Skip to main content

Advertisement

SpringerLink
Log in

The role of spine stereotactic radiosurgery for patients with breast cancer metastases

  • Research
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Purpose

Breast cancer that metastasizes to the spine is associated with low quality of life and poor survival. Radiosurgery has an increasing role in this patient population. This single-institution (2003–2023) study analyzes clinical outcomes and prognostic factors for patients who underwent spinal stereotactic radiosurgery (SSRS) for metastatic breast cancer.

Methods

Ninety patients (155 unique breast cancer spinal metastases) were treated with SSRS. The median age was 57 years (range: 35–88), and the median KPS was 80 (range: 40–100). Forty-two (27%) lesions were managed surgically prior to radiosurgery. At SSRS, 75 (48%) lesions impinged or compressed the spinal cord per the epidural spinal cord scale (ESCC). Seventy-nine (51%) lesions were categorized as potentially unstable or unstable by the Spinal Instability Neoplastic Score (SINS).

Results

The median follow-up was 15 months (range: 1–183). The median single-session tumor volume was 25.4 cc (range: 2–197), and the median single-fraction prescription dose was 17 Gy (range: 12–25). Seven (5%) lesions locally progressed. The 1-, 2-, and 5-year local control rates were 98%, 97%, and 92%, respectively. The median overall survival (OS) for the cohort was 32 months (range: 2–183). The 1-, 2-, and 5-year OS rates were 72%, 53%, and 30%, respectively. On univariate analysis, KPS ≥ 80 (p = 0.009, HR: 0.51, 95% CI: 0.31–0.84) was associated with improved OS. Patient-reported pain improved (68%), remained stable (29%), or worsened (3%) following radiosurgery. Fifteen (10%) radiation-induced toxicities were reported.

Conclusions

Spinal radiosurgery is a safe and highly effective long-term treatment modality for metastases to the spine that originate from breast cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

SSRS:

Spine stereotactic radiosurgery

ESCC:

Epidural Spinal Cord Scale

EBRT:

External beam radiation therapy

SINS:

Spinal Instability Neoplastic Score

KPS:

Karnofsky Performance Score

OS:

Overall survival

LC:

Local control

References

  1. Seferis C, Torrens M, Paraskevopoulou C, Psichidis G (2014) Malignant transformation in vestibular schwannoma: report of a single case, literature search, and debate. J Neurosurg 121(Suppl):160–166. https://doi.org/10.3171/2014.7.GKS141311

    Article  PubMed  Google Scholar 

  2. Tao Z, Shi A, Lu C, Song T, Zhang Z, Zhao J (2015) Breast cancer: epidemiology and etiology. Cell Biochem Biophys 72:333–338. https://doi.org/10.1007/s12013-014-0459-6

    Article  CAS  PubMed  Google Scholar 

  3. Orranti a-Borunda E, Anchondo-Nunez P, Acuna-Aguilar LE, Gomez-Valles FO, Ramirez-Valdespino CA (2022) Subtypes of breastcancer. In: Mayrovitz HN (ed) Breast cancer. Exon Publications, Brisbane (AU). https://doi.org/10.36255/exon-publications-breast-cancer-subtypes

    Chapter  Google Scholar 

  4. Ju DG, Yurter A, Gokaslan ZL, Sciubba DM (2014) Diagnosis and surgical management of breast cancer metastatic to the spine. World J Clin Oncol 5:263–271. https://doi.org/10.5306/wjco.v5.i3.263

    Article  PubMed  PubMed Central  Google Scholar 

  5. Shehadi JA, Sciubba DM, Suk I, Suki D, Maldaun MV, McCutcheon IE, Nader R, Theriault R, Rhines LD, Gokaslan ZL (2007) Surgical treatment strategies and outcome in patients with breast cancer metastatic to the spine: a review of 87 patients. Eur Spine J 16:1179–1192. https://doi.org/10.1007/s00586-007-0357-3

    Article  PubMed  PubMed Central  Google Scholar 

  6. Yeung C, Hilton J, Clemons M, Mazzarello S, Hutton B, Haggar F, Addison CL, Kuchuk I, Zhu X, Gelmon K, Arnaout A (2016) Estrogen, progesterone, and HER2/neu receptor discordance between primary and metastatic breast tumours-a review. Cancer Metastasis Rev 35:427–437. https://doi.org/10.1007/s10555-016-9631-3

    Article  CAS  PubMed  Google Scholar 

  7. Guo Y, Arciero CA, Jiang R, Behera M, Peng L, Li X (2020) Different breast cancer subtypes show different metastatic patterns: a study from a large public database. Asian Pac J Cancer Prev 21:3587–3593. https://doi.org/10.31557/APJCP.2020.21.12.3587

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Tahara RK, Brewer TM, Theriault RL, Ueno NT (2019) Bone metastasis of breast cancer. Adv Exp Med Biol 1152:105–129. https://doi.org/10.1007/978-3-030-20301-6_7

    Article  CAS  PubMed  Google Scholar 

  9. Abrahm JL, Banffy MB, Harris MB (2008) Spinal cord compression in patients with advanced metastatic cancer: “all I care about is walking and living my life.” JAMA 299:937–946. https://doi.org/10.1001/jama.299.8.937

    Article  CAS  PubMed  Google Scholar 

  10. Sciubba DM, Petteys RJ, Dekutoski MB, Fisher CG, Fehlings MG, Ondra SL, Rhines LD, Gokaslan ZL (2010) Diagnosis and management of metastatic spine disease. A review. J Neurosurg Spine 13:94–108. https://doi.org/10.3171/2010.3.SPINE09202

    Article  PubMed  Google Scholar 

  11. Tancioni F, Navarria P, Mancosu P, Pedrazzoli P, Morenghi E, Santoro A, Baena RR, Scorsetti M (2011) Surgery followed by radiotherapy for the treatment of metastatic epidural spinal cord compression from breast cancer. Spine (Phila Pa 1976) 36:E1352-1359. https://doi.org/10.1097/BRS.0b013e318207a222

    Article  PubMed  Google Scholar 

  12. Zadnik PL, Hwang L, Ju DG, Groves ML, Sui J, Yurter A, Witham TF, Bydon A, Wolinsky JP, Gokaslan ZL, Sciubba DM (2014) Prolonged survival following aggressive treatment for metastatic breast cancer in the spine. Clin Exp Metastasis 31:47–55. https://doi.org/10.1007/s10585-013-9608-3

    Article  CAS  PubMed  Google Scholar 

  13. Tan KA, Tan JH, Zaw AS, Tan JYH, Hey HWD, Kumar N (2018) Evaluation of prognostic factors and proposed changes to the modified tokuhashi score in patients with spinal metastases from breast cancer. Spine (Phila Pa 1976) 43:512–519. https://doi.org/10.1097/BRS.0000000000002350

    Article  PubMed  Google Scholar 

  14. Bollen L, Wibmer C, Wang M, van der Linden YM, Leithner A, Bunger CE, Jensen AB, Fiocco M, Bratschitsch G, Pondaag W, Bovee JV, Dijkstra PD (2015) Molecular phenotype is associated with survival in breast cancer patients with spinal bone metastases. Clin Exp Metastasis 32:1–5. https://doi.org/10.1007/s10585-014-9685-y

    Article  CAS  PubMed  Google Scholar 

  15. Yin L, Duan JJ, Bian XW, Yu SC (2020) Triple-negative breast cancer molecular subtyping and treatment progress. Breast Cancer Res 22:61. https://doi.org/10.1186/s13058-020-01296-5

    Article  PubMed  PubMed Central  Google Scholar 

  16. Chen WZ, Shen JF, Zhou Y, Chen XY, Liu JM, Liu ZL (2017) Clinical characteristics and risk factors for developing bone metastases in patients with breast cancer. Sci Rep 7:11325. https://doi.org/10.1038/s41598-017-11700-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Bilsky MH, Angelov L, Rock J, Weaver J, Sheehan J, Rhines L, Azeem S, Gerszten P (2011) Spinal radiosurgery: a neurosurgical perspective. J Radiosurg SBRT 1:47–54

    PubMed  PubMed Central  Google Scholar 

  18. Abugharib A, Zeng KL, Tseng CL, Soliman H, Myrehaug S, Husain Z, Maralani PJ, Larouche J, Cheung P, Emmenegger U, Atenafu EG, Sahgal A, Detsky JS (2022) Spine stereotactic body radiotherapy for prostate cancer metastases and the impact of hormone sensitivity status on local control. Neurosurgery 90:743–749. https://doi.org/10.1227/neu.0000000000001909

    Article  PubMed  Google Scholar 

  19. Thibault I, Al-Omair A, Masucci GL, Masson-Cote L, Lochray F, Korol R, Cheng L, Xu W, Yee A, Fehlings MG, Bjarnason GA, Sahgal A (2014) Spine stereotactic body radiotherapy for renal cell cancer spinal metastases: analysis of outcomes and risk of vertebral compression fracture. J Neurosurg Spine 21:711–718. https://doi.org/10.3171/2014.7.SPINE13895

    Article  PubMed  Google Scholar 

  20. Gerszten PC, Burton SA, Ozhasoglu C, Welch WC (2007) Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution. Spine (Phila Pa 1976) 32:193–199. https://doi.org/10.1097/01.brs.0000251863.76595.a2

    Article  PubMed  Google Scholar 

  21. Gerszten PC, Burton SA, Welch WC, Brufsky AM, Lembersky BC, Ozhasoglu C, Vogel WJ (2005) Single-fraction radiosurgery for the treatment of spinal breast metastases. Cancer 104:2244–2254. https://doi.org/10.1002/cncr.21467

    Article  PubMed  Google Scholar 

  22. Gagnon GJ, Henderson FC, Gehan EA, Sanford D, Collins BT, Moulds JC, Dritschilo A (2007) Cyberknife radiosurgery for breast cancer spine metastases: a matched-pair analysis. Cancer 110:1796–1802. https://doi.org/10.1002/cncr.22977

    Article  PubMed  Google Scholar 

  23. Lemoine P, Bruand M, Kammerer E, Bogart E, Comte P, Royer P, Thariat J, Pasquier D (2021) Stereotactic body radiation therapy for oligometastatic breast cancer: a retrospective multicenter study. Front Oncol 11:736690. https://doi.org/10.3389/fonc.2021.736690

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Bilsky MH, Laufer I, Fourney DR, Groff M, Schmidt MH, Varga PP, Vrionis FD, Yamada Y, Gerszten PC, Kuklo TR (2010) Reliability analysis of the epidural spinal cord compression scale. J Neurosurg Spine 13:324–328. https://doi.org/10.3171/2010.3.SPINE09459

    Article  PubMed  Google Scholar 

  25. Fourney DR, Frangou EM, Ryken TC, Dipaola CP, Shaffrey CI, Berven SH, Bilsky MH, Harrop JS, Fehlings MG, Boriani S, Chou D, Schmidt MH, Polly DW, Biagini R, Burch S, Dekutoski MB, Ganju A, Gerszten PC, Gokaslan ZL, Groff MW, Liebsch NJ, Mendel E, Okuno SH, Patel S, Rhines LD, Rose PS, Sciubba DM, Sundaresan N, Tomita K, Varga PP, Vialle LR, Vrionis FD, Yamada Y, Fisher CG (2011) Spinal instability neoplastic score: an analysis of reliability and validity from the spine oncology study group. J Clin Oncol 29:3072–3077. https://doi.org/10.1200/JCO.2010.34.3897

    Article  PubMed  Google Scholar 

  26. Gerszten PC, Burton SA, Ozhasoglu C (2007) CyberKnife radiosurgery for spinal neoplasms. Prog Neurol Surg 20:340–358. https://doi.org/10.1159/000100177

    Article  PubMed  Google Scholar 

  27. Freites-Martinez A, Santana N, Arias-Santiago S, Viera A (2021) Using the common terminology criteria for adverse events (CTCAE - version 5.0) to evaluate the severity of adverse events of anticancer therapies. Actas Dermosifiliogr (Engl Ed) 112:90–92. https://doi.org/10.1016/j.ad.2019.05.009

    Article  CAS  PubMed  Google Scholar 

  28. Peart O (2017) Metastatic breast cancer. Radiol Technol 88:519M-539M

    PubMed  Google Scholar 

  29. Jin X, Mu P (2015) Targeting breast cancer metastasis. Breast Cancer (Auckl) 9:23–34. https://doi.org/10.4137/BCBCR.S25460

    Article  PubMed  Google Scholar 

  30. Chan-Seng E, Charissoux M, Larbi A, Tetreau R, Gerber YN, De Verbizier-Lonjon D, Segnarbieux F, Lonjon N (2014) Spinal metastases in breast cancer: single center experience. World Neurosurg 82:1344–1350. https://doi.org/10.1016/j.wneu.2014.08.010

    Article  PubMed  Google Scholar 

  31. Maccauro G, Spinelli MS, Mauro S, Perisano C, Graci C, Rosa MA (2011) Physiopathology of spine metastasis. Int J Surg Oncol 2011:107969. https://doi.org/10.1155/2011/107969

    Article  PubMed  PubMed Central  Google Scholar 

  32. Saarto T, Vehmanen L, Blomqvist C, Elomaa I (2008) Ten-year follow-up of 3 years of oral adjuvant clodronate therapy shows significant prevention of osteoporosis in early-stage breast cancer. J Clin Oncol 26:4289–4295. https://doi.org/10.1200/JCO.2007.15.4997

    Article  CAS  PubMed  Google Scholar 

  33. Zhao C, Zhang Z, Zhong N, Fan T, Gao X, Wu Z, Li Z, Liu T, Xiao J (2018) Outcomes and prognostic factors for surgically treated patients with breast cancer spine metastases. J Bone Oncol 12:38–43. https://doi.org/10.1016/j.jbo.2018.03.003

    Article  PubMed  PubMed Central  Google Scholar 

  34. Weigel B, Maghsudi M, Neumann C, Kretschmer R, Muller FJ, Nerlich M (1999) Surgical management of symptomatic spinal metastases. Postoperative outcome and quality of life. Spine (Phila Pa 1976) 24:2240–2246. https://doi.org/10.1097/00007632-199911010-00012

    Article  CAS  PubMed  Google Scholar 

  35. Weitao Y, Zhihuang L, Liangyu G, Limin N, Min Y, Xiaohui N (2022) Surgical efficacy and prognosis of 54 cases of spinal metastases from breast cancer. World Neurosurg 165:e373–e379. https://doi.org/10.1016/j.wneu.2022.06.060

    Article  PubMed  Google Scholar 

  36. Switlyk MD, Bruland OS, Skjeldal S, Hald JK, Seierstad T, Zaikova O (2014) Radiotherapy for spinal metastases from breast cancer with emphasis on local disease control and pain response using repeated MRI. J Bone Oncol 3:5–9. https://doi.org/10.1016/j.jbo.2014.02.003

    Article  PubMed  PubMed Central  Google Scholar 

  37. Makita K, Hamamoto Y, Kanzaki H, Kataoka M, Yamamoto S, Nagasaki K, Ishikawa H, Takata N, Tsuruoka S, Uwatsu K, Kido T (2021) Local control of bone metastases treated with external beam radiotherapy in recent years: a multicenter retrospective study. Radiat Oncol 16:225. https://doi.org/10.1186/s13014-021-01940-0

    Article  PubMed  PubMed Central  Google Scholar 

  38. Sahgal A, Myrehaug SD, Siva S, Masucci GL, Maralani PJ, Brundage M, Butler J, Chow E, Fehlings MG, Foote M, Gabos Z, Greenspoon J, Kerba M, Lee Y, Liu M, Liu SK, Thibault I, Wong RK, Hum M, Ding K, Parulekar WR, trial i (2021) Stereotactic body radiotherapy versus conventional external beam radiotherapy in patients with painful spinal metastases: an open-label, multicentre, randomised, controlled, phase 2/3 trial. Lancet Oncol 22:1023–1033. https://doi.org/10.1016/S1470-2045(21)00196-0

    Article  PubMed  Google Scholar 

  39. Ryu S, Deshmukh S, Timmerman RD, Movsas B, Gerszten P, Yin FF, Dicker A, Abraham CD, Zhong J, Shiao SL, Tuli R, Desai A, Mell LK, Iyengar P, Hitchcock YJ, Allen AM, Burton S, Brown D, Sharp HJ, Dunlap NE, Siddiqui MS, Chen TH, Pugh SL, Kachnic LA (2023) Stereotactic radiosurgery vs conventional radiotherapy for localized vertebral metastases of the spine: phase 3 results of NRG ONCOLOGY/RTOG 0631 randomized clinical trial. JAMA Oncol 9:800–807. https://doi.org/10.1001/jamaoncol.2023.0356

    Article  PubMed  Google Scholar 

  40. Zeng KL, Myrehaug S, Soliman H, Husain ZA, Tseng CL, Detsky J, Ruschin M, Atenafu EG, Witiw CD, Larouche J, da Costa L, Maralani PJ, Parulekar WR, Sahgal A (2022) Mature local control and reirradiation rates comparing spine stereotactic body radiation therapy with conventional palliative external beam radiation therapy. Int J Radiat Oncol Biol Phys 114:293–300. https://doi.org/10.1016/j.ijrobp.2022.05.043

    Article  PubMed  Google Scholar 

  41. Schmid P, Cortes J, Pusztai L, McArthur H, Kummel S, Bergh J, Denkert C, Park YH, Hui R, Harbeck N, Takahashi M, Foukakis T, Fasching PA, Cardoso F, Untch M, Jia L, Karantza V, Zhao J, Aktan G, Dent R, O’Shaughnessy J, Investigators K (2020) Pembrolizumab for early triple-negative breast cancer. N Engl J Med 382:810–821. https://doi.org/10.1056/NEJMoa1910549

    Article  CAS  PubMed  Google Scholar 

  42. von Minckwitz G, Procter M, de Azambuja E, Zardavas D, Benyunes M, Viale G, Suter T, Arahmani A, Rouchet N, Clark E, Knott A, Lang I, Levy C, Yardley DA, Bines J, Gelber RD, Piccart M, Baselga J, Committee AS, Investigators (2017) Adjuvant pertuzumab and trastuzumab in early HER2-positive breast cancer. N Engl J Med 377:122–131. https://doi.org/10.1056/NEJMoa1703643

    Article  Google Scholar 

  43. Spring LM, Wander SA, Andre F, Moy B, Turner NC, Bardia A (2020) Cyclin-dependent kinase 4 and 6 inhibitors for hormone receptor-positive breast cancer: past, present, and future. Lancet 395:817–827. https://doi.org/10.1016/S0140-6736(20)30165-3

    Article  CAS  PubMed  Google Scholar 

  44. Cortesi L, Rugo HS, Jackisch C (2021) An overview of PARP inhibitors for the treatment of breast cancer. Target Oncol 16:255–282. https://doi.org/10.1007/s11523-021-00796-4

    Article  PubMed  PubMed Central  Google Scholar 

  45. Fisher B, Costantino JP, Wickerham DL, Redmond CK, Kavanah M, Cronin WM, Vogel V, Robidoux A, Dimitrov N, Atkins J, Daly M, Wieand S, Tan-Chiu E, Ford L, Wolmark N (1998) Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and bowel project P-1 study. J Natl Cancer Inst 90:1371–1388. https://doi.org/10.1093/jnci/90.18.1371

    Article  CAS  PubMed  Google Scholar 

  46. Freedman GM, Jones JA, Taunk NK (2023) Stereotactic radiation for oligometastatic and oligoprogressive stage IV breast cancer: a case-based review. Curr Oncol 30:2510–2523. https://doi.org/10.3390/curroncol30020192

    Article  PubMed  PubMed Central  Google Scholar 

  47. Ling DC, Flickinger JC, Burton SA, Heron DE, Quinn AE, Bejjani GK, Engh JA, Gerszten PC, Amankulor NM, Vargo JA (2018) Long-term outcomes after stereotactic radiosurgery for spine metastases: radiation dose-response for late toxicity. Int J Radiat Oncol Biol Phys 101:602–609. https://doi.org/10.1016/j.ijrobp.2018.02.035

    Article  PubMed  PubMed Central  Google Scholar 

  48. Guckenberger M, Mantel F, Gerszten PC, Flickinger JC, Sahgal A, Letourneau D, Grills IS, Jawad M, Fahim DK, Shin JH, Winey B, Sheehan J, Kersh R (2014) Safety and efficacy of stereotactic body radiotherapy as primary treatment for vertebral metastases: a multi-institutional analysis. Radiat Oncol 9:226. https://doi.org/10.1186/s13014-014-0226-2

    Article  PubMed  PubMed Central  Google Scholar 

  49. Ning MS, Deegan BJ, Ho JC, Chapman BV, Bishop AJ, Allen PK, Tannir NM, Amini B, Briere TM, Wang XA, Tatsui CE, Rhines LD, Brown PD, Li J, Ghia AJ (2019) Low incidence of late failure and toxicity after spine stereotactic radiosurgery: secondary analysis of phase I/II trials with long-term follow-up. Radiother Oncol 138:80–85. https://doi.org/10.1016/j.radonc.2019.06.003

    Article  PubMed  Google Scholar 

  50. Bishop AJ, Tao R, Guadagnolo BA, Allen PK, Rebueno NC, Wang XA, Amini B, Tatsui CE, Rhines LD, Li J, Chang EL, Brown PD, Ghia AJ (2017) Spine stereotactic radiosurgery for metastatic sarcoma: patterns of failure and radiation treatment volume considerations. J Neurosurg Spine 27:303–311. https://doi.org/10.3171/2017.1.SPINE161045

    Article  PubMed  Google Scholar 

Download references

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author information

Authors and Affiliations

  1. School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Suchet Taori, Samuel Adida, Anthony Tang & Akshath Rajan

  2. Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA, 15213, USA

    Roberta K. Sefcik, Pascal O. Zinn & Peter C. Gerszten

  3. Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Steven A. Burton & John C. Flickinger

Authors
  1. Suchet Taori
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Samuel Adida
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anthony Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Akshath Rajan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Roberta K. Sefcik
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Steven A. Burton
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. John C. Flickinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Pascal O. Zinn
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Peter C. Gerszten
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

In this manuscript, S.T., S.A., R.S., S.B., J.F., P.Z., P.G., designed the study. Material preparation, data collection, and analysis were performed by S.T., S.A., A.T., A.R.. The first draft of the manuscript was written by S.T. and S.A., and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Roberta K. Sefcik.

Ethics declarations

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Ethical Committee at the University of Pittsburgh Medical Center.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent to publish

The authors affirm that human research participants provided informed consent for publication of the images in Figure(s) 1 (A-D).

Competing interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Taori, S., Adida, S., Tang, A. et al. The role of spine stereotactic radiosurgery for patients with breast cancer metastases. J Neurooncol 167, 257–266 (2024). https://doi.org/10.1007/s11060-024-04599-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-024-04599-1

Keywords

Search

Navigation