Spinal tumor treatment can run the gamut from “watch and wait” to a combination of surgical intervention, radiation and chemotherapy to somewhere in between. It all depends on the tumor’s pathology, its characteristics and the level of discomfort the patient is experiencing. No matter the situation, though, a care plan that harnesses the expertise of an entire team of specialists provides patients with the opportunity for the best possible outcome.

This collaborative approach to treatment is available at OHSU’s Spine Center, the only health care facility in Oregon offering this level of multidisciplinary spinal tumor care. Depending on specific needs, patients work with fellowship-trained neurosurgeons and orthopaedic spine surgeons, interventional radiologists, neuroradiologists, medical oncologists and/or radiation oncologists to meet the goal of creating and executing a tailored care plan for each individual, regardless of complexity. While the majority of treatment happens at OHSU or an OHSU Health partner hospital, like Hillsboro Medical Center, the spinal tumor team will work with patients living outside the Portland metro area to help them access certain components of treatment, like chemotherapy or radiation, closer to home, saving them the added stress of travel or temporary relocation.

Urgent appointments for patients with tumors

Patients typically enter the spinal tumor program through a referral from a primary care physician or an oncologist. A spine surgeon reviews every referral involving a spinal tumor individually, and these patients take precedence in terms of urgent appointments. Because of the risk posed by spinal tumors, the team addresses them without delay — developing a treatment plan if needed — regardless of whether the tumor in question is benign, metastatic or the manifestation of a new, primary cancer.

The spinal tumor team is available to see patients in need of second opinions as well.

Advanced treatment modalities

Treatment plans for spinal tumors often include surgery, and while some patients require full surgical resections, the surgeons on the spinal tumor team aim to use minimally invasive techniques, like microsurgery, kyphoplasty, tubular retractors and neuronavigation, whenever possible. This approach minimizes complications, lessens the need for pain medication, helps reduce intra- and postoperative blood loss, and leads to faster postsurgery functional improvement. It fosters the ability to start systemic therapy and radiation therapy earlier due to the fact that the patient will likely heal more quickly than they would otherwise, and also makes way for the use of stereotactic body radiation therapy (SBRT) for patients with spinal malignancies.

“This is a more focal type of radiation therapy that allows for increased dose to the tumor while sparing surrounding tissue,” said Eric Chang, M.D., a radiation oncologist with OHSU’s Knight Cancer Center. “As opposed to conventional radiation therapy, which is given in multiple daily doses, this can be given in five or fewer treatments.”

Not only does the use of SBRT minimize delays to the patient’s treatment schedule it can also help improve treatment outcomes (including greater tumor control and improved pain relief), Chang said.

OHSU’s Spine Center surgeons recently started incorporating the use of carbon fiber instrumentation in some cases, as an alternative to titanium. Carbon fiber is extremely advantageous because it renders images easier to interpret (titanium leaves a lot of artifact on CT scans and MRIs). This ultimately makes it easier to deliver targeted radiation and also reduces the wait time between surgery and the onset of subsequent treatments, with the goal of reducing morbidity and maximizing quality of life for patients.

When to refer

Any patient with a tumor on or adjacent to the spinal column is a candidate for care and treatment at OHSU’s Spine Center, including:

• Patients with spinal metastases.
• Patients with a history of cancer who have ongoing back or neck pain.
• Patients with a history of cancer who have pain radiating down the arm.
• Patients with a combination of neurological deficit and abnormal or suspicious imaging.
• Patients with tumors on or near nerves and/or spinal bones.
• Patients with benign spinal tumors.
• Patients seeking a second opinion.
• Patients with or without a formal diagnosis.