Introduction
Cleveland_Clinic_Host: Today, take advantage of this opportunity to chat live with Lilyana Angelov, MD, an expert in the use of stereotactic spine radiosurgery as a treatment option for spine tumors. Get answers to common questions regarding this state-of-the-art procedure as well as expert information about other possible treatment options for all types of spine tumors and other related conditions.
The diagnosis of cancer is delivered to more than one million Americans each year. Of these, 70 percent develop skeletal metastases (lesions from the spread of cancer to the skeletal system), which can mean painful symptoms and, frequently, uncomfortable and intensive treatment procedures. Now, there is a revolutionary treatment option for spinal tumors, called stereotactic spine radiosurgery, that can provide pain relief through a non-invasive, outpatient procedure with no recovery time. Cleveland Clinic is one of only a few locations across the country to offer stereotactic spinal radiosurgery.
Pain relief is the No. 1 use of stereotactic spine radiosurgery; more than 80 percent of patients achieve pain relief, often within a few days to weeks. The procedure also can be used as the first line of treatment against tumors, for treating any residual tumor left after surgery, as a radiation boost following conventional treatment and as another option when other treatments haven't been successful.
Dr. Lilyana Angelov is board-certified in neurological surgery in both the United States and Canada. She is the Head of the Section of Spinal Tumors and Director of the Brain Tumor and Neuro-Oncology Center Primary CNS Lymphoma Program at Cleveland Clinic. Dr. Angelov specializes in neuro-oncology, gamma knife radiosurgery, intra-arterial chemotherapy with blood-brain-barrier disruption, CNS metastatic disease and spine radiosurgery.
Dr. Angelov received her medical degree from the University of Toronto Faculty of Medicine and completed her internal medicine internship at Saint Michael's Hospital in Toronto, Ontario, Canada. She completed her neurosurgery residency at the University of Toronto and also received fellowships in both neuro-oncology and neurosurgery from Cleveland Clinic and Saint Michael's Hospital in Toronto. Dr. Angelov is also certified in neurosurgery by the Royal College of Physicians and Surgeons of Canada.
To make an appointment with Dr. Lilyana Angelov, or any of our other specialists within the Center for Spine Health or the Brain Tumor and Neuro-Oncology Center, please call our patient access coordinator at 866.588.2264. You may also visit us online at clevelandclinic.org/neuroscience. You may also request an appointment online at clevelandclinic.org/appointments.
Cleveland_Clinic_Host: Welcome to our Online Health Chat with Dr. Lilyana Angelov. We are thrilled to have Dr. Angelov here today for this chat. She is considered an expert in the field of spinal tumors and the state-of-the art treatment options called stereotactic spinal surgery. Let’s begin with some general questions about spine tumors.
Spine Tumors : Stereotactic Spine Radiosurgery
jk_goblue: What treatment options are available for a patient diagnosed with a spine tumor?
Speaker_-_Dr__Lilyana_Angelov: The treatment options depend on the type of the tumor, the location of the tumor and the symptoms that a patient is experiencing. In general categories, the things that we can do to control a tumor are:
- Expectant management (observation)
- Open surgery
- Conventional radiation
- Stereotactic radiosurgery
- Chemotherapy
Speaker_-_Dr__Lilyana_Angelov: The treatment that we recommend depends on the clinical situation.
jk_goblue: I'm not familiar with stereotactic spine radiosurgery as a treatment option for spinal tumors. Can you explain how it works? Is it something that is available to any patient or are their particular requirements?
Speaker_-_Dr__Lilyana_Angelov: Spine radiosurgery is a one-day outpatient radiation treatment. In contrast to conventional radiation, very high dosages of radiation are delivered to the tumor in one session. However, to do this safely, the dosage has to be specifically focused the tumor and have little spill over radiation to the surrounding normal tissue such as the spinal cord which sits very near the tumor.
The clinical situation determines whether this is appropriate treatment for a patient, but this is therapy that is only available at specialized centers.
lys_k86: Is radiation exposure with spine radiosurgery a concern?
Speaker_-_Dr__Lilyana_Angelov: While the dose of radiation with spine radiosurgery is significantly higher to the target area, dose to the surrounding normal tissue is lower than with conventional radiation. A good analogy would be that the radiation is like a glove fitting a hand where the hand is the target and the glove is the radiation dose. This is the key to the effectiveness and safety of the treatment.
calliep: How is this procedure different from a more invasive, open procedure?
Speaker_-_Dr__Lilyana_Angelov: Spine radiosurgery is a non-invasive procedure. There is no incision (cut) that is required for the treatment. There is essentially no recovery time and minimal if any post treatment symptoms.
Typically treatment time is approximately one hour for most patients. This is considered a one-day outpatient procedure, but precision targeting requires some pre-planning steps that often require a prior outpatient visit to the outpatient department.
Hope4thebest: Is stereotactic spinal radiosurgery used instead of “normal” radiation therapy or after, if that fails?
Speaker_-_Dr__Lilyana_Angelov: That is an excellent question. It can be used as upfront therapy or in patients who have had conventional radiation that has subsequently failed. Previous to the development of spine radiosurgery there were more limited treatment options for patients who had failed conventional radiation. This is why we are so excited to be able to offer this therapy at Cleveland Clinic.
The Cleveland Clinic Brain Tumor and Neuro-Oncology Center was the first in Ohio to offer this novel treatment option and our program has been running for nearly 4 years.
lys_k86: What makes stereotactic spine radiosurgery different from other treatment options for spine tumors?
Speaker_-_Dr__Lilyana_Angelov: Surgery requires an incision and hospital stay. Conventional radiation is multi-session treatment. With spine radiosurgery we can achieve rapid and effective local pain control and tumor control in a non-invasive manner.
pluckett: What are the success rates?
Speaker_-_Dr__Lilyana_Angelov: The success rate of the spine radiosurgery partially depends on the type of tumor we are treating. However, in general we achieve 80-85 percent local pain relief in patients within one month of treatment and often in less time.
Local tumor control rate is also between 80-90 percent.
pluckett: What, if any, side effects are there to this procedure?
Speaker_-_Dr__Lilyana_Angelov: Treatment is typically well-tolerated. There is no discomfort related to it. Most patients resume their baseline activity immediately post treatment. Occasionally patients may experience some temporary difficulty with swallowing or sore throat, GI upset and fatigue. The risk of having radiation induced injury to the spinal cord as a result of the treatment is approximately 1:1,000 in most situations.
slynch0: Is spine radiosurgery used only as a treatment option for spine tumors or is it just used to relieve pain or both?
Speaker_-_Dr__Lilyana_Angelov: Spine radiosurgery is effective treatment to control both the pain and the local tumor growth. We treat patients that present with local pain related to their tumor; locally progressive spine tumors or patients with a combination of both pain and tumor growth.
lynnice: A spinal tumor within the canal under the dura covering has been located via MRI in my mother's spine. It is the size of a peanut and causing pain. What should we do? She is getting a 2nd opinion. Where should we seek help?
Speaker_-_Dr__Lilyana_Angelov: Up to this point we have been primarily discussing the use of spine radiosurgery for treatment of metastatic tumors to the spine.
Your question suggests that in your mother's case this may be a benign tumor within the spinal canal. However, without knowing more about her particular case, I obviously cannot comment. While we have definitely performed spine radiosurgery in this setting, other treatment options may also be appropriate and determined on a case by case basis.
To make an appointment at Cleveland Clinic for a second opinion with any of our specialists within the Center for Spine Health or the Brain Tumor and Neuro-Oncology Center, please call our patient access coordinator at 866.588.2264. You may also visit us online at clevelandclinic.org/neuroscience.
newtonm: What is the recuperation process like after surgery, i.e. how long, PT, OT, etc.? Does one usually have a full recovery or are there still problems afterwards?
Speaker_-_Dr__Lilyana_Angelov: While this is called 'radiosurgery' - this is not a surgical procedure/operation. It is called radiosurgery to indicate that it is treatment delivered in one day in contrast to radiation therapy (conventional radiation) which is multi-day treatment.
There is essentially not recovery period post procedure and a patient feels nothing during the procedure (similar to having a chest X-ray for example). Patient’s can immediately assume their pretreatment activity level and in many cases, as pain improves with this treatment, patients are often able to be much more active than before their tumor was treated.
slynch0: So is stereotactic radiosurgery used as an alternative to chemotherapy or radiation for treating spine tumors?
Speaker_-_Dr__Lilyana_Angelov: Depending on the case, stereotactic spine radiosurgery can be used as either an alternative to using chemotherapy or conventional radiation therapy for treating the local spine tumor or as a complement (in addition) to these therapies. Obviously, this is local therapy only and is not intended as definitive treatment for the primary cancer.
Again, treatment options are tailored to patients very specifically and the decision making is complex.
play4me: If surgery is not an option, where do you go from there?
Speaker_-_Dr__Lilyana_Angelov: The appropriate management of spine tumors can often be very complicated and require sophisticated decision making.
At the Cleveland Clinic we hold a weekly multi-disciplinary spine tumor board to discuss the appropriate management of many of spine tumor patients we have seen in our clinics. This team approach allows us to recommend an integrated management strategy to help determine the best course of treatment and what options may be available.
Closing
Cleveland_Clinic_Host: I'm sorry to say that our time with Dr. Lilyana Angelov is now over. Thank you again Dr. Angelov for taking the time to answer our questions about spine tumors today.
Speaker_-_Dr__Lilyana_Angelov: Thank you too. The questions have been great, and I am pleased to have had the opportunity to talk about our very exciting program.
More Information
For more information about Cleveland Clinic’s Center for Spine Health and/or Brain Tumor and Neuro-Oncology Center, you may visit clevelandclinic.org/neuroscience.
To make an appointment with Dr. Lilyana Angelov, or any of our other specialists within the Center for Spine Health or the Brain Tumor and Neuro-Oncology Center, please call our patient access coordinator at 866.588.2264. You may also request an appointment online at clevelandclinic.org/appointments.
Some interesting articles about this topic from Cleveland Clinic may be found at the following links:
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This chat occurred on May 20, 2009.
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