Inclusion Criteria:

- Patients must have histologic proof of a malignancy suitable for radiation therapy.

- Patients must have received prior external beam radiation therapy to the region
proposed for HDR brachytherapy treatment; evaluation of doses previously delivered to
spinal cord/cauda equina and other critical structures (bowel, kidneys, rectum) will
be taken into consideration.

- If repeat irradiation would exceed any normal tissue constraint set by MSKCC
Radiation Oncology Department dose constraint criteria, the patient will potentially
be eligible.

- If the total prior radiation dose to the cord exceeds 100 Gy in 2 Gy BED equivalents,
the patient will be potentially eligible, where a total of 100 Gy in 2 Gy equivalents
is determined by the biological equivalent dose (BED) calculation; BED(2Gy
equivalents) = nd(1 + d/α/β), where n = number of fractions and d = dose per
fraction; α/β is the constant for spinal cord late effect and equals 2. [Rades 2005,
Nieder 2005, Sahgal 2012]

- KPS ≥ 60

- Age ≥ 18 years old

Exclusion Criteria:

- Patients who may receive therapeutically effective doses via an external beam
approach to the lesion of interest as specified by MSKCC Radiation Oncology
Department dose constraint criteria.

- Patients with kyphoplasty cement or hardware that would preclude effective catheter
placement.

- Patients with paraspinal extension of disease with visceral involvement.

- Abnormal complete blood count. Any of the following:

- Platelet count < 75,000/ml

- Hb level < 9gm/dl

- WBC < 3.5/ml

- Abnormal coagulation profile: INR > 2.5 and/or PTT > 80

- Patients who are on anticoagulation medication that may not be safely held for the
procedure (≥ 5 days for antiplatelet agents and warfarin; ≥ 24 hours for
low-molecular weight heparin formulations) will be excluded.

- Contraindications to general anesthesia