Correlation of Computed Tomography Imaging Features With Pain Response in Patients With Spine Metastases After Radiation Therapy

Journal Article · Tue Nov 01 04:00:00 EDT 2011 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2010.06.036· OSTI ID:21590463

Mitera, Gunita ^[1]; Probyn, Linda ^[2]; Ford, Michael ^[3]; Donovan, Andrea; Rubenstein, Joel ^[2]; Finkelstein, Joel ^[3]; Christakis, Monique ^[2]; Zhang, Liying; Campos, Sarah; Culleton, Shaelyn; Nguyen, Janet; Sahgal, Arjun; Barnes, Elizabeth; Tsao, May; Danjoux, Cyril; Holden, Lori ^[1]; Yee, Albert ^[3]; Khan, Luluel; Chow, Edward ^[1]

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1. Rapid Response Radiotherapy Program, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada)
2. Department of Radiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada)
3. Department of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada)

Purpose: To correlate computed tomography (CT) imaging features of spinal metastases with pain relief after radiotherapy (RT). Methods and Materials: Thirty-three patients receiving computed tomography (CT)-simulated RT for spinal metastases in an outpatient palliative RT clinic from January 2007 to October 2008 were retrospectively reviewed. Forty spinal metastases were evaluated. Pain response was rated using the International Bone Metastases Consensus Working Party endpoints. Three musculoskeletal radiologists and two orthopaedic surgeons evaluated CT features, including osseous and soft tissue tumor extent, presence of a pathologic fracture, severity of vertebral height loss, and presence of kyphosis. Results: The mean patient age was 69 years; 24 were men and 9 were women. The mean worst pain score was 7/10, and the mean total daily oral morphine equivalent was 77.3 mg. Treatment doses included 8 Gy in one fraction (22/33), 20 Gy in five fractions (10/33), and 20 Gy in eight fractions (1/33). The CT imaging appearance of spinal metastases included vertebral body involvement (40/40), pedicle involvement (23/40), and lamina involvement (18/40). Soft tissue component (10/40) and nerve root compression (9/40) were less common. Pathologic fractures existed in 11/40 lesions, with resultant vertebral body height loss in 10/40 and kyphosis in 2/40 lesions. At months 1, 2, and 3 after RT, 18%, 69%, and 70% of patients experienced pain relief. Pain response was observed with various CT imaging features. Conclusions: Pain response after RT did not differ in patients with and without pathologic fracture, kyphosis, or any other CT features related to extent of tumor involvement. All patients with painful spinal metastases may benefit from palliative RT.

• OSTI ID: 21590463
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 3 Vol. 81; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ALKALOIDS
ANALGESICS
BODY
CENTRAL NERVOUS SYSTEM AGENTS
CENTRAL NERVOUS SYSTEM DEPRESSANTS
COMPUTERIZED TOMOGRAPHY
DIAGNOSTIC TECHNIQUES
DISEASES
DOSES
DRUGS
FAILURES
FRACTURES
MEDICINE
METASTASES
MORPHINE
NARCOTICS
NEOPLASMS
NUCLEAR MEDICINE
OPIUM
ORGANIC COMPOUNDS
ORGANS
PAIN
RADIATION DOSES
RADIOLOGY
RADIOTHERAPY
SIMULATION
SKELETON
SYMPTOMS
THERAPY
TOMOGRAPHY
VERTEBRAE