Rapid access SABR spine pathway

The launch of the new GenesisCare Rapid Access Spine SABR Pathway provides a new treatment pathway to ensure patients with symptomatic vertebral metastases can access the optimal palliative radiotherapy treatment technique in as little as 7 days from referral.

Vertebral metastases are common amongst many different tumour types. They are often symptomatic, and poorly controlled pain can be significantly detrimental to a patient’s quality of life. Local tumour control and optimal pain relief are particularly important in an era where patients with metastatic disease have improved prognosis due to the availability of an increasing number of effective systemic therapy options.

Palliative radiotherapy for painful vertebral metastases has, for many years, been delivered with simple radiotherapy techniques and a low overall dose. SABR delivers higher doses to the tumour using a more precise radiotherapy technique, and treatment-related toxicity is low and predictable.

There is now an increasing body of robust randomised clinical trial evidence showing that stereotactic radiotherapy (SABR) leads to improved pain control compared to conventional palliative radiotherapy. For example, in the phase 2/3 SC.24 trial, patients were randomised to receive SABR (24Gy in 2 fractions) or conventional palliative radiotherapy (20Gy in 5 fractions). There was a significantly improved complete pain response at three months (35 vs 14%, p=0.0002) and six months (32 vs 16%, p=0.004) in the patients who received SABR.

Unfortunately, symptomatic patients have traditionally had to wait significantly longer to start a course of spine SABR compared to a more simple conventional palliative radiotherapy treatment. This has been a barrier to the more widespread use of SABR for the relief of painful bone metastases.

We have therefore developed a Rapid Access Spine SABR Pathway which aims to commence treatment within 7 working days of receipt of the radiotherapy booking form. The eligibility criteria are as follows:

• Metastatic solid malignancy
• ECOG PS 0-2
• Estimated prognosis > 6 months
• Whole body imaging +/- whole spine MRI within 6 weeks
• Spinal Instability Neoplastic Score (SINS)
• No or minimal epidural disease (Bilsky 0-1)
• No previous RT or spinal surgery to site(s) being treated
• Single area of symptomatic spinal disease for treatment (ie single treatment plan needed)
• Maximum 3 consecutive involved vertebrae at site being treated
• * (Patients with SINS < /= 12 can be considered if they have already had a spinal surgery opinion) 
  Exclusion: any patient with true mechanical back pain

The pathway is being rolled out to centres currently offering spine SABR within the GenesisCare network. All these centres have modern machines capable of treating patients with the accuracy needed for safe and effective SABR delivery. In addition, within the network we also have two state-of-the-art linear accelerators in London (Cromwell) and Oxford which can deliver spine SABR with even smaller treatment margins.

How to refer:

Use the standard radiotherapy referral process either by Horizon portal or paper radiotherapy booking form. 

Horizon portal referrals please ensure: 

Select Category 3 within the RCR Treatment Delay Priority section  

Select Emergency in the priority section.  

Paper referrals please ensure: 

All information including the minimum dataset is provided stating, ‘Category 3’ and ‘Emergency’ on the booking form.

Your local GenesisCare Centre Leader can provide a list of Oncologists who offer spine SABR at your centre.  GenesisCare also has a spinal SABR credentialing programme for Clinical Oncologists who are keen to treat their own patients with spine SABR, but who do not yet have any experience in the NHS or private sector.