Discussion
pain
SPINAL METASTASES, COMPLICATIONS
This trial investigates same-day SBRT and surgery in patients with symptomatic spinal metastases to achieve faster improvement of mobility, earlier pain relief, and faster continuation of systemic oncological therapy, compared to the standard of care, which is surgery followed by radiotherapy (either cRT or SBRT). Same-day treatment may significantly decrease the burden for the patients which may be substantial considering the often limited life expectancy of these patients. In addition, same-day treatment may overcome limitations related to the standard of care, such as an increased risk of wound complications when radiotherapy is delivered too early. Furthermore, metallic spinal implants may cause imaging artifacts and may limit the dose behind the implants [A systematic review reported mixed findings on the association between preoperative radiotherapy and wound complications [We will use the TwiCs design as it has several advantages over the conventional RCT design. One of the shortcomings of the conventional RCT design when investigating this research question is that blinding is not possible and patients know whether they receive the intervention or not [In the UMC Utrecht, three trials in the oncological setting using the TwiCs design were successfully completed [We expect that this trial will eventually result in change of current clinical practices and evidence-based treatment recommendations for spine oncology.