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Stereotactic Body Radiotherapy for Spinal Metastases

Practice Guidelines, Outcomes, and Risks

Jabbari, Siavash MD*; Gerszten, Peter C. MD; Ruschin, Mark PhD; Larson, David A. MD, PhD§; Lo, Simon S. MB, ChB, FACR; Sahgal, Arjun MD, FRCPC

doi: 10.1097/PPO.0000000000000205
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Spine metastases can be a debilitating and difficult therapeutic challenge for a significant number of cancer patients. Surgical management of spine metastases is often limited because of the complexity, risks, and recovery delays associated with open invasive surgical procedures. Conventional palliative external beam radiation therapy is the most common treatment modality. However, it is associated with limited palliative efficacy and local tumor control, including in the postoperative setting. In the era of improving systemic disease control, spine stereotactic body radiotherapy is fast emerging as the therapeutic modality of choice for selected de novo, postoperative, and salvage reirradiation spine metastases patients. Considerable expertise, multidisciplinary collaboration, and rigid adherence to quality metrics are required for the safe application of this highly conformal ablative therapy. This review highlights the current state of the evidence, understanding of the late effects, and technological requirements for spine stereotactic body radiotherapy specific to spinal metastases.

From the *Department of Radiation Oncology, The Laurel Amtower Cancer Institute and Neuro-oncology Center, Sharp Healthcare, San Diego, CA; †Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA; ‡Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; §Department of Radiation Oncology, University of California San Francisco, San Francisco, CA; and ∥Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH.

A.S. has received honoraria for past educational seminars from Medtronic and Elekta AB and research grants from Elekta AB. S.S.L. is a member of a research group supported by Elekta AB and honorarium from Varian Medical Systems and Accuray. The other authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Reprints: Arjun Sahgal, MD, FRCPC, Department of Radiation Oncology, University of Toronto Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5. E-mail: arjun.sahgal@sunnybrook.ca.

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