Do you routinely offer spine SBRT for vertebral metastases regardless of overall patient disease burden or response?

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 continu...

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 thei...