24 Gy in Two Daily Spine SBRT Fractions as Developed by the Sunnybrook Health Sciences Centre

The application of stereotactic body radiotherapy (SBRT) to spinal metastases is now an established treatment option in appropriately selected patients as an alternative to conventional palliative radiation. This chapter details the spine SBRT technique developed by the Sunnybrook Health Sciences Centre (SHSC) of the University of Toronto and summarize the spine SBRT literature specific to the 24 Gy in 2 daily fractions regimen. Spine SBRT is a highly precise radiation therapy technique that delivers high doses of radiation to metastatic spinal lesions while sparing the surrounding organs-at-risk (OARs), the most critical of which are the spinal cord and cauda equina nerve roots. Therefore, near-rigid body immobilization and adequate visualization of the thecal sac and spinal cord are of utmost importance. The toxicity profile of spine SBRT is generally favorable, and acute toxicities are mild.