Proton SBRT for Spinal Metastasis

Eligibility Criteria

• 1. Histologic proof or unequivocal cytologic proof of nonhematologic malignancy. This may be obtained from either the primary or any metastatic site.
• 2. Participants must have radiographic evidence of spinal metastasis on MRI.
• 3. Participants must have a complex case that is unable to be effectively treated with photon SBRT, defined as inability to develop a photon SBRT plan that achieves adequate coverage (≥80% PTV coverage) with a prescription dose of 30 Gy in 5 fractions. Such cases include:
• 1. Extensive paraspinal disease
• 2. Reirradiation setting
• 3. Epidural extension (Bilsky grade ≥1c)
• 4. Age ≥ 18 years.
• 5. Eastern Cooperative Oncology Group (ECOG) performance status ≤2 (Karnofsky \>60%).
• 6. Patients of childbearing potential (male or female) must practice adequate contraception due to possible harmful effects of radiation therapy on an unborn child.
• 7. Patients must have the ability to understand and the willingness to sign a written informed consent document.
• 8. All patients must be informed of the investigational nature of this study and must be given written informed consent in accordance with institutional and federal guidelines.
• 1. Participants may not have a spinal metastases case amenable to standard of care photon SBRT planning techniques that achieve ≥80% PTV coverage with a prescription dose of 30 Gy in 5 fractions.
• 2. Patients who are unable to receive MRIs will be excluded from the study since MRIs will be critical in treatment planning.
• 3. Uncontrolled intercurrent illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.