Vienna, Austria

ESTRO 2023

Session Item

May 13
16:45 - 17:45
Plenary Hall
Palliation - Oligometastases
Mateusz Spałek, Poland;
Vincent Khoo, United Kingdom
Proffered Papers
17:35 - 17:45
SBRT for spine metastases: A systematic review for preparation of an ESTRO practice guideline
Ricarda Stella Guninski, Switzerland


SBRT for spine metastases: A systematic review for preparation of an ESTRO practice guideline

Ricarda Stella Guninski1, Francesco Cuccia2, Nicolaus Andratschke1, Claus Belka3, David Bellut4, Max Dahele5, Mirjana Josipovic6, Pietro Mancosu7, Giuseppe Minniti8, Maximilian Niyazi3, Umberto Ricardi9, Per Munck af Rosenschöld10, Arjun Sahgal11, Wilko Verbakel5, Yat Man Tsang12, Matthias Guckenberger1, Filippo Alongi13,14

1University Hospital Zurich, University of Zurich, Department of Radiation Oncology, Zurich, Switzerland; 2ARNAS Civico Hospital , Radiation Oncology Unit, Palermo, Italy; 3University Hospital, LMU Munich, Department of Radiation Oncology, Munich, Germany; 4University Hospital Zurich, University of Zurich, Department of Neurosurgery, Zurich, Switzerland; 5Amsterdam University Medical Center, Department of Radiation Oncology, Amsterdam, The Netherlands; 6Rigshospitalet, Department of Oncology, Section of Radiotherapy, Copenhagen, Denmark; 7IRCCS Humanitas Research Hospital, Medical Physics Unit of Radiotherapy Dept., Rozzano, Italy; 8University of Siena, Radiation Oncology Unit, Department of Medicine, Surgery and Neurosciences, Siena, Italy; 9University of Turin, Department of Oncology, Turin, Italy; 10Rigshospitalet, Radiation Medicine Research Center, Copenhagen, Denmark; 11Odette Cancer Center of the Sunnybrook Health Sciences Center, Department of Radiation Oncology, Toronto, Canada; 12Princess Margaret Cancer Centre, Radiation Medicine Program, Toronto, Canada; 13IRCCS Sacro Cuore Don Calabria Hospital, Advanced Radiation Oncology Department Cancer Care Center, Negrar, Italy; 14University of Brescia, Advanced Radiation Oncology Department, Brescia, Italy

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Purpose or Objective

The role of stereotactic body radiotherapy (SBRT) for the treatment of spinal metastases is gaining in relevance as more effective systemic therapy leads to improved overall survival (OS) in selected patients with metastatic cancer. For an increasing number of patients, this shifts the goal of spinal radiotherapy from short-term palliation to long-term symptom and tumor control. As preparation for an evidence-based ESTRO guideline, we conducted a systematic review of the literature concerning SBRT for spine metastases.

Material and Methods

Pubmed, Embase and Cochrane databases were interrogated and PRISMA methodology was used. Extracted data included local metastasis control, survival outcomes, pain relief, vertebral compression fracture (VCF) rates and adverse events incidence. Re-irradiation was excluded.


Initial screening identified 1417 potential references, of which 72 studies were included in the systematic review. Sixty were retrospective and 12 prospective (n=12). Evaluated patients had a median Karnofsky performance status of 90 (range, 70-100) and oligometastatic disease in a median proportion of 40% (20-100%). The most frequent primary histologies were breast cancer, non-small cell lung cancer and renal cell cancer in 48, 46 and 39 studies, respectively. Spine SBRT was delivered using VMAT technique in 47% of the studies and Cyberknife in 18%. Daily image guided was performed in all studies (mainly CBCT in 61% of cases, ExacTrac in 10%, kV imaging in 12.5%). A median total dose of 24 Gy (18-42 Gy) was delivered in a median of 2 fractions (1-5 fractions), with a median dose per fraction of 12 Gy (6-20 Gy).

With a median follow-up of 14.2 months (7-80.4 months), median local control rates after SBRT were 85% (67-100%) and 78.5% (66.2-100%) at 1- and 2-years, respectively, while 1- and 2-years OS rates were 71% (23-100%) and 58% (23-89.9%), respectively. Median overall and complete pain response rate were 87% and 51%, respectively. Pain flare was reported in 0-30% of the patients and the median incidence of VCF was 4.4% (0-34.4%). Radiation induced myelopathy was reported in 3 studies with rates ranging between 1.9% and 2.6%; in 54 out of 72 studies no myelopathy was observed.


The currently available literature indicates that in appropriately selected patients, SBRT for spinal metastases is associated with excellent pain response and local tumor control rates, with a low risk of severe adverse events.