The Changing Landscape for the Treatment of Painful Spinal Metastases: is Stereotactic Body Radiation Therapy the New Standard of Care?

Due to advancements in systemic targeted and immunotherapies resulting in improved disease control and overall survival, and the increasing use of computed tomography and spine magnetic resonance imaging surveillance, the number of patients presenting with both asymptomatic and symptomatic spinal metastases is increasing. The need for versatile tumour ablative local management strategies, beyond the limits afforded by conventional palliative external beam radiation therapy (cEBRT), is increasingly more important. Stereotactic body radiation therapy (SBRT) was developed to meet such a need. This highly conformal technique allows the delivery of high biologically effective doses of radiation to the vertebral target, while controlling the differential dose exposure to the adjacent critical neural tissue. Identifying patients with painful spine metastases who would gain the most benefit from this important therapeutic option can be challenging. Here we summarise the randomised evidence specific to spine SBRT, comparing cEBRT with SBRT for pain control in patients with spine metastases in the palliative setting to better understand the role of spine SBRT in modern oncological spinal care. (C) 2022 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Automated summary

With advancements in targeted and immunotherapies, the number of spinal metastases cases is increasing, and there is a growing need for local management strategies beyond conventional radiation therapy. Stereotactic body radiation therapy (SBRT) is a highly conformal technique that allows precise targeting of vertebral lesions while minimizing damage to adjacent neural tissue. However, identifying the most suitable patients for SBRT in the palliative setting remains a challenge.