24 Gy in Two Daily Spine SBRT Fractions as Developed by the Sunnybrook Health Sciences Centre

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Abstract
Approximately 40% of cancer patients will develop spinal metastases (1), which can present with axial pain, vertebral compression fracture (VCF), and radiculopathy, with 5 to 10% having extra osseous extension in the form of epidural disease. The latter is critical, given that progression to metastatic epidural spinal cord compression (MESCC) can lead to a significant impairment in quality of life resulting from severe pain and devastating neurologic deficits (2). Moreover, patients may require surgical intervention (3), which has its own consequences with respect to morbidity, mortality, and delays in subsequent oncologic care.