Recurrence or second cancers regularly require a second (or third) radio-oncological treatment. Fortunately, the amount and quality of clinical data on the outcome and particularly the adverse events of re-irradiation constantly ameliorate [1,2]. Due to improvements in clinical care and therapy, more and more patients are being diagnosed with and living longer with vertebral metastases. Approximately 60–70% of patients with systemic cancer will develop vertebral metastases . Vertebral tumours are important in clinical practice because their presence can significantly affect patient quality of life.