Eligibility criteria {10}
neurological deficits, malignancy, partial neurological deficits, ASIA
MULTIPLE MYELOMA, SOLID TUMORS, SPINAL METASTASES, SPINAL INSTABILITY
To be eligible, patients must meet the following inclusion criteria: (1) at least 18 years of age, (2) having symptomatic (cervical, thoracic and/or lumbar) spinal metastases from solid tumors and (impending) spinal instability requiring surgical stabilization (with or without decompression) and radiotherapy, (3) histologic proof of malignancy or radiographic/clinical characteristics indicating malignancy beyond reasonable doubt, (4) radiographic evidence of spinal metastases, (5) fit for (radio)surgery, (6) participation in PRESENT cohort, including consent for providing PROMs and randomization into future trials, and (7) written informed consent. Potential patients will be excluded when (1) SBRT cannot be delivered, (2) routine surgical stabilization with or without decompression and/or radiotherapy cannot be performed (e.g., multiple spinal metastases requiring surgical bridging of more than five vertebral levels and/or requiring radiotherapy on more than one location), (3) prior surgery or radiotherapy to the index level(s), (4) multiple myeloma, (5) neurological deficits (American Spinal Injury Association (ASIA) impairment scale grade A, B, or C) or partial neurological deficits (ASIA grade D) with rapid progression (hours to days), (6) current treatment with Bevacizumab and other medication with long half-life that interferes with radiotherapy, (7) life expectancy of less than 3 months, and/or (8) pregnancy.