Do you routinely offer spine SBRT for vertebral metastases regardless of overall patient disease burden or response?
Does the volume of or recent progression of other non-spine disease influence your patient selection? Does the patient's performance status, eligibility for or options of further systemic therapy influence your selection? The question assumes the case is eligible for SBRT based on the disease position relative to the spinal cord.
Answer from: Radiation Oncologist at Community Practice
I presume this will be controversial, but I tend to offer SBRT if feasible for palliation of pain from bone metastases. We have two positive studies (MDACC for non-spine, Canadian for spine) and one negative study. In addition, these are just 1-2 treatments. Billing becomes an issue, as I’ve c...
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Answer from: Radiation Oncologist at Community Practice
For me, the volume of disease and progression affects the decision of whether or not to use SBRT.
For example, if someone is effectively pre-terminal from systemic disease, I'm not going to make them come back for an MRI, and bill them for an SBRT sim, image fusion, etc. Rather, the same day as the...