Spinal SBRT as emerging practice has been shown to be a feasible option in the treatment of spinal metastases in properly selected patients. Nevertheless, no randomized trials comparing SBRT with conventional RT in terms of pain and tumor control are available. Moreover, there is still no consensus for the optimal treatment schedule. Preliminary data indicate local control rates exceeding those obtained with conventional RT.

The ability to deliver ablative doses in the spine also challenges traditional viewpoints on the role of surgery for spinal metastases, and will reshape not only how we select patients for surgery, but what surgery should be performed.

Although, compared to surgery and to other local approaches, including, radiofrequency ablation, cryosurgery etc, the non-invasiveness of SBRT represents a really attracting feature in the panorama of local treatment options, prospective studies with standardized outcome measures to make accurate conclusions, and ultimately, randomized studies to prove superiority of SBRT to other local options are required.

In summary although only retrospective and some phase I–II studies are available, SBRT seems to be a promising technique for isolated or few spinal metastases. In particular, it should be probably considered as a standard approach in some clinical situations, such as re-treatments, or when a more “curative” dose would be delivered, such as in patients with a long life expectancy and/or in oligometastatic settings. Ongoing prospective studies will definitively establish its role in the treatment of spinal metastases.