Laser Interstitial Thermal Ablation and Stereotactic Radiosurgery for Patients With Spine Metastases

Inclusion Criteria: * Age \> 18 years old. (The indication for this technique is controversial in skeletally immature patients.) * Histologic diagnosis of solid malignant tumor (not one of the more radiosensitive histologic subtypes, see Exclusion Criteria), including but not limited to non-small cell lung cancer, breast, prostate, renal cell, melanoma, gastrointestinal, sarcoma, thyroid, head and neck primary, and unknown primary tumors. * Quantification of the degree of epidural spinal cord compression as grade 1C, 2, or 3 by MRI, with and without contrast sequences. Axial T2 sequence is encouraged but not required. * The vertebral body site to be treated must be located from T2 to L1 * No more than 3 contiguous or dis-contiguous vertebral levels involved with metastasis in the spine to be irradiated in a single session or 3 sessions. * Motor strength ≥4 out of 5 in extremity or extremities affected by the level of the spinal cord compression (see section 4 for grading method). * ECOG performance status \<2 or Karnofsky performance status (KPS) \>50 * Life expectancy \>3 months. * Inoperable disease because of patient refusal, neurosurgical evaluation, or any other medical reasons. * Women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) before study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately. * Prior conventional radiation to the same site is allowed as long as there is a greater than 3 months interval. * Signed informed consent. Exclusion Criteria: * Requires open spinal procedure or a percutaneous procedure without the use of image guidance. * Primary tumors of radiosensitive histology (lymphoma, multiple myeloma, small cell carcinoma, germ cell tumors), as conventional radiation is likely to be effective in such cases. * Unable to tolerate general anesthesia and prone position. * Unable to undergo MRI scan of the spine. * Inability to lie flat on a treatment table for \>60 minutes. * Pregnant. (Urine testing must be done no more than 10 days prior to surgery.) * Prior conventional irradiation of the spine site and level to be treated with an interval shorter than 3 months. * Frank cord compression or cord compression from bone components or configuration and acute neurological deficits (defined as motor strength \<4/5 in extremity or extremities affected by the level of the spinal cord compression)