ABSTRACT
New techniques and technology have opened the way to improve old and achieve new objectives of spinal irradiation. Pain relief and prevention/reduction of morbidities from bone metastases, like neurological deficits or vertebral instability, are still the main goals. In 2011, a survey among radiation oncologists in the United States showed that 39% of the physicians were using stereotactic body radiotherapy (SBRT) for the treatment of spinal tumors. Regarding SBRT alone in patients with metastatic spinal cord compression, these patients are usually excluded from clinical trials, as are patients with high-grade epidural disease. Diagnostic imaging is necessary to determine the precise local tumor extension and the overall disease burden of the spine and the entire body. The importance of high-quality imaging is critical, given the requirement for accurate target and normal tissue delineation and the steep dose gradients between organs at risk such as spinal cord and cauda equina and the target volume.
