Stereotactic body radiation therapy (SBRT) practice patterns for spine metastases in Spain: a national survey by the SRS/SBRT SEOR (Spanish Society of Radiation Oncology) Working Group

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Abstract
This study aims to evaluate the clinical practice in the treatment of spine metastases using stereotactic body radiation therapy (SBRT) among members of the SEOR (Spanish Society of Radiation Oncology) SRS/SBRT Working Goup to gather comprehensive data on clinical protocols, equipment usage, and treatment parameters. A 31-question electronic survey via Google Forms platform was distributed to members of the Working Group, with responses collected from 24 Spanish institutions, representing 1 per institution. This study aimed to assess demographic profiles, equipment, treatment protocols, immobilization techniques, dose and fractionation schedules, IGRT practices, and prescription criteria for spine SBRT. Most respondents (64.3%) were radiation oncologists with over 10 years of experience. The predominant equipment used was C-LINAC (85.7%). Most institutions (96.4%) had specific protocols for spine metastases management. The Spine Instability Neoplastic Score (SINS) was used by 85.7% of the surveyed for evaluating vertebral stability. According to the number of contiguous spine metastases treated, 81.5% treated up to two. Guidelines from Cox et al. and ESTRO were followed by 96.4% for intact spine metastases, with 81% adhering to Redmond et al. for adjuvant SBRT. Among the 24 surveyed centers, 32.1% used a single dose, 48.1% 2 fractions, 96.3% 3 fractions, and 74.1% 5 fractions. IGRT systems included CBCT (71.4%), X-ray (10.7%), and CBCT and X-ray (25%). The majority of responders (66.7%) indicated coverage of 95% of the PTV with 95-100% of the prescribed dose. This survey highlights significant variability in equipment, protocols, and practices for spine SBRT among Spanish institutions. Standardization of treatment approaches could enhance consistency and oncologic outcomes in spine SBRT.

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