Practical Guidelines for Spinal SBRT Post-Treatment Follow-Up: Empirical Consensus from Quebec Oncology Centers.
[PURPOSE] Spinal stereotactic body radiotherapy (SBRT) provides durable local control for metastatic spine disease but creates new demands on post-treatment surveillance, particularly in healthcare sy
APA
Fabi F, Gaudreault M, et al. (2026). Practical Guidelines for Spinal SBRT Post-Treatment Follow-Up: Empirical Consensus from Quebec Oncology Centers.. Practical radiation oncology. https://doi.org/10.1016/j.prro.2026.03.011
MLA
Fabi F, et al.. "Practical Guidelines for Spinal SBRT Post-Treatment Follow-Up: Empirical Consensus from Quebec Oncology Centers.." Practical radiation oncology, 2026.
PMID
42009281
Abstract
[PURPOSE] Spinal stereotactic body radiotherapy (SBRT) provides durable local control for metastatic spine disease but creates new demands on post-treatment surveillance, particularly in healthcare systems where magnetic resonance imaging (MRI) access is limited. Existing guidelines recommend calendar-based imaging that is challenging to implement in resource-constrained environments. We aimed to develop practical, risk-stratified follow-up guidelines for post-SBRT surveillance, grounded in real-world feasibility across province-wide oncology centres.
[METHODS] Seven radiation oncologists from four SBRT-providing centers (three tertiary academic, one regional) participated in a structured modified Nominal Group Technique. Panelists reviewed literature on imaging surveillance, contributed center-specific considerations, and iteratively refined recommendations. Nineteen candidate statements across four items were generated. Consensus thresholds were predefined as ≥80% ("strong"), 60-79% ("moderate"), and <60% ("no consensus").
[RESULTS] In Round 1, 11/19 statements achieved strong consensus, 5 moderate, and 3 failed to meet threshold. Following structured adjudication, wording refinement, and one item removal, all remaining 18 statements achieved strong consensus in Round 2. Key themes included: (1) anchoring imaging intensity to actionable clinical intent; (2) prioritizing early post-SBRT MRI only when salvage therapy is feasible; (3) de-escalating surveillance in low-risk or systemically progressing patients; (4) tailoring modality selection to resource availability; and (5) integrating tumor-specific considerations, including prostate cancer-specific pathways. The resulting framework replaces rigid schedules with risk-adapted intervals, emphasizes clinical triggers and feasibility, and promotes thoughtful resource use.
[CONCLUSION] These consensus-derived guidelines present a pragmatic surveillance strategy for spine SBRT, calibrated to the realities of MRI access and clinical workflows. By embracing risk-adapted imaging, the framework reduces unnecessary investigations, preserves resources, and focuses surveillance where it is most likely to influence clinical outcomes. While rooted in the local context, the recommendations are broadly applicable to settings facing similar constraints. Prospective validation is warranted to evaluate oncologic and patient-reported outcomes under this de-escalated, resource-conscious model.
[METHODS] Seven radiation oncologists from four SBRT-providing centers (three tertiary academic, one regional) participated in a structured modified Nominal Group Technique. Panelists reviewed literature on imaging surveillance, contributed center-specific considerations, and iteratively refined recommendations. Nineteen candidate statements across four items were generated. Consensus thresholds were predefined as ≥80% ("strong"), 60-79% ("moderate"), and <60% ("no consensus").
[RESULTS] In Round 1, 11/19 statements achieved strong consensus, 5 moderate, and 3 failed to meet threshold. Following structured adjudication, wording refinement, and one item removal, all remaining 18 statements achieved strong consensus in Round 2. Key themes included: (1) anchoring imaging intensity to actionable clinical intent; (2) prioritizing early post-SBRT MRI only when salvage therapy is feasible; (3) de-escalating surveillance in low-risk or systemically progressing patients; (4) tailoring modality selection to resource availability; and (5) integrating tumor-specific considerations, including prostate cancer-specific pathways. The resulting framework replaces rigid schedules with risk-adapted intervals, emphasizes clinical triggers and feasibility, and promotes thoughtful resource use.
[CONCLUSION] These consensus-derived guidelines present a pragmatic surveillance strategy for spine SBRT, calibrated to the realities of MRI access and clinical workflows. By embracing risk-adapted imaging, the framework reduces unnecessary investigations, preserves resources, and focuses surveillance where it is most likely to influence clinical outcomes. While rooted in the local context, the recommendations are broadly applicable to settings facing similar constraints. Prospective validation is warranted to evaluate oncologic and patient-reported outcomes under this de-escalated, resource-conscious model.