title: Single versus multiple session stereotactic body radiotherapy for spinal metastasis: the risk-benefit ratio.
abstract: Spine stereotactic body radiation therapy represents an important advancement in the management of spinal metastases that allows precise delivery of ablative doses of radiation therapy with excellent local control. Although the technique is being increasingly used in clinical practice, the optimal fractionation schedule remains uncertain. In this perspective paper, we review radiobiologic principles that support the use of multiple- versus single-fraction spine stereotactic body radiation therapy schedules and clinical data supporting the multiple-fraction approach. Specifically, we suggest that there may be a local control benefit of fractionation, while helping to limit the risk of toxicities such as vertebral body fracture, pain flare and radiation myelopathy. We conclude with future directions and the need for future study on this important topic.
authors.affiliation: Department of Radiation Oncology, John Hopkins University, Baltimore, MD, USA.
authors.forename: Kristin J
authors.initials: KJ
authors.lastname: Redmond
authors.affiliation: Department of Radiation Oncology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada.
authors.forename: Arjun
authors.initials: A
authors.lastname: Sahgal
authors.affiliation: Department of Radiation Oncology, Princess Alexandra Hospital, School of Medicine, University of Queensland, Queensland, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Foote
authors.affiliation: Department of Radiation Medicine, North Shore - Long Island Jewish Health System, North Shore University Hospital, Manhasset, NY, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Knisely
authors.affiliation: Department of Neurological Surgery & Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Gerszten
authors.affiliation: Department of Radiation Oncology, Rose Ella Burkhardt Brain Tumor & Neuro-oncology Center, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Samuel T
authors.initials: ST
authors.lastname: Chao
authors.affiliation: Department of Radiation Oncology, Rose Ella Burkhardt Brain Tumor & Neuro-oncology Center, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: John H
authors.initials: JH
authors.lastname: Suh
authors.affiliation: Departments of Neurological Surgery & Pathology, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Sloan
authors.affiliation: Department of Radiation Oncology, Norris Cancer Center & Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Chang
authors.affiliation: Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland, OH, USA.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Machtay
authors.affiliation: Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland, OH, USA.
authors.forename: Simon S
authors.initials: SS
authors.lastname: Lo
mesh_terms: D006801:Humans; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods; D018570:Risk Assessment; D013125:Spinal Neoplasms / Q000150:complications / Q000556:secondary* / Q000601:surgery*; D016896:Treatment Outcome
keywords: hypofractionation; multiple-fraction spine treatment; spine stereotactic body radiation therapy