ABSTRACT
Surgery and radiation therapy represent the mainstay treatments for spinal metastases. Traditionally, conventionally fractionated low-dose radiotherapy alone has been used for patients with oncologic/ nonmechanical pain with minimal epidural disease. Conventionally fractionated palliative radiotherapy is the primary treatment option for patients with widely metastatic spinal disease that cannot be addressed with surgical resection, patients that are medically un‚t for surgery, and among patients with limited life expectancy. Patients with spinal instability, malignant epidural spinal cord compression (MESCC), and/or mechanical pain resulting from pathologic fracture are generally best addressed with up-front surgery.
