@article{138762d7-b027-46ea-8182-2b37115a4fe6,
  abstract     = {{<p>Background: Stereotactic body radiotherapy (SBRT) is an established treatment for previously unirradiated spinal metastases; however, the literature is limited with respect to SBRT as a re-irradiation salvage therapy. We performed a systematic review and meta-analysis as basis for joint ESTRO-ISRS clinical practice recommendations of salvage SBRT for spinal metastases. Methods: A systematic review and meta-analysis were performed using PRISMA methodology, including publications from January 2006 to September 2024, reporting on the clinical outcomes of ≥ 5 patients treated with spine SBRT re-irradiation (≥5 Gy per fraction) for vertebral metastases. These data served as basis for joint ESTRO-ISRS clinical practice recommendations. Results: After the initial article screen, 20 studies (5 prospective, 15 retrospective) met the inclusion criteria for analysis. A total of 1538 spine metastases were treated in 1284 patients. The median re-irradiation dose was 24 Gy in 2 fractions (range: 16–30 Gy in 1–5 fractions) after a median 30 Gy in 10 fractions of prior conventional radiotherapy. Vertebral compression fracture, nerve root damage, and myelopathy events were observed in a pooled proportion of 5.0 %, 5.6 %, and 1.7 %, respectively. With a median follow-up of 12 months, the pooled 1- and 2-year LC rates were 81 % (95 % CI: 77–86 %) and 70 % (95 % CI: 61–79 %), respectively. Despite the low level of evidence, a consensus was reached after the first round of voting for 11 practice recommendations, suggesting a substantial level of agreement among the experts. Conclusions: Re-irradiation with SBRT for spine metastases following prior conventional radiation or SBRT was efficacious, safe, and is a recommended treatment option in appropriately selected patients. Joint practice recommendations are provided on behalf of ESTRO and ISRS to guide clinical practice.</p>}},
  author       = {{Alongi, Filippo and Cuccia, Francesco and Kotecha, Rupesh and Campione, Marina and Louie, Alexander V. and Ma, Lijun and Minniti, Giuseppe and Tree, Alison C. and Dahele, Max and Lo, Simon and af Rosenschold, Per Munck and Suh, John H. and Niyazi, Maximilian and Sheehan, Jason and Guckenberger, Matthias and Sahgal, Arjun}},
  issn         = {{0167-8140}},
  keywords     = {{External beam radiotherapy; Guidelines; Re-irradiation; Spinal metastases; Stereotactic Body Radiotherapy}},
  language     = {{eng}},
  pages        = {{1--11}},
  publisher    = {{Elsevier}},
  series       = {{Radiotherapy and Oncology}},
  title        = {{ESTRO-ISRS clinical practice recommendations for re-irradiation of spinal metastases with Stereotactic Body Radiotherapy : Delphi consensus supported by a systematic review and meta-analysis}},
  url          = {{http://dx.doi.org/10.1016/j.radonc.2025.111304}},
  doi          = {{10.1016/j.radonc.2025.111304}},
  volume       = {{214}},
  year         = {{2026}},
}