Conformal High Dose Intensity Modulated Radiation Therapy for Disease to Thoracic and Lumbar Spine

Inclusion Criteria:

- Histological confirmation of malignancy (non-small cell lung cancer, breast cancer
(hormone refractory), prostate cancer (hormone refractory), lymphoma, renal cell
carcinoma, myeloma by either biopsy or cytology of the primary or metastatic lesion.

- Patients must have radiological documentation of metastatic disease to the thoracic or
lumbar spine including both positron emitted tomography (PET) or nuclear medicine bone
scan (NMBS) and Magnetic Resonance Imaging (MRI) within 4 weeks prior to study entry.

- Patients with one to three spinal metastases to the thoracic or lumbar spine will be
included.

- Spinal metastatic lesions should be limited to one vertebral body level or ≤ 6cm in
greatest dimension.

- Tumors should not directly abut the spinal cord, and have at least 5mm separation from
the spinal cord. For patients with tumors closer than 5mm, inclusion is permissible at
the discretion of the treating radiation oncologist such that dosimetric review
demonstrates that the total dose to spinal cord is within tolerable range of <10Gy to
10% partial volume or max point dose 18 Gy.

- Patients must be able to fit into either the Elekta Stereotactic Body Frame or the
Elekta Stereotactic BodyFix immobilization device.

- Must be ≥ 18 years of age.

- ECOG status 0-2.

- Women of childbearing potential and male participants must use an effective
contraception method. (Until at least 60 days following treatment.)

- Negative urine pregnancy test within at least one week before starting treatment in
women of child-bearing age.

- Patients must sign a study-specific informed consent form.

Exclusion Criteria:

- Patients with evidence of spinal instability OR neurologic deficit resulting from bony
compression of neurologic structures.

- Patients with other systemic illness, or have not recovered adequately from their
primary treatment or who have evidence of progression of their current cancer prior to
therapy that, in the investigator's opinion, would preclude their inclusion.

- Patient may not receive concomitant cytotoxic anti-neoplastic therapy during
treatment. Patients may be allowed to use hormonal suppression therapy or
bisphosphonates for hypercalcemia.

- Pregnant or lactating women.

- Any patient with symptoms of pain, compression fracture, neurologic deficit will not
be included.

- Patients previously treated with radiation therapy to the thoracic or lumbar spinal
levels of involved disease will not be included.