Table 2 Target specific factors influencing indication for spine SBRT
| Â | 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 |