Radiotherapy of spinal metastases

Background. Radiotherapy plays a pivotal role in interdisciplinary management of spinal metastases. Objective. This article provides an overview of the clinical use of radiotherapy in treatment of spinal metastases. Materials and methods. Technical standards and innovations are discussed based on contemporary knowledge. The current evidence on radiotherapy of spinal metastases is reviewed. Results and conclusion. Radiotherapy of spinal metastases is highly effective in providing local tumor control, symptomatic palliation, and prophylactic effects. Radiotherapy is performed after surgical stabilization or without surgery. It is routinely realized by linear accelerators following three-dimensional CT-based planning. Acute toxicity is low. Regarding ideal fractionation concepts, moderate hypofractionation offers the best balance between burden and goals of treatment. Technical innovations such as stereotactic radiosurgery (SRS) enable highly conformal dose escalation as part of curative tumor-ablative treatment approaches.