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

At a Glance

Category	Detail
Condition	Spinal metastases in adults aged 70 years or older
Key Mechanisms	Metastases may cause refractory pain, mechanical instability, or neurologic impairment from epidural compression of the spinal cord or nerve roots.
Target Population	Adults aged 70 years or older treated with stereotactic body radiation therapy (SBRT) for spinal metastases.
Care Setting	Specialist oncology and spine care; the study describes SBRT delivered alone or alongside surgical decompression and stabilization.

Key Highlights

Retrospective analysis of a prospectively maintained, single-center database of patients treated with SBRT for spinal metastases from 2002 to 2024.
The analyzed cohort included 161 patients aged 70 years or older with 208 spinal metastases; 21 patients with 40 metastases lacking baseline radiographic imaging were excluded.
SBRT was delivered alone or alongside surgical decompression and stabilization; treatment selection was individualized according to neurologic findings, epidural involvement, spinal stability, tumor histology, systemic disease burden, and treatment history.
The study sought to characterize outcomes by chronologic age and identify predictors of local failure and vertebral compression fracture.
The supplied article excerpt does not report study results.

Guideline-Based Recommendations

Diagnosis

Study methods included radiographic assessment of Bilsky grade and Spinal Instability Neoplastic Score (SINS).
MRI was registered with simulation CT for delineation; CT myelography was used when metal artifact obscured neural elements.

Management

SBRT was administered alone or alongside surgical decompression and stabilization, with selection individualized according to clinical and tumor factors.
At treatment, dose constraints followed institutional and published consensus guidelines.

Monitoring & Follow-up

The study reports follow-up at 1 month after SBRT, every 3 months during the first year, and annually thereafter.
Imaging surveillance, preferably spine MRI, was generally advised at 3 months after SBRT; subsequent schedules varied by physician preference.

Risks

The source describes pain, mechanical instability, and neurologic impairment from epidural compression as possible manifestations of spinal metastases.
The source notes concerns about diminished bone quality and elevated vertebral compression fracture risk in older adults.
The source notes heightened perioperative risk among elderly individuals and that comorbidities or diminished performance status can restrict treatment options.

Patient & Prescribing Data

The analyzed cohort comprised 161 patients aged 70 years or older with 208 spinal metastases; 21 patients with 40 metastases lacking baseline radiographic imaging were excluded.

SBRT was delivered using CyberKnife, Synergy, or TrueBeam systems, alone or alongside surgery. The supplied excerpt does not state the prescription isodose line or planning target volume margin.

Clinical Best Practices

Study treatment selection was individualized according to neurologic findings, epidural involvement, spinal stability, tumor histology, systemic disease burden, and treatment history.
For target delineation, MRI was registered with simulation CT; CT myelography was used when metal artifact obscured neural elements.
The study assessed local failure by comparing pre- and post-SBRT imaging; confirmation on later imaging was required.
The supplied excerpt does not include the study's vertebral compression fracture definition.