What is your preferred fractionation scheme for spine SBRT for radioresistant histologies?

As long as it's safe, and I can meet the OAR constraints, I escalate the GTV (but not the entire VB) to 20-24 Gy in 1 fx, 28 Gy in 2 fxs, 30-33 Gy in 3 fxs, 35-40 Gy in 5 fxs. While more work has been published in escalation with single fraction, I find that it's easier to safely escalate those to 4...

I have not changed my doses based on "radioresistance" as this is a bit of a nebulous concept with heterogeneity intra/inter-patient.

I have typically done 27 Gy in 3 fractions or 24 Gy in 2 fractions.

I am not aware of any evidence showing different outcomes based on the scheme. I typically lean ...

Agree with prior comments that higher-level evidence is needed.

Based on data suggesting worse tumor control as well as higher rates of re-irradiation with radioresistant histologies, we tend to escalate to 28 Gy/2, 30-33 Gy/3, or 40 Gy/5, in line with HyTEC data, to achieve 85-90% probability of dis...