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Title: Vertebral Compression Fracture (VCF) After Spine Stereotactic Body Radiation Therapy (SBRT): Analysis of Predictive Factors

Abstract

Purpose: Vertebral compression fractures (VCFs) are increasingly observed after spine stereotactic body radiation therapy (SBRT). The aim of this study was to determine the risk of VCF after spine SBRT and identify clinical and dosimetric factors predictive for VCF. The analysis incorporated the recently described Spinal Instability Neoplastic Score (SINS) criteria. Methods and Materials: The primary endpoint of this study was the development of a de novo VCF (ie, new endplate fracture or collapse deformity) or fracture progression based on an existing fracture at the site of treatment after SBRT. We retrospectively scored 167 spinal segments in 90 patients treated with spine SBRT according to each of the 6 SINS criteria. We also evaluated the presence of paraspinal extension, prior radiation, various dosimetric parameters including dose per fraction ({>=}20 Gy vs <20 Gy), age, and histology. Results: The median follow-up was 7.4 months. We identified 19 fractures (11%): 12 de novo fractures (63%) and 7 cases of fracture progression (37%). The mean time to fracture after SBRT was 3.3 months (range, 0.5-21.6 months). The 1-year fracture-free probability was 87.3%. Multivariate analysis confirmed that alignment (P=.0003), lytic lesions (P=.007), lung (P=.03) and hepatocellular (P<.0001) primary histologies, and dose per fraction ofmore » 20 Gy or greater (P=.004) were significant predictors of VCF. Conclusions: The presence of kyphotic/scoliotic deformity and the presence of lytic tumor were the only predictive factors of VCF based on the original 6 SINS criteria. We also report that patients with lung and hepatocellular tumors and treatment with SBRT of 20 Gy or greater in a single fraction are at a higher risk of VCF.« less

Authors:
 [1];  [2];  [3]; ;  [2];  [4];  [5];  [6];  [7];  [6];  [8];  [2];  [9]
  1. Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada)
  2. Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario (Canada)
  3. Department of Biostatistics, University Health Network, University of Toronto, Toronto, Ontario (Canada)
  4. Department of Medical Physics, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada)
  5. Department of Radiology and Otolaryngology-Head and Neck Surgery, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Ontario (Canada)
  6. Department of Radiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada)
  7. Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada)
  8. Division of Neurosurgery and Spinal Program, Toronto Western Hospital, University of Toronto, Toronto, Ontario (Canada)
  9. (Canada)
Publication Date:
OSTI Identifier:
22149589
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 84; Journal Issue: 3; Other Information: Copyright (c) 2012 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; COMPRESSION; FRACTURES; HEALTH HAZARDS; HISTOLOGY; LUNGS; MULTIVARIATE ANALYSIS; NEOPLASMS; PATIENTS; PROBABILITY; RADIATION DOSES; RADIOTHERAPY; VERTEBRAE

Citation Formats

Cunha, Marcelo V.R., Al-Omair, Ameen, Atenafu, Eshetu G., Masucci, Giuseppina Laura, Letourneau, Daniel, Korol, Renee, Yu, Eugene, Howard, Peter, Lochray, Fiona, Costa, Leodante B. da, Fehlings, Michael G., Sahgal, Arjun, E-mail: arjun.sahgal@sunnybrook.ca, and Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario. Vertebral Compression Fracture (VCF) After Spine Stereotactic Body Radiation Therapy (SBRT): Analysis of Predictive Factors. United States: N. p., 2012. Web. doi:10.1016/J.IJROBP.2012.04.034.
Cunha, Marcelo V.R., Al-Omair, Ameen, Atenafu, Eshetu G., Masucci, Giuseppina Laura, Letourneau, Daniel, Korol, Renee, Yu, Eugene, Howard, Peter, Lochray, Fiona, Costa, Leodante B. da, Fehlings, Michael G., Sahgal, Arjun, E-mail: arjun.sahgal@sunnybrook.ca, & Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario. Vertebral Compression Fracture (VCF) After Spine Stereotactic Body Radiation Therapy (SBRT): Analysis of Predictive Factors. United States. doi:10.1016/J.IJROBP.2012.04.034.
Cunha, Marcelo V.R., Al-Omair, Ameen, Atenafu, Eshetu G., Masucci, Giuseppina Laura, Letourneau, Daniel, Korol, Renee, Yu, Eugene, Howard, Peter, Lochray, Fiona, Costa, Leodante B. da, Fehlings, Michael G., Sahgal, Arjun, E-mail: arjun.sahgal@sunnybrook.ca, and Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario. Thu . "Vertebral Compression Fracture (VCF) After Spine Stereotactic Body Radiation Therapy (SBRT): Analysis of Predictive Factors". United States. doi:10.1016/J.IJROBP.2012.04.034.
@article{osti_22149589,
title = {Vertebral Compression Fracture (VCF) After Spine Stereotactic Body Radiation Therapy (SBRT): Analysis of Predictive Factors},
author = {Cunha, Marcelo V.R. and Al-Omair, Ameen and Atenafu, Eshetu G. and Masucci, Giuseppina Laura and Letourneau, Daniel and Korol, Renee and Yu, Eugene and Howard, Peter and Lochray, Fiona and Costa, Leodante B. da and Fehlings, Michael G. and Sahgal, Arjun, E-mail: arjun.sahgal@sunnybrook.ca and Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario},
abstractNote = {Purpose: Vertebral compression fractures (VCFs) are increasingly observed after spine stereotactic body radiation therapy (SBRT). The aim of this study was to determine the risk of VCF after spine SBRT and identify clinical and dosimetric factors predictive for VCF. The analysis incorporated the recently described Spinal Instability Neoplastic Score (SINS) criteria. Methods and Materials: The primary endpoint of this study was the development of a de novo VCF (ie, new endplate fracture or collapse deformity) or fracture progression based on an existing fracture at the site of treatment after SBRT. We retrospectively scored 167 spinal segments in 90 patients treated with spine SBRT according to each of the 6 SINS criteria. We also evaluated the presence of paraspinal extension, prior radiation, various dosimetric parameters including dose per fraction ({>=}20 Gy vs <20 Gy), age, and histology. Results: The median follow-up was 7.4 months. We identified 19 fractures (11%): 12 de novo fractures (63%) and 7 cases of fracture progression (37%). The mean time to fracture after SBRT was 3.3 months (range, 0.5-21.6 months). The 1-year fracture-free probability was 87.3%. Multivariate analysis confirmed that alignment (P=.0003), lytic lesions (P=.007), lung (P=.03) and hepatocellular (P<.0001) primary histologies, and dose per fraction of 20 Gy or greater (P=.004) were significant predictors of VCF. Conclusions: The presence of kyphotic/scoliotic deformity and the presence of lytic tumor were the only predictive factors of VCF based on the original 6 SINS criteria. We also report that patients with lung and hepatocellular tumors and treatment with SBRT of 20 Gy or greater in a single fraction are at a higher risk of VCF.},
doi = {10.1016/J.IJROBP.2012.04.034},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 3,
volume = 84,
place = {United States},
year = {2012},
month = {11}
}