Stereotactic Body Radiotherapy Followed by Surgical Stabilization in Spinal Metastases

Inclusion Criteria: * Participation in PRESENT cohort * Painful radiosensitive metastases from solid tumors in the cervical, thoracic or lumbar spine needing surgical stabilization * Histologic proof of malignancy or radiographic/clinical characteristics indicating malignancy beyond reasonable doubt * Radiographic evidence of spinal metastases * Fit for (radio)surgery * Age \> 18 years at the time of given informed consent in the PRESENT cohort. * Written informed consent Exclusion Criteria: * SBRT cannot be delivered, e.g. in patients who cannot lie on the treatment table because of pain * Surgery cannot be performed, e.g. in patients with multiple spinal metastases that cannot be bridged * Previous surgery or radiotherapy to index lesion * Neurological deficits (ASIA C, B or A) * Partial neurological deficits (ASIA D) with rapid progression (hours to days) * Non-ambulatory patients * Patient in hospice or with \< 3 months life expectancy * Medically inoperable or patient refused surgery * Radiosensitizing systemic treatment that cannot reasonably be stopped (for example immunotherapy and EGFR inhibitors)