## 4 Discussion
Therefore, this study evidences a benefit in the antalgic response with SBRT in 2 fractions up to a total of 24 Gy, less local failure, and less need for re-irradiation in favor of SBRT [27]. These findings encourage us to indicate SBRT in oligometastatic spinal lesions, such as those in our series. A recent study by [PERSON] and colleagues demonstrated that while SBRT is an excellent treatment method for LC in patients with spinal metastases, the risk of vertebral body fracture (VBF) remains significant. In their series, the 12% VBF rate one year after SBRT aligns with previous publications reporting VBF rates ranging from 11% to 39%. Notably,their study stands out as the largest investigation to date that explored the role of antiresorptive drugs in mitigating VBF frequency after SBRT. Their data indicate that patients who received antiresorptive medication before SBRT had a significantly lower incidence of VBF at 1 year and 2 years post-treatment compared to those not taking antiresorptive drugs. Remarkably, the cumulative incidence of VBF remained at 4% among patients who initiated antiresorptive medication before SBRT, a notably lower rate than that historical data would predict. These findings suggest that antiresorptive drugs may serve as a noninvasive and low-risk preventive solution to reduce the risk of VBF following spinal SBRT [28]. Furthermore, in the study conducted by [PERSON] et al., local tumor control (LC) at 1 year and 2 years was reported as 83% and 71%, respectively. The median overall survival (OS) was 30.6 months. Specifically, OS rates at 1 year and 2 years were 88% and 59%, respectively. Univariate analysis revealed that worse outcomes were associated with the presence of visceral metastases (\(p=0.001\)), uncontrolled primary disease (\(p=0.02\)), and having more than three vertebral metastases (\(p=0.04\)). In the multivariate analysis of OS, only the presence of visceral metastases remained statistically significant (\(p=0.002\)) [28]. In our study, we did not administer antiresorptive drugs, but it is something that should be recommend in present and future clinical practice. [PERSON] et al. also found, in their randomized study, that SBRT has a faster and better pain response than cEBRT [29]. We cannot compare the results of our series with cEBRT, but acute form pain relief at 1-3 months was very statistically significant. The planned phase 3 component of RTOG 0631 analyzes pain relief at 3 months without finding superiority of cEBRT for its primary endpoint of patient-reported pain response at 3 months, and there were no spinal cord complications at 2 years after cEBRT. This finding may serve as a basis for future research on the use of spinal radiosurgery in the setting of oligometastases, where durability of cancer control is essential [30]. Nevertheless, we advocate that pain relief could be more rapid with SBRT, but this needs to be demonstrated, and further prospective randomized studies are necessary. [PERSON] et al. also demonstrated that a dose of 24 Gy in 2 daily fractions is superior to cEBRT to a dose of 20 Gy in 5 daily fractions with a better complete response rate for pain. More awareness of specialized multidisciplinary involvement is needed for palliative patients and their end-of-life care [31]. Pain relief--by administering few sessions and even in a single day--is very convenient for patients, and that is why we have chosen this treatment with SBRT in our patients. On the other hand, [PERSON] et al. found that single fraction SBRT is better for LC than multi-fraction SBRT in their systematic review and meta-analysis (SAFFRON). However, these results are hypothesis-generating, and prospective randomized clinical trials are needed [32]. Due to the advancements in immunotherapies and systemic targeted treatments, disease control and overall survival have improved significantly.