SOaR2 protocols and pathways
The leading advantage of early intervention in spinal metastases is avoidance of the destructive progression of MSCC.
Moreover, early diagnosis and consensus on care can prompt neurological improvement, a return to ambulation, and, for many patients, restoration to working life (BMC Palliative Care, March 2018).
To expedite the diagnosis and treatment of spinal metastases, the SOaR2 program eliminates delays from the outset to abbreviate gaps and delays in the patient journey:
At hospital admission, a SOaR2 team of specialists works together to form a timely consensus on direction of care. If hospital admission can be avoided, it will be avoided.
Effective communication between radiologists and treatment teams is critical to ensure timely treatment.
To address this, the team developed a novel dictation template incorporating spine oncology imaging standardized language and findings. With a common language and automated notification system, spine oncology referrals are prioritized and accelerate where appropriate.
Prompt diagnosis and confirmation is ensured by the SOaR2 program’s combination of same-day outpatient Rapid MRI and dedicated MRI slots expressly for patients requiring evaluation for urgent spinal symptoms.
Rapid MRI involves a series of accelerated imaging techniques that streamline the MRI scanning process to significantly reduce scan times without sacrificing image quality. Patients have access to same-day outpatient appointments.
All patients are assigned a radiology risk score to accelerate decision-making. In addition to accelerating care, rapid MRI reduces clinician emergency burden (the cumulative effects of high-demand, complex emergent care) and ER/hospital resource needs.
A weekly multidisciplinary conference involving specialists in addition to the SOaR2 clinical core team is drawn from a variety of disciplines, including palliative care, thoracic, orthopaedic, and plastic surgery, urology, interventional pain, vascular care, and spinal interventionists. The object of each meeting is to garner recommendations and develop an expert consensus care plan for individual patients.
The multi-disciplinary spine oncology tumor board now evaluates 12-20 patients each week.
Surgery is a fundamental part of the SOaR2 program and seeks to provide timely interventions predicated on innovation to enhance disposition to home for at-risk patients, improve the care path, improve recovery after surgery, and reduce readmissions.
Surgical innovations include a Surgical Rapid Access Clinic (SRAC), the use of carbon fiber instrumentation, separation surgery (a surgical technique used to create a space between MSCCs and the spinal cord), and advanced wound care.
The surgery program also involves risk assessment and prediction tools to abate readmissions, and a post-surgical enhanced recovery path to simplify post-surgical patient care. All innovations are designed to improve and ease the course of therapy.
The SOaR2 team is led by radiation oncologists who specialize in spinal oncology and are experts in the delivery of spine stereotactic body radiotherapy (SBRT). An efficacious treatment for SMs, SBRT targets lesions with ablative doses that spare critical organs at risk, particularly neural tissues.
All participating radiation oncologists undergo a rigorous credentialing process, and the department has advanced treatment infrastructure and a dedicated planning team that is solely focused on spine SBRT. This means that every member is committed to understanding the evolving techniques of surgical and radiotherapeutic management for spinal metastases and is proficient in the development of complex radiation plans, even in the setting of prior radiation.
A weekly multidisciplinary spine oncology clinic is held in conjunction with Neurosurgery to facilitate patient-centered, comprehensive care. On the same day, a dedicated CT/MR simulation slot is available for patients proceeding with spine SBRT to expedite treatment.
Neuroradiology innovations include a recently developed structured spine MRI dictation macro integrating MRI-relevant elements of the Spine Imaging Neoplastic Score and an expanded Epidural Spinal Cord Compression scale into a novel in-house Spine Oncology Imaging Score (SOIS).
When combined with an automated notification system to a specialized SOaR2 spine oncology team, the macro significantly reduced time to consultation and treatment in patients with spinal metastases.
Development of the in-house novel radiology risk score (SOIS) resulted in >3,400 Automated Electronic Notifications of our program’s Spinal Oncology Macro report for spine MRIs since 2021 (American Journal of Neuroradiology, May 2025). These notifications have led to improved time to visits (median 3 days in patients who underwent spine MRI with the SOIS report), accelerated time-to-treatment from diagnostic imaging (median 14 days).
A smooth return to home is ensured via the Penn Medicine at Home Program, which extends hospital-level care to the community setting.
This includes skilled nursing, rehabilitation therapies (physical, occupational, speech), and medical social services, among much else, to improve patient outcomes and promote greater patient independence.