spinal tumors
The reviewed studies consistently indicate that SRS is a well-tolerated treatment for benign spinal tumors, with a minimal incidence of side effects. Across 15 studies, the complication rate was only 1.4%, emphasizing SRS’s safety in treating these tumors. The low complication rate suggests that SRS is a reliable treatment option with limited adverse effects on surrounding neural structures and critical tissues. Radiation myelopathy, as the most feared complication of SRS, has been reported between 0% and 3% in the literature [28]. The literature suggests that the main factors associated with the risk of radiation-induced myelopathy include the total dose, fraction size, length of the spinal cord irradiated, and total duration of treatment. Delayed radiation myelopathy from conventional radiation therapy typically occurs within 6 to 24 months [8]. However, in the current review, when analyzing the key parameters such as tumor volume, BED for an SS and MS SRS, and spinal cord maximum dose in the studies that reported SRS-induced complications versus studies that did not report this complication, no significant factors were identified that influenced spinal cord complications. Sahgal et al. [6] have published the spinal cord tolerance guidelines for radiation naïve patients, demonstrating that limiting doses to specific levels can effectively reduce the risk of radiation myelopathy to 5% or lower, with a logistic regression model showing a strong predictive capability for radiation myelopathy risk (area under the curve of 0.87). The findings emphasize the importance of careful dose planning in SBRT to protect normal spinal cord tissues while delivering effective treatment. The established dose limits serve as guidelines for clinicians to optimize treatment plans, ensuring that the risk of radiation myelopathy remains within acceptable levels, and as more data becomes available, these recommendations may be refined to enhance patient safety and treatment efficacy [31].
Regarding tumor recurrence, the studies reported a low recurrence rate of 1.4%, underscoring the effectiveness of SRS in providing durable tumor control. Correlation analyses between gross tumor volume and SRS dose revealed a weak correlation, with a Spearman correlation coefficient (r) of 0.2638 and a Pearson correlation coefficient (r) of 0.09944, along with an R-squared value of 0.009888. These statistics imply that the SRS dose is not strongly dependent on tumor volume and may be more influenced by factors such as tumor proximity to the spinal cord, tumor histology, and surrounding structures like the cauda equina [5,7,9]. The spinal cord and cauda equina are the primary organs at risk that limit the prescribed target dose in spinal radiosurgery [10]. Clinically, these findings suggest that SRS is an effective and safe treatment modality for benign spinal tumors, with precision that minimizes collateral damage and preserves neurological function. However, the need for additional pain management strategies in a small proportion of patients highlights the importance of careful patient selection and follow-up to optimize outcomes and address any potential complications early.
FUTURE DIRECTIONS
While the results are promising, further studies could focus on long-term outcomes, particularly concerning tumor recurrence and long-term side effects. Additionally, more research into optimizing SRS dosing and fractionation schedules could further enhance its efficacy and safety profile. Understanding the impact of SRS on quality of life and functional outcomes will also be critical in refining its role in managing benign spinal tumors.
CONCLUSION
SRS is a safe and effective treatment for benign spinal tumors, achieving high local tumor control rates (75-100%) and minimal complications (1.4%). It is particularly beneficial for patients with prior surgeries or radiotherapy, offering significant pain relief and neurological improvements. As a versatile and precise modality, SRS represents a promising option for managing benign spinal tumors, though further research is needed to refine treatment protocols and establish optimal fractionation schedules.
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