Summary of Recommendations

Document Overview

Design and created by Guideline Central in participation with the European Society for Radiotherapy and Oncology and International Stereotactic Radiosurgery Society.

Re-Irradiation of Spinal Metastases with Stereotactic Body Radiotherapy

European Society for Radiotherapy and Oncology

International Stereotactic Radiosurgery Society

Publication Date: Dec 2, 2025

Page Last Updated: May 5, 2026

Levels of evidence and grades of recommendation

Levels of evidence	Description
I	Evidence from at least one large randomised, controlled trial of good methodological quality (low potential for bias) or meta-analyses of well-conducted randomised trials without heterogeneity
II	Small randomised trials or large randomised trials with a suspicion of bias (lower methodological quality) or meta-analyses of such trials or of trials demonstrated heterogeneity
III	Prospective cohort studies
IV	Retrospective cohort studies or case-control studies
V	Studies without control group, case reports, expert opinions
Grades of recommendation	Description
A	Strong evidence for efficacy with a substantial clinical benefit, strongly recommended
B	Strong or moderate evidence for efficacy but with a limited clinical benefit, generally recommended
C	Insufficient evidence for efficacy or benefit does not outweigh the risk or the disadvantages (adverse events, costs, etc.), optional
D	Moderate evidence against efficacy or for adverse outcome, generally not recommended
E	Strong evidence against efficacy or for adverse outcome, never recommended

Document Overview

Document Title: Re-Irradiation of Spinal Metastases with Stereotactic Body Radiotherapy

Authoring Societies

European Society for Radiotherapy and Oncology

International Stereotactic Radiosurgery Society

Document Publication Date: Dec 2, 2025

Page Last Reviewed/Updated: May 5, 2026

Document Type: Consensus Statement

Country of Publication: Global

Full Text Freely Available: Yes

Full Text Guideline: www.thegreenjournal.com/article/S0167-8140(25)05308-3/fulltext

Source Citation: Alongi F, Cuccia F, Kotecha R, Campione M, Louie AV, Ma L, Minniti G, Tree AC, Dahele M, Lo S, Af Rosenschold PM, Suh JH, Niyazi M, Sheehan J, Guckenberger M, Sahgal A. 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. Radiother Oncol. 2026 Jan;214:111304. doi: 10.1016/j.radonc.2025.111304. Epub 2025 Dec 2. PMID: 41344516.

Document Scope, Criteria, and Use Cases

Document Objectives: 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. 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.

Scope: Management

Diseases/Conditions (MeSH)

D016634 - Radiosurgery

D000069475 - Re-Irradiation

D016634 - Radiosurgery

D000069475 - Re-Irradiation

Keywords: External beam radiotherapy, Re-irradiation, Spinal metastases, Stereotactic body radiotherapy, Stereotactic radiosurgery, radiosurgery

Inclusion Criteria: Male, Female, Adult, Older Adult

Health Care Settings: Hospital, Operating and Recovery Room, Outpatient, Radiology Services

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

PICO Questions

Is SBRT re-irradiation effective in pain control for painful vertebral metastases?
Is SBRT re-irradiation effective in local control for vertebral metastases?
What is the toxicity profile of spine SBRT re-irradiation?