Randomized Trial on Same-day SBRT and Surgical Stabilization for Symptomatic Spinal Metastases

Inclusion Criteria: * Symptomatic (cervical, thoracic and/or lumbar) spinal metastases from solid tumors and (impending) spinal instability requiring radiotherapy and surgical decompression and/or stabilization * Histologic proof of malignancy or radiographic/clinical characteristics indicating malignancy beyond reasonable doubt * Radiographic evidence of spinal metastases * Participation in PRESENT cohort, including consent for randomization into future trials * Fit for (radio)surgery * Age \>18 years * Written informed consent Exclusion Criteria: * SBRT cannot be delivered, e.g. in patients who cannot lie on the treatment table because of pain * Routine surgical decompression and/or stabilization and radiotherapy cannot be performed, e.g., multiple spinal metastases requiring surgical bridging of more than five vertebral levels and/or requiring radiotherapy on more than one location * Prior surgery or radiotherapy to the index level(s) * Multiple myeloma * Neurological deficits (ASIA C, B or A), or partial neurological deficits (ASIA D) with rapid progression (hours to days) * Treated with Bevacizumab and other medication with long half-life that interferes with radiotherapy * Life expectancy of less than 3 months