Postoperative Stereotactic Body Radiation Therapy (SBRT) for Spine Metastases: A Critical Review to Guide Practice

• Published in: International journal of radiation oncology, biology, physics Vol. 95; no. 5; pp. 1414 - 1428
• Main Authors: Redmond, Kristin J., MD, MPH, Lo, Simon S., MD, FACR, Fisher, Charles, MD, MHSc, FRCSC, Sahgal, Arjun, MD, FRCPC
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2016
• Subjects: Clinical Decision-Making - methods; Combined Modality Therapy - standards; DECISION MAKING; Evidence-Based Medicine; EXTERNAL BEAM RADIATION THERAPY; Hematology, Oncology and Palliative Medicine; Humans; Internationality; METASTASES; Patient Selection; Postoperative Care - standards; Practice Guidelines as Topic; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; Radiosurgery - standards; Radiotherapy Dosage; Radiotherapy, Adjuvant - standards; REVIEWS; Spinal Neoplasms - radiotherapy; Spinal Neoplasms - secondary; Treatment Outcome; VERTEBRAE
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2016.03.027

Postoperative stereotactic body radiation therapy (SBRT) for metastatic spinal tumors is increasingly being performed in clinical practice. Whereas the fundamentals of SBRT practice for intact spinal metastases are established, there are as yet no comprehensive practice guidelines for the postoperative indications. In particular, there are unique considerations for patient selection and treatment planning specific to postoperative spine SBRT that are critical for safe and effective management. The purpose of this critical review is to discuss the rationale for treatment, describe those factors affecting surgical decision making, introduce modern surgical trends, and summarize treatment outcomes for both conventional postoperative external beam radiation therapy and postoperative spine SBRT. Lastly, an in-depth practical discussion with respect to treatment planning and delivery considerations is provided to help guide optimal practice.