Spinal Metastases: Fractionated Radiation Therapy Perspective

Abstract

Approximately 40% of all cancer patients will develop metastatic spinal disease [1]. Some patients may be satisfactorily treated with conventional radiotherapy for palliation of pain and neurologic symptoms arising from spinal metastases. For other patients, a conventional dose of 30 to 45 Gy may be inadequate to achieve durable control. Furthermore, reirradiation of the spine with conventional means is rarely an option. The American Society for Therapeutic Radiology and Oncology (ASTRO) has described a new field of stereotactic body radiation therapy (SBRT) in conjunction with the American College of Radiology (ACR). SBRT is a “newly emerging radiotherapy treatment method to deliver a high dose of radiation to the target, utilizing either a single dose or small number of fractions with a high degree of precision within the body. The ability to deliver a single or a few fractions of high dose ionizing radiation with high targeting accuracy and rapid dose falloff gradients encompassing tumors within a patient provides the basis for the development of SBRT [2].” This perspective explores the respective merits of single-dose and hypofractionated SBRT to the spine.