A critical appraisal of clinical guidelines on radiotherapy treatments for spinal metastasis

This review systematically reviewed the current guidelines related to radiotherapy for spinal metastases, summarized the relevant recommendations, and assessed the quality of their supporting evidence. The guidelines on radiotherapy for spinal metastases were searched by the keyword "guidelines" and "spinal metastasis". The most updated guidelines on radiotherapy for spinal metastasis were selected based on pre-defined inclusion and exclusion criteria. AGREE II was used to evaluate the quality of these guidelines. In addition, the related recommendations were extracted, and their quality was assessed using an evidence-grading scale. Nine guidelines established between 2013 and 2024 were included in this study. Three of the guidelines had an applicability rating of less than 50%. The difference in scores was the largest in rigor of development (range 48.50-88.03%). A total of 44 recommendations based on indications, re-irradiation, radiation dose and regimen, and emergency radiotherapy, were extracted and evaluated for SM. In conclusion, this study summarizes nine guidelines on radiotherapy for SM and provides useful information for improving treatment outcomes in patients with SM. All nine guidelines scored low in terms of adaptability, and most recommendations were based on a moderate-to-high LOE. The timing of re-radiotherapy varies across guidelines and fractionated radiotherapy regimens are available for specific SM patients. SBRT is more suitable than RBRT for patients with oligo-metastases, but more high-quality evidence is needed to confirm the more advantages of SBRT compared with conventional radiotherapy.