Effectiveness of PET-CT as a guide for palliative radiation therapy for spinal metastases

As back pain is the presenting symptoms in 95% of patients with epidural spinal metastases, appropriately identifying and treating the most symptomatic levels can provide significant palliation. The purpose of this study is to analyze the ability of PET-CT to identify spinal metastases with high metabolic activity and guide radiotherapy. We sought to correlate improvement in back pain with reduction in SUV uptake following treatment. We conducted a retrospective review of 72 patients with bony spinal metastases treated with stereotactic ablative radiation therapy at a single center between 2002 and 2014. PET-CT scan imaging was used to calculate SUV values for their spinal metastases and treatment planning was based on PET-CT results. Pre- and post-operative pain level was assessed in all patients. Analyses revealed a reduction in pain scores in 78% of treated patients. A significant reduction in pain was identified in patients with greater than 5 metastases as compared to a fewer number of lesions (p