Comparing SingLe- Vs Multi-Fraction Spine STereotActic Radiosurgery in Spinal Metastases

Inclusion Criteria:

   - Histologically, cytologically, or radiographically confirmed diagnosis of metastatic
   cancer Age ≥ 18 years

   - Patients who have cervical, thoracic, or lumbar spine metastasis that need treatment.

   - Patients will have 1 to 3 separate spinal sites that require treatment.

   - Each spinal site to be treated on trial will span 1-2 contiguous vertebral levels

   - ECOG 0-2

   - Negative serum or urine pregnancy test within 14 days prior to enrollment for women of
   childbearing potential or who are not postmenopausal

   - Women of childbearing potential and male participants who are sexually active must
   agree to use a medically effective means of birth control

   - Ability to understand and the willingness to sign (personally or by a legal authorized
   representative) the written IRB approved informed consent document

Exclusion Criteria:

   - Prior or planned radiation off study within or overlapping with study treatment site

   - Inability to have either an MRI or a CT scan. Patients with pacemaker will be allowed
   to undergo CT instead of MRI

   - Pediatric patients (age <18 years old), pregnant women, and nursing patients will be
   excluded

   - Histology's of myeloma or lymphoma

   - Patients with strength 1-3 (of 5), bladder incontinence, bowel incontinence, and/or
   bladder retention that is associated with spinal site to be treated

   - Prior surgery to spinal site intended to be treated with protocol SRS

   - Excluded those with SINS 13-18