Spinal radiosurgery

Vertebral metastases are a common and potentially debilitating source of morbidity in cancer patients. While surgery and conventionally fractionated external beam radiation therapy have been established as standard of care for relieving pain and preventing local disease progression, long term outcomes with these techniques alone are lacking. The hypofractionated delivery of ablative radiation doses under careful image guidance and immobilization, known as stereotactic spinal radiosurgery (SSRS), holds significant promise with reported 1-year local control rates of 90% and low long term complication rates. In this chapter, we review the relevant clinical evidence, patient selection criteria, treatment planning and delivery technique, and potential complications of SSRS.