Background and rationale {6a}
cancer, tumor, pain
TUMOR, METASTASIS, SPINAL METASTASES, METASTATIC SPINAL CORD COMPRESSION, CANCER, BONE METASTASES
With improved cancer survival rates, more patients will develop bone metastases, with the spine as the most common site [Radiotherapy is the standard of care for symptomatic spinal metastases and aims to relieve pain and to obtain local control of the tumor. In addition, in case of metastatic spinal cord compression or unstable spinal metastases, surgical stabilization with or without decompression may be required [Stereotactic body radiotherapy (SBRT) enables the delivery of high-dose radiation precisely to the spinal metastasis while keeping the dose to the spinal cord and surrounding tissues, including the surgical area, low [However, performing SBRT post-operatively is challenging. Accurate imaging (i.e., magnetic resonance imaging (MRI) and computed tomography (CT)) is required for the precise delivery of the ablative radiation dose to a spinal metastasis. Metallic spinal implants may cause imaging artifacts, preventing accurate identification of the neural structures to be avoided during radiation, and spinal implants may limit the dose behind implants [By providing radiotherapy followed by surgery within a single hospital stay, patients may experience faster improvement of mobility, earlier pain relief, and faster restart of systemic oncological therapy. The benefits of having both treatments in a single hospital stay are substantial considering the often short life expectancy of these patients.