Abstract: Objective To assess the effcacy and adverse reactions of tomotherapy in patients with spinal tumor metastasis. Methods Thirtyfve spinal tumor metastasis patients (51 lesions) admitted to our hospital from December 2011 to December 2012 were included in this study and underwent tomotherapy. The target area was outlined into GTV and CTV which received 15-20 times of tomotherapy at the dose of 40-50 Gy and 50-60 Gy. Results Of the 97.14% followed up patients, 31.43% (11/35) had CR, 54.29% (19/35) had PR, and 8.57% (3/35) had MR, with a total response rate of 94.29%(33/35). The tomotherapy began to exert its effect 6.5 times after treatment and its median maintenance time was 7 months. The lesions improved in 17 patients (50%), became stable in 16 patients (47.06%), and deteriorated in 1 patient (2.94%). The median survival time of patients without local progression was 7 months. The main acute side effects were hematologic toxicity, including grade 1 bone marrow depression in 11.43% of the patients, grade 2 bone marrow depression in 25.71% of the patients and grade 3 bone marrow depression in 2.86% of the patients. However, grade 4 bone marrow depression was not observed in any of the patients. Conclusion Tomotherapy can alleviate the pain in spinal tumor metastasis patients with a long maintenance time and less adverse reactions, and is thus a safe and effective treatment modality for spinal tumor metastasis.