Vertebral bodies remain one of the most common sites of
metastases. In cases where surgical intervention is not indicated or appropriate, conventional external
radiation therapy (cEBRT) has been the standard treatment modality. Unfortunately, cEBRT is typically limited, with low complete response and poor local control rates. Disappointing results with
re-irradiation using cEBRT highlight the need for innovative salvage therapeutic strategies, such as stereotactic body radiotherapy. A detailed description of this complex treatment strategy is outlined, as is a systematic review of current literature. Although data are limited to single institution series,
re-irradiation has consistently been found to be effective with respect to local control (1 year rates range from 66 to 90%) and
pain response. Importantly, the treatment is shown to be safe, with the crude rate of radiation
myelopathy <1% and a rate of vertebral
compression fracture of 12%. As further research and technologic advances continue to refine
therapy, stereotactic body radiotherapy is now a recommended option for the treatment of previously irradiated vertebral body
metastases.