While SPINO and other guidelines recommend MRI every 2-3 months after spine radiosurgery, real-world follow-through remains…aspirational. A Québec-based consensus panel of seven radiation oncologists from four cancer centers used formalized consensus methodology to develop a pragmatic, risk-adapted surveillance framework. Lesions were categorized as low-, intermediate-, or high-risk based on epidural disease, SINS score, and paraspinal extension conferring estimated 2-year recurrence rates of 16%, 27%, and 48%, respectively. The resulting recommendations substantially de-escalate imaging for lower-risk patients while preserving intensive surveillance for those most likely both to recur and to benefit from salvage therapy. Most practically, the panel emphasizes that surveillance should only be intensified when retreatment is realistically feasible and clinically actionable. At the same time, dedicated spine imaging likely stops making sense once dominated by other sites of progression. | Fabi, Pract Radiat Oncol 2026
