SIB-in on some SRS-urp.

Check out this great review article of the management of spinal cord compression, including roles of surgery and different fractionation schemes. One reason stereotactic radiosurgery (SRS) can be a challenge is lack of space between the target and the spinal cord. A good potential alternative in this scenario is a simultaneous integrated boost (SIB) to the tumor with more broad coverage of the spinal canal. In this series from MDACC, spine metastases not amenable to SRS were prescribed 30 Gy in 10 fractions plus an SIB of 40 Gy to gross tumor with a max dose of 34 Gy to the cord. At 1 year, local control was >90% and nearly 80% reported improvement in pain with no > grade 1 toxicity. TBL: SIB techniques for spinal mets are a good alternative to questionably safe SRS. | Lawton, J Clin Oncol 2018 and Faroogi, Pract Radiat Oncol 2018