Stereotactic Body Radiotherapy for Older Adults With Spinal Metastases

By
Brock J. Gjesdal
Samuel Adida
Suchet Taori
Andrew H. Zureick
Serah Choi
John C. Flickinger
Pascal O. Zinn
James C. Bayley
Peter C. Gerszten
Roberta K. Sefcik
October 16, 2026

Journal Of Neuro-Oncology

Overview

This retrospective study examined stereotactic body radiotherapy (SBRT) outcomes in adults aged 70 years or older with spinal metastases. The supplied article excerpt describes the study cohort and treatment methods but does not provide outcome results, so rates of local failure, vertebral compression fracture, or other clinical outcomes cannot be reported.

Background

Spinal metastases can cause refractory pain, mechanical instability, and neurologic impairment from epidural compression. Treatment selection considers neurologic status, tumor histology and radiosensitivity, spinal stability, systemic disease burden, performance status, and anticipated survival. Older adults may face increased perioperative risk and limitations on systemic treatment, while concerns about bone quality and vertebral compression fracture may influence radiotherapy selection. The article notes that older adults have been underrepresented in randomized trials and that evidence specific to spine SBRT in this population is limited.

Data Highlights

Study characteristic	Reported data
Design and setting	Retrospective analysis of a prospectively maintained database at the University of Pittsburgh Medical Center; treatments delivered from 2002 to 2024
Database population	600 patients with 936 spinal metastases
Patients aged 70 years or older	182 patients with 248 metastases
Final study cohort	161 patients with 208 metastases, after excluding 21 patients with 40 metastases lacking baseline radiographic imaging
Treatment	SBRT alone or alongside surgical decompression and stabilization; selection was individualized
Outcomes of interest	Local failure and vertebral compression fracture predictors; outcome results are not included in the supplied excerpt

Key Findings

The study defined older adults as patients aged 70 years or older at treatment.
The final cohort comprised 161 patients and 208 spinal metastases after exclusion of cases without baseline radiographic imaging.
SBRT was delivered using CyberKnife, Synergy, or TrueBeam systems, with image guidance and immobilization approaches varying across treatment eras.
Treatment could be SBRT alone or combined with surgical decompression and stabilization; selection considered neurologic findings, epidural involvement, spinal stability, histology, systemic disease burden, and prior treatment.
Radiographic assessment included Bilsky grade and Spinal Instability Neoplastic Score; the study classified melanoma, sarcoma, thyroid, renal cell, and gastrointestinal carcinomas as radioresistant histologies.
The supplied excerpt states that the study aimed to assess outcomes by chronologic age and identify predictors of local failure and vertebral compression fracture, but it does not report those results.

Clinical Implications

The excerpt describes individualized treatment selection and the use of spinal cord or cauda equina constraints during SBRT planning, but it does not provide outcome data sufficient to characterize efficacy or safety in this cohort. It therefore does not support conclusions about comparative treatment benefit or specific clinical recommendations for older adults.

Conclusion

The article excerpt establishes the design, cohort, and treatment approach of a study of spine SBRT in adults aged 70 years or older. Its principal outcome findings are not present in the supplied material and cannot be summarized.