Phase II Trial of Stereotactic Radiation Therapy (SRT) Versus SRT Plus Vertebral Augmentation Procedure (VAP) for Vertebral Metastasis

Inclusion Criteria: 1. Age ≥ 18 years. 2. ECOG performance status 0-1. 3. Known histologically proven malignancy. 4. Localized osteolytic spine metastases from T7 to L5 demonstrated by MRI, CT, PET or bone scan: a solitary spine metastasis; two separate spine levels; or up to 3 separate sites (each site may have a maximal involvement of 2 contiguous vertebral bodies with or without a paraspinal mass of no more than 5 cm). 5. Negative serum pregnancy test within 2 weeks prior to registration for women of childbearing potential. 6. Women of childbearing potential and male participants who are sexually active must agree to use a medically effective means of birth control. 7. Numerical Rating Pain Scale (NRPS) and movement-related pain score(MRPS) within two (2) weeks prior to registration. 8. The patient must have a score of ≥ 5 for at least one of the planned sites for SRT. 9. Patients must provide study specific informed consent prior to study entry. 10. Required Pre-treatment Evaluations: baseline Numerical Rating Pain Scale (NRPS), movement-related pain score, dose and frequency of all pain medications; QOL Measure using the Oswestry Disability Questionnaire, and EuroQOL(EQ-5D). Exclusion Criteria: 1. Non-ambulatory patients. 2. Frank spinal cord compression or epidural compression within 3 mm of the spinal cord. 3. Osteoblastic vertebral metastasis. 4. Prior radiation to the index spine. 5. Patients with rapid neurologic decline.