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Title: A Study of Pseudoprogression After Spine Stereotactic Body Radiation Therapy

Abstract

Purpose: To determine the incidence of pseudoprogression (PP) after spine stereotactic body radiation therapy based on a detailed and quantitative assessment of magnetic resonance imaging (MRI) morphologic tumor alterations, and to identify predictive factors distinguishing PP from local recurrence (LR). Methods and Materials: A retrospective analysis of 35 patients with 49 spinal segments treated with spine stereotactic body radiation therapy, from 2009 to 2014, was conducted. The median number of follow-up MRI studies was 4 (range, 2-7). The gross tumor volumes (GTVs) within each of the 49 spinal segments were contoured on the pretreatment and each subsequent follow-up T1- and T2-weighted MRI sagittal sequence. T2 signal intensity was reported as the mean intensity of voxels constituting each volume. LR was defined as persistent GTV enlargement on ≥2 serial MRI studies for ≥6 months or on pathologic confirmation. PP was defined as a GTV enlargement followed by stability or regression on subsequent imaging within 6 months. Kaplan-Meier analysis was used for estimation of actuarial local control, disease-free survival, and overall survival. Results: The median follow-up was 23 months (range, 1-39 months). PP was identified in 18% of treated segments (9 of 49) and LR in 29% (14 of 49). Earlier volume enlargement (5 months for PPmore » vs 15 months for LR, P=.005), greater GTV to reference nonirradiated vertebral body T2 intensity ratio (+30% for PP vs −10% for LR, P=.005), and growth confined to 80% of the prescription isodose line (80% IDL) (8 of 9 PP cases vs 1 of 14 LR cases, P=.002) were associated with PP on univariate analysis. Multivariate analysis confirmed an earlier time to volume enlargement and growth within the 80% IDL as significant predictors of PP. LR involved the epidural space in all but 1 lesion, whereas PP was confined to the vertebral body in 7 of 9 cases. Conclusions: PP was observed in 18% of treated spinal segments. Tumor growth confined to the 80% IDL and earlier time to tumor enlargement were predictive for PP.« less

Authors:
;  [1];  [2]; ; ; ;  [1];  [3];  [1]
  1. Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec (Canada)
  2. Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec (Canada)
  3. Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada)
Publication Date:
OSTI Identifier:
22645706
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 96; Journal Issue: 4; Other Information: Copyright (c) 2016 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; BIOMEDICAL RADIOGRAPHY; MAGNETIC RESONANCE; MULTIVARIATE ANALYSIS; NEOPLASMS; NMR IMAGING; RADIOTHERAPY; VERTEBRAE

Citation Formats

Bahig, Houda, Simard, Dany, Létourneau, Laurent, Wong, Philip, Roberge, David, Filion, Edith, Donath, David, Sahgal, Arjun, and Masucci, Laura. A Study of Pseudoprogression After Spine Stereotactic Body Radiation Therapy. United States: N. p., 2016. Web. doi:10.1016/J.IJROBP.2016.07.034.
Bahig, Houda, Simard, Dany, Létourneau, Laurent, Wong, Philip, Roberge, David, Filion, Edith, Donath, David, Sahgal, Arjun, & Masucci, Laura. A Study of Pseudoprogression After Spine Stereotactic Body Radiation Therapy. United States. doi:10.1016/J.IJROBP.2016.07.034.
Bahig, Houda, Simard, Dany, Létourneau, Laurent, Wong, Philip, Roberge, David, Filion, Edith, Donath, David, Sahgal, Arjun, and Masucci, Laura. Tue . "A Study of Pseudoprogression After Spine Stereotactic Body Radiation Therapy". United States. doi:10.1016/J.IJROBP.2016.07.034.
@article{osti_22645706,
title = {A Study of Pseudoprogression After Spine Stereotactic Body Radiation Therapy},
author = {Bahig, Houda and Simard, Dany and Létourneau, Laurent and Wong, Philip and Roberge, David and Filion, Edith and Donath, David and Sahgal, Arjun and Masucci, Laura},
abstractNote = {Purpose: To determine the incidence of pseudoprogression (PP) after spine stereotactic body radiation therapy based on a detailed and quantitative assessment of magnetic resonance imaging (MRI) morphologic tumor alterations, and to identify predictive factors distinguishing PP from local recurrence (LR). Methods and Materials: A retrospective analysis of 35 patients with 49 spinal segments treated with spine stereotactic body radiation therapy, from 2009 to 2014, was conducted. The median number of follow-up MRI studies was 4 (range, 2-7). The gross tumor volumes (GTVs) within each of the 49 spinal segments were contoured on the pretreatment and each subsequent follow-up T1- and T2-weighted MRI sagittal sequence. T2 signal intensity was reported as the mean intensity of voxels constituting each volume. LR was defined as persistent GTV enlargement on ≥2 serial MRI studies for ≥6 months or on pathologic confirmation. PP was defined as a GTV enlargement followed by stability or regression on subsequent imaging within 6 months. Kaplan-Meier analysis was used for estimation of actuarial local control, disease-free survival, and overall survival. Results: The median follow-up was 23 months (range, 1-39 months). PP was identified in 18% of treated segments (9 of 49) and LR in 29% (14 of 49). Earlier volume enlargement (5 months for PP vs 15 months for LR, P=.005), greater GTV to reference nonirradiated vertebral body T2 intensity ratio (+30% for PP vs −10% for LR, P=.005), and growth confined to 80% of the prescription isodose line (80% IDL) (8 of 9 PP cases vs 1 of 14 LR cases, P=.002) were associated with PP on univariate analysis. Multivariate analysis confirmed an earlier time to volume enlargement and growth within the 80% IDL as significant predictors of PP. LR involved the epidural space in all but 1 lesion, whereas PP was confined to the vertebral body in 7 of 9 cases. Conclusions: PP was observed in 18% of treated spinal segments. Tumor growth confined to the 80% IDL and earlier time to tumor enlargement were predictive for PP.},
doi = {10.1016/J.IJROBP.2016.07.034},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 4,
volume = 96,
place = {United States},
year = {2016},
month = {11}
}