Journal of Neuro-Oncology

, Volume 101, Issue 1, pp 91–99 | Cite as

Radiosurgery using the Cyberknife for benign spinal tumors: Korea Cancer Center Hospital experience

  • Ung-Kyu Chang
  • Chang Hun Rhee
  • Sang Min Youn
  • Dong Han Lee
  • Sukh Que Park
Clinical Study – Patient Study


This study evaluated clinical outcome and safety of radiosurgery using the Cyberknife for treatment of benign spinal tumors. The authors treated 30 benign spinal tumors in 20 patients with the Cyberknife (Accuray, Inc., Sunnyvale, CA, USA) from 2002 to 2008. Among these there were 20 neurogenic tumors, eight hemangioblastomas, and two meningiomas. Four patients with neurofibromatosis (NF) type 2 and four patients with Von Hippel Lindau disease were also included. Radiosurgery was done as primary treatment for 22 lesions, for postoperative residual tumor control for four lesions, and for the remaining four lesions with image-based progression after initial subtotal resection. The distribution of lesions was cervical (18 tumors), thoracic (six), and cauda equina level (six). Follow-up data included imaging studies, clinical findings, and radiotherapy data. Tumor volume ranged from 0.04 to 33.65 cm3 (mean, 4.52 cm3). A 14–33 Gy marginal dose was delivered in 1–5 fractions. The mean follow-up period was 35.6 months (range, 12–84 months). On follow-up, most lesions decreased in size (57%) or remained unchanged (33%). Two lesions initially decreased, then increased later. One lesion increased without response. With regard to clinical aspects, radicular pain and myelopathic pain improved after radiosurgery in most cases (94%). Motor weakness recovered in two out of five patients and recovery of sensory change occurred in four out of ten patients. In two patients, symptoms were aggravated by tumor enlargement and the occurrence of new lesion. Mean spinal cord volumes receiving more than 10 and 8 Gy were 0.40 ± 0.4 and 0.81 ± 0.7 cm3, respectively. Stereotactic radiosurgery (SRS) using the Cyberknife showed the ability to control benign spinal tumors without complication in most cases.


Benign spinal tumor Cyberknife Radiosurgery 


  1. 1.
    Gibbs IC, Kamnerdsupaphon P, Ryu MR, Dodd R, Kiernan M, Chang SD et al (2007) Image-guided robotic radiosurgery for spinal metastases. Radiother Oncol 82(2):185–190. doi: 10.1016/j.radonc.2006.11.023 CrossRefPubMedGoogle Scholar
  2. 2.
    Gerszten PC, Ozhasoglu C, Burton SA, Vogel WJ, Atkins BA, Kalnicki S et al (2003) CyberKnife frameless single-fraction stereotactic radiosurgery for benign tumors of the spine. Neurosurg Focus 14(5):e16CrossRefPubMedGoogle Scholar
  3. 3.
    Gerszten PC, Burton SA, Ozhasoglu C, Welch WC (2007) Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution. Spine 32(2):193–199. doi: 10.1097/01.brs.0000251863.76595.a2 CrossRefPubMedGoogle Scholar
  4. 4.
    Ryu SI, Chang SD, Kim DH, Murphy MJ, Le QT, Martin DP et al (2001) Image-guided hypo-fractionated stereotactic radiosurgery to spinal lesions. Neurosurgery 49(4):838–846CrossRefPubMedGoogle Scholar
  5. 5.
    Dodd RL, Ryu MR, Kamnerdsupaphon P, Gibbs IC, Chang SD Jr, Adler JR Jr (2006) CyberKnife radiosurgery for benign intradural extramedullary spinal tumors. Neurosurgery 58(4):674–685. doi: 10.1227/01.NEU.0000204128.84742.8F (discussion 674–685)CrossRefPubMedGoogle Scholar
  6. 6.
    Gerszten PC, Burton SA, Ozhasoglu C, McCue KJ, Quinn AE (2008) Radiosurgery for benign intradural spinal tumors. Neurosurgery 62(4):887–895. doi: 10.1227/01.neu.0000318174.28461.fc (discussion 895–896)CrossRefPubMedGoogle Scholar
  7. 7.
    Lim M, Adler JR (2006) CyberKnife radiosurgery for extremity schwannomas: technical note and case report. Stereotact Funct Neurosurg 84(2–3):60–63. doi: 10.1159/000094033 CrossRefPubMedGoogle Scholar
  8. 8.
    Murovic JA, Gibbs IC, Chang SD, Mobley BC, Park J, Adler JR Jr (2009) Foraminal nerve sheath tumors: intermediate follow-up after Cyberknife radiosurgery. Neurosurgery 64(2 Suppl):A33–A43. doi: 10.1227/01.NEU.0000341632.39692.9E CrossRefPubMedGoogle Scholar
  9. 9.
    Ryu SI, Kim DH, Chang SD (2003) Stereotactic radiosurgery for hemangiomas and ependymomas of the spinal cord. Neurosurg Focus 15(5):E10CrossRefPubMedGoogle Scholar
  10. 10.
    Sahgal A, Chou D, Ames C, Ma L, Lamborn K, Huang K et al (2007) Image-guided robotic stereotactic body radiotherapy for benign spinal tumors: The University of California San Francisco preliminary experience. Technol Cancer Res Treat 6(6):595–604PubMedGoogle Scholar
  11. 11.
    Sinclair J, Chang SD, Gibbs IC, Adler JR Jr (2006) Multisession CyberKnife radiosurgery for intramedullary spinal cord arteriovenous malformations. Neurosurgery 58(6):1081–1089. doi: 10.1227/01.NEU.0000215891.25153.BA (discussion 1081–1089)CrossRefPubMedGoogle Scholar
  12. 12.
    Kondziolka D, Nathoo N, Flickinger JC, Niranjan A, Maitz AH, Lunsford LD (2003) Long-term results after radiosurgery for benign intracranial tumors. Neurosurgery 53(4):815–821 (discussion 821–822)PubMedGoogle Scholar
  13. 13.
    Kondziolka D, Lunsford LD, McLaughlin MR, Flickinger JC (1998) Long-term outcomes after radiosurgery for acoustic neuromas. N Engl J Med 339(20):1426–1433CrossRefPubMedGoogle Scholar
  14. 14.
    Benzil DL, Saboori M, Mogilner AY, Rocchio R, Moorthy CR (2004) Safety and efficacy of stereotactic radiosurgery for tumors of the spine. J Neurosurg 101(Suppl 3):413–418PubMedGoogle Scholar
  15. 15.
    Bhatnagar AK, Gerszten PC, Ozhasaglu C, Vogel WJ, Kalnicki S, Welch WC et al (2005) CyberKnife frameless radiosurgery for the treatment of extracranial benign tumors. Technol Cancer Res Treat 4(5):571–576PubMedGoogle Scholar
  16. 16.
    Cheshier SH, Hanft SJ, Adler JR, Chang SD (2007) CyberKnife radiosurgery for lesions of the foramen magnum. Technol Cancer Res Treat 6(4):329–336PubMedGoogle Scholar
  17. 17.
    Gerszten PC, Ozhasoglu C, Burton SA, Vogel WJ, Atkins BA, Kalnicki S et al (2004) CyberKnife frameless stereotactic radiosurgery for spinal lesions: clinical experience in 125 cases. Neurosurgery 55(1):89–98 (discussion 98–99)PubMedGoogle Scholar
  18. 18.
    Gibbs IC, Patil C, Gerszten PC, Adler JR Jr, Burton SA (2009) Delayed radiation-induced myelopathy after spinal radiosurgery. Neurosurgery 64(2 Suppl):A67–A72. doi: 10.1227/01.NEU.0000341628.98141.B6 CrossRefPubMedGoogle Scholar
  19. 19.
    Thariat J, Castelli J, Chanalet S, Marcie S, Mammar H, Bondiau PY (2009) CyberKnife stereotactic radiotherapy for spinal tumors: value of computed tomographic myelography in spinal cord delineation. Neurosurgery 64(2 Suppl):A60–A66. doi: 10.1227/01.NEU.0000339129.51926.D6 CrossRefPubMedGoogle Scholar
  20. 20.
    Ryu S, Jin JY, Jin R, Rock J, Ajlouni M, Movsas B et al (2007) Partial volume tolerance of the spinal cord and complications of single-dose radiosurgery. Cancer 109(3):628–636. doi: 10.1002/cncr.22442 CrossRefPubMedGoogle Scholar
  21. 21.
    Chang EL, Shiu AS, Mendel E, Mathews LA, Mahajan A, Allen PK et al (2007) Phase I/II study of stereotactic body radiotherapy for spinal metastasis and its pattern of failure. J Neurosurg Spine 7(2):151–160. doi: 10.3171/SPI-07/08/151 CrossRefPubMedGoogle Scholar
  22. 22.
    Yamada Y, Bilsky MH, Lovelock DM, Venkatraman ES, Toner S, Johnson J et al (2008) High-dose, single-fraction image-guided intensity-modulated radiotherapy for metastatic spinal lesions. Int J Radiat Oncol Biol Phys 71(2):484–490. doi: 10.1016/j.ijrobp.2007.11.046 CrossRefPubMedGoogle Scholar
  23. 23.
    Schultheiss TE, Kun LE, Ang KK, Stephens LC (1995) Radiation response of the central nervous system. Int J Radiat Oncol Biol Phys 31(5):1093–1112CrossRefPubMedGoogle Scholar
  24. 24.
    Nieder C, Grosu AL, Andratschke NH, Molls M (2006) Update of human spinal cord reirradiation tolerance based on additional data from 38 patients. Int J Radiat Oncol Biol Phys 66(5):1446–1449. doi: 10.1016/j.ijrobp.2006.07.1383 CrossRefPubMedGoogle Scholar
  25. 25.
    Sahgal A, Ames C, Chou D, Ma L, Huang K, Xu W et al (2009) Stereotactic body radiotherapy is effective salvage therapy for patients with prior radiation of spinal metastases. Int J Radiat Oncol Biol Phys 74(3):723–731. doi: 10.1016/j.ijrobp.2008.09.020 CrossRefPubMedGoogle Scholar
  26. 26.
    Moss JM, Choi CY, Adler JR Jr, Soltys SG, Gibbs IC, Chang SD (2009) Stereotactic radiosurgical treatment of cranial and spinal hemangioblastomas. Neurosurgery 65(1):79–85. doi: 10.1227/01.NEU.0000348015.51685.D2 (discussion 85)CrossRefPubMedGoogle Scholar
  27. 27.
    Gibbs IC (2007) Spinal and paraspinal lesions: The role of stereotactic body radiotherapy. Front Radiat Ther Oncol 40:407–414. doi: 10.1159/0000106050 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2010

Authors and Affiliations

  • Ung-Kyu Chang
    • 1
  • Chang Hun Rhee
    • 1
  • Sang Min Youn
    • 1
  • Dong Han Lee
    • 2
  • Sukh Que Park
    • 3
  1. 1.Department of Neurosurgery, Korea Cancer Center HospitalKorea Institute of Radiological and Medical ScienceSeoulKorea
  2. 2.Korea Cancer Center Hospital Cyberknife CenterKorea Institute of Radiological and Medical ScienceSeoulKorea
  3. 3.Department of NeurosurgerySooncheonhyang UniversitySeoulKorea

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