Cord Dose Escalated Spine Stereotactic Radiosurgery in Treating Patients with Metastatic Spinal Cord Compression

Inclusion Criteria

• Greater than or equal to 18 years old
• Radiographically documented spinal metastasis on spine MRI within 4 weeks of registration
• Proximity of spinal metastasis to spinal cord or cauda equina which precludes achieving a gross tumor volume (GTV) minimum dose (Dmin) of at least 14 gray (Gy) per the principal investigator (PI)
• All patients must be able to receive single fraction SSRS at the site of interest with 0.01 cc of the spinal cord receiving 14-16 Gy and/or 0.01 cc of the cauda equina receiving 18-20 Gy. The goal of treatment is to select the minimal dose to the organ at risk which will achieve a GTV Dmin of 14 Gy at the treating physician’s discretion
• Maximum of 3 contiguous vertebral levels involved with metastasis in the spine to be irradiated in a single session
• All patients must be able to receive a single fraction spine radiosurgery at the designated site of interest to at least a dose of 18 Gy
• All patients must have a vertebral level site of interest from cervical vertebrae 1 (C1) to sacral vertebrae 2 (S2)
• Signed informed consent
• Diagnosis of cancer excluding ultra-radiosensitive histologies
• Motor strength ≥ 4 out of 5 in extremity or extremities affected by the level of cord compression
• Eastern Cooperative Oncology Group (ECOG) ≤ 2

Exclusion Criteria

• Patients with ultra-radiosensitive histologies (lymphoma, multiple myeloma/plasmacytoma)
• Prior history of radiation at the spinal site of interest
• Inability to lie supine comfortably for ≥ 60 minutes
• Progressive neurological deficits due to compression
• Inability of obtain an MRI
• Inability or refusal to undergo an MR simulation
• No eligible for single fraction SSRS for any reason
• Patients who are pregnant