The purpose of this study is to test the safety of stereotactic body radiation therapy (SBRT) followed by surgical stabilization within 1 week. All participants will have metastatic cancer in the bone (bone metastases), and they will be at risk of pathologic fracture (broken bone caused by a disease). Another purpose of this study is to see if the treatment approach of SBRT followed by surgical stabilization within 1 week prevents cancer from returning to the bone.

Inclusion Criteria:

• Diagnosis of metastatic cancer with radiologic evidence of skeletal metastases
• Treatment target involving humerus, radius, pelvis, sacrum, femur, or tibial diaphysis
• Age at enrollment ≥18 years
• Life expectancy >3 months
• Ability to tolerate radiation simulation and treatment with immobilization of involved anatomic site
• Surgical candidate, as determined by the treatment team
• Ability to obtain informed consent from patient or legally authorized representative in the setting of patient with impaired decision-making capacity.
• Must agree to practice an effective contraceptive method (for those with reproductive potential)

Exclusion Criteria:

• Prior radiotherapy to the treatment site
• Prior surgery involving the treatment site
• Tumor volume or distribution precluding effective SBRT
• Expected skin dose at the operative site ≥9 Gy
• Imminently impending fracture requiring immediate stabilization surgery
• Involvement of proximal tibia
• Autoimmune connective tissue disorder
• Administration of radiosensitizing medication 3 days before, during, and 3 days after RT
• Active infection
• Absolute neutrophil count <1.0
• Pregnancy

Memorial Sloan Kettering Cancer Center supports the international committee of medical journal editors (ICMJE) and the ethical obligation of responsible sharing of data from clinical trials. The protocol summary, a statistical summary, and informed consent form will be made available on clinicaltrials.gov when required as a condition of Federal awards, other agreements supporting the research and/or as otherwise required. Requests for deidentified individual participant data can be made beginning 12 months after publication and for up to 36 months post publication. Deidentified individual participant data reported in the manuscript will be shared under the terms of a Data Use Agreement and may only be used for approved proposals. Requests may be made to: crdatashare@mskcc.org.