Treatments

Spinal Tumors Treatments

Northwestern Medicine specialists have expertise in the treatment of primary tumors and metastatic tumors of the spine, including rare tumors like chordoma, as well as tumors within the spinal canal, spinal cord and spinal nerves. If you have been diagnosed with a spine tumor, your physician may recommend surgery, medication (chemotherapy), radiation therapy or a combination of these treatments.

Surgery

Surgery is a common treatment for many spine tumors and is often the first course of treatment. For some patients, it may be the only treatment they need. Surgery may:

• Possibly remove the tumor in its entirety
• Relieve your symptoms
• Remove a small piece of tumor to determine what it is (biopsy)
• Stabilize a spine damaged by a tumor

The type of surgery you may need depends upon:

• The type of tumor
• The size and location of the tumor
• Whether the tumor can be fully removed

Spine tumors can be removed through surgery in several ways, such as:

• The surgeon may cut your tumor out with a scalpel or special surgical scissors
• If the tumor is very soft, the surgeon might use a vacuum device to remove it
• A special tool can be used to liquefy the tumor, after which it can be vacuumed out
• If a tumor is hard to reach with regular surgery, a laser may be used to kill cancer cells

Your neurosurgeon will try to remove your whole tumor if possible. If your surgical team can’t remove all of the tumor without harming your spine, they will take out as much of the tumor as possible. This is called debulking surgery. Reducing the size of a tumor through surgery can help lower the pressure on the spine and relieve some of your symptoms.

Leading-edge surgical techniques

Northwestern Medicine offers groundbreaking treatments by internationally recognized expert neurosurgeons who have either pioneered or trained in:

• En Bloc Resection: Removing the tumor entirely in one piece, without ‘spilling’ tumor
• Spondylectomy: Removing an entire segment of the mobile spine
• Sacrectomy/Sacral Amputation: Removing part of, or the entire, sacrum
• Spinal Reconstructions
• Separation Surgery: Creating space around the spinal cord and nerve roots so that radiation therapy can be delivered to a tumor while minimizing the former’s effect on the spinal cord and nerve roots.
• Transmandibular approaches to the cervical spine
• Minimally invasive tumor approaches
• Endoscopic Transcervical Odontoidectomy
• DaVinci Robotic Surgery®: Minimally invasive approaches to the spine and sacrum
• Lumbar fusion

Radiation therapy

Radiation therapy may be used to treat a spine tumor after surgery, or as your primary treatment when surgery isn’t an option. The type of radiation treatment recommended depends upon the stage and location of your tumor. Northwestern Medicine specialists are skilled in the very latest radiation therapy techniques, which allow them to precisely target your tumor with high levels of radiation, while striving to preserve healthy cells and limit your side effects. Your radiation treatment may include:

• Proton therapy: Proton therapy is one of the most precise forms of radiation therapy, proton treatment can be controlled so most of the radiation ends up directly in the tumor, reducing the risk of damage to surrounding healthy tissues, and causing fewer short- and long-term side effects. Proton therapy has been effective in treating certain types of spine cancer. The Northwestern Medicine Proton Center is the first and only proton center in Illinois, and the ninth in the country, to offer proton therapy.
• External beam radiation therapy (EBRT): EBRT directs high-energy rays of radiation from outside of your body directly at cancerous tissues inside. It effectively treats large areas of the body, such as your spine. Often, EBRT is followed by brachytherapy
• Brachytherapy: In this therapy, small radioactive seeds are implanted at the site of the tumor. Depending on the cancer, your physicians may recommend a low-dose rate (LDL) or a high-dose rate (HDL)
• 3-D conformal radiation therapy: In this technique, radiation beams are sculpted in the exact shape of the tumor, to better preserve nearby healthy tissue and organs
• Intensity modulated radiation therapy (IMRT): Ideal for difficult to reach tumors, IMRT uses advanced software to prepare a precise dose of radiation, matched to the tumor's size, shape and location
• Image guided radiation therapy (IGRT): Due to breathing and other body movements, the tumor can also move. IGRT allows our specialists to track the tumor’s movement for the most precise treatment possible
• TomoTherapy®: This leading-edge technology combines the advanced sculpting precision of IMRT with the accuracy of CT scanning technology to confirm the shape and position of the tumor prior to treatment
• Stereotactic radiosurgery: This treatment involves a single high dose of radiation. Sometimes it may be several high doses aimed right at the tumor from many different directions. Since it is very focused, the normal tissue around the tumor gets little or no radiation. A machine will beam the radiation to the tumor. Some of the most common machines used are the Gamma Knife®, the CyberKnife® and the linear accelerator

Clinical trials

If you have a brain or spine tumor, a clinical trial may provide a promising alternative to your care. As a patient at Northwestern Medicine, you have access to some of the most advanced research trials available anywhere. Talk with your care team about your options.