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Table 2 Target specific factors influencing indication for spine SBRT

From: Clinical practice of image-guided spine radiosurgery - results from an international research consortium

  UHW UPMC UofT UVAMC RSMC
Location of vertebral metastases (C, T, L) No relevant factor No relevant factor No relevant factor No relevant factor No relevant factor
Number of vertebras in one target volume Maximum of 3 levels Maximum of 3 levels Maximum of 3 levels Maximum of 3 levels Maximum of 2 levels
Extent of vertebral metastases Symptomatic and progressive cord compression is contraindication. Significant spinal cord compression associated with myelopathy is contraindication. Symptomatic cord compression is contraindication. Symptomatic cord compression is contraindication. Symptomatic cord compression is contraindication.
Epidural involvement No relevant factor No relevant factor Surgery if high grade epidural involvement present Minimum of 2 mm of clearance between the gross metastastic disease and the spinal cord No relevant factor
Stability of metastatic vertebra Surgical opinion sought first Instability is preferably treated with stabilization procedure Surgical opinion sought first Instability is preferably treated with stabilization procedure Instability is preferably treated with stabilization procedure
Lytic or sclerotic metastasis No relevant factor No relevant factor No relevant factor No relevant factor No relevant factor
Vertebral compression fracture Symptomatic compression fracture are discussed with neurosurgeons in advance Compression fracture causing kyphosis and pain will be treated BEFORE radiosurgery if possible Surgical opinion sought first Compression fracture causing marked kyphosis or instability will be treated with stabilization procedure first Compression fracture is preferably treated with stabilization procedure
Location of metastasis relative to other organs at risk No relevant factor No relevant factor No relevant factor No relevant factor No relevant factor