At what field size would you consider splitting a palliative spine treatment into two different courses?

I usually don’t treat radiograph only. I usually ask for a detailed pain history and limit the size of RT to correlate with the pain and target MRI areas that are problematic (epidural, impending cord or fracture). I usually limit the sections if pt complains of pain involving many regions regions (entire L spine, c spine and will split ½ T spine). Usually if pt needs RT to more than this I give 8 Gy in single fraction but will stage the fields. If the patient has diffuse disease, requiring significantly large fields, the patient may benefit more from hospice rather than local therapy.

The goal of RT is for palliation of symptoms, areas of pain rather than treating the radiograph. I don’t necessarily include one vertebral body above and b...