ABSTRACT
This chapter focuses on postoperative spine image-guided hypofractionated stereotactic radiation therapy (IG-HSRT) with an emphasis upon treatment considerations and technique, clinical outcomes, and future directions. Furthermore, it gave credence to the concept that aggressive intervention combining surgery and postoperative radiotherapy is able to improve patient outcomes in the appropriate clinical scenario. The existing literature for postoperative spine IG-HSRT is highly variable with regard to dose selection and fractionation making it difficult to offer generalized recommendations. Discerning the balance between dose escalation and minimizing toxicity is critical for optimizing patient outcomes. While the existing literature is promising from a local control, pain control, and toxicity perspective, it remains inadequate at present. The incidence of spinal metastases is anticipated to increase as systemic therapies continue to improve and prolong survival of patients with metastatic disease. Surgery and radiation therapy are the mainstays of treatment for spinal metastases.
