Rafael García

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.

The use of stereotactic body radiation therapy (SBRT) to treat non-spine bone metastases (NSBM) is becoming increasingly common in clinical practice. The clinical advantages of SBRT include good pain control and high local control rates, although only limited data are available. The Spanish Society of Radiation Oncology (SEOR) SBRT group recently convened a task force of experts in the field to address key questions related to SBRT for NSBM, including treatment indications, planning, techniques, and dose fractionation. The task force reviewed the available literature to develop evidence-based recommendations for the safe application of NSBM SBRT and to standardize and optimize SBRT processes. The present document provides a comprehensive analysis of the available data, including ongoing clinical trials and controversies, providing clinically applicable recommendations.