Table 1.
Approach to Assessment of Suitability for Spine SBRT.
| Factors | Suitable | Cautionary | Unsuitable |
|---|---|---|---|
| Patient | |||
| Performance status | ECOG 0-2 | ECOG ≥3 | |
| Life expectancy | ≥3 months | ||
| Pain | Intractable | ||
| Neurologic | Symptomatic cord compression or cauda equina syndrome | ||
| Oncologic | |||
| Disease burden | Oligometastatic disease | Widespread, rapidly progressive disease | |
| Tumor histology | Histological proof of malignancy | Radiosensitive (eg, myeloma, lymphoma) | |
| Systemic therapy | Systemic therapeutic options available or indolent disease course | ||
| Treatment | |||
| Imaging | ESCC (Bilsky) grade 0-1 | ESCC (Bilsky) grade 2 | ESCC (Bilsky) grade 3 or cauda equina compressions |
| Up to 3 contiguous or noncontiguous levels | >3 contiguous or noncontiguous levels | ||
| Spinal stability | SINS 0-6 | SINS 7-12 | SINS 13-18 |
| Prior radiation | Previous cEBRT to affected level | Previous SBRT to affected level | Previous EBRT to affected level within 90 days or systemic radionuclide within 30 days |
| Positioning | Inability to tolerate near-rigid body immobilization |
Abbreviations: SBRT, stereotactic body radiotherapy; ECOG, Eastern Cooperative Oncology Group; ESCC, epidural spinal cord compression; SINS, Spinal Instability Neoplastic Score; EBRT, external beam radiotherapy; cEBRT, conventional EBRT.