Stereotactic radiation for spinal metastases

Spinal metastases remain a common problem in the natural history of multiple malignancies. Historically, conventionally fractionated radiation has been used in the palliative setting to reduce pain and/or neurologic symptoms; however, results may not be complete or durable, particularly for long-term survivors. Stereotactic body radiotherapy (SBRT) for spinal metastases represents an evolving paradigm shift in the field of palliative radiotherapy. Utilizing higher dose per fraction radiation, this modality increases both the biologically effective dose and conformality of the radiation dose distribution, thereby potentially improving local disease control and reducing side effects. Retrospective and prospective studies suggest excellent local control and pain control with an acceptable toxicity profile. In this chapter, the data supporting SBRT in spine metastases will be described and compared to conventionally fractionated, non-stereotactic radiation including a review of toxicities unique to spine SBRT. The treatment technique of spine SBRT, including appropriate patient selection, prescription dose normal tissue constraints, common side effects, and contraindications to its use will also be described in detail.