Figure 1
Figure 2
Figure 3
![(A) Representative images for Patient 7a showing at L1 with reduction in dynamic contrast enhanced (DCE) parameters [i] time-dependent leakage (Ktrans); [ii] permeability surface product (PS); [iii] fractional plasma volume (Vp); [iv] extracellular volume (Ve); and [v] perfusion (F) across the 3 time points.](https://sciendo-parsed.s3.eu-central-1.amazonaws.com/647356604e662f30ba53ab53/j_raon-2022-0046_fig_003.jpg?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Content-Sha256=UNSIGNED-PAYLOAD&X-Amz-Credential=AKIA6AP2G7AKOUXAVR44%2F20251105%2Feu-central-1%2Fs3%2Faws4_request&X-Amz-Date=20251105T221558Z&X-Amz-Expires=3600&X-Amz-Signature=0977118bd52212e2c45e1038850e803837041f9ec03e0a885186ea35a19ab428&X-Amz-SignedHeaders=host&x-amz-checksum-mode=ENABLED&x-id=GetObject)
Figure 3
![(B) [i] Metastatic deposit in L1 vertebral body (yellow arrow), as shown on T1 Axial MR (with gadolinium contrast); [ii] stereotactic body radiotherapy (SBRT) planning image (CT, MRI fused). SBRT 27 Gy in 3 fractions, delivered using volumetric modulated arc therapy. Clinical target volume (CTV) (blue outline), planning organ at risk volume (PRV)_cord (red outline), 95% isodose (orange colourwash).](https://sciendo-parsed.s3.eu-central-1.amazonaws.com/647356604e662f30ba53ab53/j_raon-2022-0046_fig_004.jpg?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Content-Sha256=UNSIGNED-PAYLOAD&X-Amz-Credential=AKIA6AP2G7AKOUXAVR44%2F20251105%2Feu-central-1%2Fs3%2Faws4_request&X-Amz-Date=20251105T221558Z&X-Amz-Expires=3600&X-Amz-Signature=ef5387ce72ba1429981265c4ed1cc21c95f4217183fe682de516acbcd24f4f20&X-Amz-SignedHeaders=host&x-amz-checksum-mode=ENABLED&x-id=GetObject)
Figure 4
Inclusion and exclusion criteria
| Inclusion criteria | Exclusion criteria | ||
|---|---|---|---|
| 1. | Age ≥ 21 years | 1. | Metastatic haematological and germ cell neoplasms |
| 2. | Proven metastatic disease | 2. | Inability to undergo MRI or receive gadolinium contrast |
| 3. | Life expectancy > 3 months | 3. | Prior radiotherapy to region of interest |
| 4. | Eastern Cooperative Oncology group (ECOG) 0–2 | 4. | Recent immediate surgery surgical to affected intervention spinal levels, or patients requiring |
| 5. | ≤ 3 contiguous vertebral body segments, including para-spinal disease | 5. | Spinal instability score (SINS) > 12 |
| 6. | Able to lie supine for ≥ 60 minutes | 6. | Symptomatic cord compression (Bilksy grade 2 or 3), or worsening neurological deficits |
Clinical outcomes
| Patient ID | (Change Post-SBRT from VAS pre- SBRT baseline) | Acute toxicity | Late toxicity | Response at 3 months assessment (MD Anderson criteria) | Follow-up duration (months) | Local recurrence at last follow-up | Status of patient at last follow-up |
|---|---|---|---|---|---|---|---|
| 1 | 0 (-8) | G1 esophagitis | Nil | PR | 39 | No | Dead |
| 2 | 0 (-3) | Nil | Nil | PR | 54 | Yes | Alive |
| 3 | 0 (-5) | Nil | G1 compression fracture | PR | 50 | No | Alive |
| 4 | 0 (-8) | G1 esophagitis | Nil | SD | 15 | No | Dead |
| 5 | 3 (-3) | G1 esophagitis | Nil | PR | 22 | No | Dead |
| 6 | 0 (-3) | Nil | Nil | SD | 13 | No | Dead |
| 7a | 2 (-5) | Nil | G1 compression fracture | PR | 42 | No | Alive |
| 7b | 2 (-5) | Nil | Nil | PR | 42 | No | Alive |
| 8a | - | Nil | N/A | - | N/A | N/A | Dead |
| 8b | - | Nil | N/A | - | N/A | N/A | Dead |
| 8c | - | Nil | N/A | - | N/A | N/A | Dead |
| 9 | 0 | Nil | G3 compression fracture | SD | 37 | No | Alive |
| 10 | 0 (-3) | Nil | Nil | PR | 22 | No | Alive |
Patient characteristics
| Patient ID | Age | Gender | Primary histology | Level of spinal metastases | Extraspinal disease site | Baseline analgesia requirement: opioid/non- opioid/nil | Prior chemotherapy | anti-Prior VEGF therapy | Prior immunotherapy | ECOG | treatment Pre- VAS | SINS | Indication | SBRT | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Dose (Gy) | Fractions | ||||||||||||||
| 1 | 69 | M | RCC | C1 | Lung | Non-opioid | No | No | Yes | 1 | 8 | 6 | Radioresistant histology, pain control | 24 | 3 |
| 2 | 60 | M | RCC | S1 | Nil | Nil | No | No | No | 0 | 3 | 3 | Oligometatasis | 27 | 3 |
| 3 | 60 | M | NSCLC-EGFR - | T5 | Brain, lung bone. | Nil | Yes | No | No | 1 | 5 | 6 | Oligometastasis | 24 | 3 |
| 4 | 62 | F | NSCLC-EGFR - | C5 | Brain, bone nodal, | Opioid | No | No | No | 1 | 8 | 7 | Oligometastasis, pain control | 24 | 2 |
| 5 | 75 | M | adenocarcinoma Prostate | T1 | Bone | Nil | No | No | No | 1 | 6 | 5 | Oligometastasis | 24 | 3 |
| 6 | 62 | M | adenocarcinoma Colon | L1 | LN, lung | Nil | Yes | No | No | 1 | 3 | 9 | Oligometastasis | 27 | 3 |
| 7a | 52 | M | RCC | L1 | Bone | Opioid | No | No | Yes | 1 | 7 | 7 | Radioresistant histology, pain control | 27* | 3* |
| 7b | 52 | M | RCC | L2 | Bone | Opioid | No | No | Yes | 1 | 7 | 7 | Radioresistant histology, pain control | 27* | 3* |
| 8a | 69 | F | NSCLC-EGFR + | T1 | Brain, lung bone. | Non-Opioid | No | No | Yes | 1 | 3 | 5 | Oligometastasis | 24 | 3 |
| 8b | 69 | F | NSCLC-EGFR + | T10 | Brain, lung bone. | Non-Opioid | No | No | Yes | 1 | 3 | 4 | Oligometastasis | 27* | 3* |
| 8c | 69 | F | NSCLC-EGFR + | T12 | Brain, lung bone. | Non-Opioid | No | No | Yes | 1 | 3 | 6 | Oligometastasis | 27 | 3 |
| 9 | 51 | F | ductal Breast carcinoma Invasive | T4 | Nil | Nil | Yes | No | No | 1 | 0 | 2 | Oligometastasis | 27 | 3 |
| 10 | 72 | M | adenocarcinoma Prostate | L3 | Nil | Nil | No | No | No | 2 | 3 | 2 | Oligometastasis | 24 | 2 |