Radiation Therapy Alone Versus Radiation Therapy Plus Radiofrequency Ablation (RFA)/Vertebral Augmentation

Inclusion Criteria:

* The patient must have localized spine metastasis from the T5 to L5 levels by an imaging study (bone scan, PET, CT, or MRI). Patients can have other visceral metastasis, and radioresistant tumors (including soft tissue sarcomas, melanomas, and renal cell carcinomas) are eligible.
* Zubrod Performance Status 0-3
* History/physical examination within 2 weeks prior to registration
* Negative serum pregnancy test within 2 weeks prior to registration for women of childbearing potential; Women of childbearing potential and male participants who are sexually active must agree to use a medically effective means of birth control;
* MRI (contrast is not required but strongly recommended) of the involved spine within 6 weeks prior to registration to determine the extent of the spine involvement;
* Numerical Rating Pain Scale within 1 week prior to registration; the patient must have a score on the Scale of ≥ 5 for at least one of the planned sites for intervention. Documentation of the patient's initial pain score is required. Patients taking medication for pain at the time of registration are eligible.
* Patients with epidural compression are eligible provided that there is a ≥ 3 mm gap between the spinal cord and the edge of the epidural lesion.
* Patients must provide study specific informed consent prior to study entry.

Exclusion Criteria:

* Histologies of myeloma, lymphoma, small-cell lung cancer, germ-cell tumor
* Non-ambulatory patients;
* Frank spinal cord compression or displacement or epidural compression within 3 mm of the spinal cord;
* Patients with rapid neurologic decline;
* Bony retropulsion causing neurologic abnormality;
* Prior radiation to the index spine
* Patients requiring immediate neurosurgical intervention
* Patients receiving concurrent chemotherapy
* Patients needing palliative to more than 2 sites of spinal disease in total