Dose-Escalated Spine SbRT for Localized Metastasis to the Spinal Column

Inclusion Criteria: * Zubrod Performance Status 0-2 * Localized spine metastasis from a solid tumor from the C1 to L5 levels (a solitary spine metastasis, two separate spine levels, or up to 3 separate sites; each of the separate sites may have a maximal involvement of 2 contiguous vertebral bodies) * Patients with epidural extension are eligible as long as there is a ≥ 2 mm gap between the spinal cord and the edge of the epidural lesion * Paraspinal disease extension is allowed as long as it measures ≤ 5 cm in the greatest dimension and that it is contiguous with the spine metastasis * For patients enrolled in cohort 2, the minimum time to re-irradiation should be 6 months * Numerical Rating Pain Scale (NRPS) score of ≥ 5 at the index site(s) (as rated when the patient is not taking pain medication) Exclusion Criteria: * Radiosensitive histologies (myeloma, lymphoma, germ cell tumors, small cell lung cancer) * Non-ambulatory patients * \>50% loss of vertebral body height or spinal instability to due pathologic compression fracture * Frank spinal cord compression, spinal cord displacement, or epidural extension within 2 mm of the spinal cord * Rapid neurologic decline * Patients for whom an MRI of the spine is medically contraindicated * Pregnant women