Clinical Workflow of Spine Stereotactic Radiotherapy and Radiosurgery: Insights from a Single-Institution Physics...

Spine stereotactic radiotherapy and radiosurgery (SSRS) techniques, encompassing both fractionated stereotactic treatments and single-fraction radiosurgery, are widely used for the management of spinal metastases due to their ability to deliver highly conformal radiation while limiting dose to adjacent critical structures. Clinical outcomes following SSRS, including durable local control and acceptable toxicity, have been reported previously in multiple institutional series. In this manuscript, we describe the clinical workflow used to deliver SSRS at a high-volume academic center, with emphasis on the medical physics processes that support routine clinical practice. Key elements of the workflow include patient selection, treatment region-specific immobilization, CT and MRI-based simulation, treatment planning, patient-specific quality assurance, and image-guided treatment delivery. Rather than presenting new outcome data, this work provides a descriptive overview of how established SSRS techniques are integrated into day-to-day clinical care.