Metastatic malignant tumors comprise the vast majority of spinal tumors in adults. The most
devastating complication of spinal metastatic disease (SMD) is invasion of the spinal canal
and compression of the spinal cord or the nerve roots of the cauda equina, resulting in a
clinical entity known as cord compression that manifests with progressive loss of motor
function and sensation in the legs, as well as bladder and bowel incontinence.
The treatment of spinal metastases is mostly palliative with the goals of improving or
maintaining neurologic function, achieving local tumor control, and spinal stability. Most
patients with spinal metastatic disease are currently treated effectively with radiation
therapy and/or surgery with good results. There are however certain limitations in the
current treatment of SMD. Radiation therapy has two important limitations: 1) if the targeted
SMD is in close proximity the spinal cord, delivery of high radiation doses is
contraindicated as it may cause radiation-induced damage to the spinal cord (myelopathy, and
2) there is limit on the cumulative amount of radiation dose, which means that recurrent
tumors may not be amenable to repeat radiation therapy. As far spinal surgery is concerned,
the main limitation is that some patients are not fit for surgery because of medical
co-morbidities.
This phase I clinical research trial will test the hypothesis that a new minimally invasive
treatment called spinal intra-arterial chemotherapy (SIAC) can be safely applied in patients
with SMD.