offer surgery (case 17–19). All three presented with large
tumors very close to the neural structures. Surgical removal
would have resulted in severe neural damage. Nowadays we
would preferably perform SAE instead of primary irradiation
whenever surgery is not reasonable. Local recurrences of
the spine are much more difficult to treat than of the
extremities. Additionally, tumors of the axial skeleton seem
to be diagnosed at a later stage of disease often presenting
with a soft tissue mass. Wide or marginal excision of the
tumor or en bloc resections may result in a lower recurrence
rate but often cause unacceptable neurological impairments
[19]. Liljenqvist et al. stated in a publication on malignant
tumors of the spine that en bloc spondylectomy enables
wide or marginal resection in most cases with acceptable
morbidity