Vertebral compression fracture rate following stereotactic ablative body radiotherapy for spine oligometastases: a UK experience

2021 ◽  
pp. 1-5
Author(s):  
Sameed Hussain ◽  
Anjali Zarkar ◽  
Ahmed Elmodir ◽  
Daniel Ford ◽  
Sundus Yahya ◽  
...  
Keyword(s):  
Vertebral Compression Fracture ◽  
Demographic Data ◽  
Spinal Metastases ◽  
Compression Fracture ◽  
Spinal Instability ◽  
Fracture Rate ◽  
Strict Adherence ◽  
Stereotactic Ablative Body Radiotherapy ◽  
Vertebral Bodies ◽  
Pre Treatment

Abstract Aim: Stereotactic ablative body radiotherapy (SABR) for spine metastases is associated with a risk of vertebral compression fracture (VCF). The aim of this study was to determine the rate of VCF at one UK institution and evaluate the use of the Spinal Instability Neoplastic Score (SINS) to predict these. Materials and methods: A retrospective analysis of all patients who underwent SABR for spinal metastases between 2014 and 2018 at one UK institution was performed. Basic demographic data were collected, and SINS prior to SABR was calculated. The primary outcome was VCF rate. Secondary outcomes included time to VCF and need for surgical intervention following VCF. Results: A total of 48 oligometastases were treated with a median follow-up of 20·5 months. A maximum of two vertebral bodies were treated. The median baseline SINS was calculated as 3. The median dose was 26 Gy in three fractions. Two patients were reported to have VCF and both were successfully conservatively managed. Findings: SABR for spine oligometastases is being performed safely with low VCF rates which are comparable with those in international publications. This may be as a result of strict adherence to criteria for delivery of SABR with low pre-treatment SINS.

scholarly journals Evaluation of predictive factors of vertebral compression fracture after conventional palliative radiotherapy for spinal metastasis from colorectal cancer

2018 ◽  
Vol 28 (3) ◽  
pp. 333-340 ◽  
Author(s):  
Jeongshim Lee ◽  
Woo Joong Rhee ◽  
Jee Suk Chang ◽  
Sei Kyung Chang ◽  
Woong Sub Koom
Keyword(s):  
Colorectal Cancer ◽  
Vertebral Compression Fracture ◽  
De Novo ◽  
Spinal Metastasis ◽  
Multivariable Analysis ◽  
Spinal Metastases ◽  
Compression Fracture ◽  
Palliative Radiotherapy ◽  
Spinal Instability ◽  
Spinal Segments

OBJECTIVEDelayed consequences of spinal radiotherapy (RT), including vertebral compression fracture (VCF), are critical complications. However, the predisposing factors that contribute to VCF after conventional RT are unclear. The aim of this study was to assess the incidence of VCF and to determine the predictors of VCF following conventional spinal RT specific to colorectal cancer (CRC).METHODSThe authors retrospectively reviewed 237 spinal segments (147 metastatic and 90 nonmetastatic) in 53 patients with CRC who underwent RT with a median total dose of 30 Gy in 10 fractions between January 2007 and December 2014. The primary end point was the development of a VCF following RT, either de novo VCF or the progression of a baseline VCF. VCFs were assessed using the spinal instability neoplastic score (SINS) criteria.RESULTSAmong all 237 spinal segments, 22 VCFs (9.3%) were observed following RT, including 13 de novo and 9 progressive fractures, and the median time to VCF was 4 months. All VCFs developed in metastatic spines. Among 147 metastatic spinal segments, 22 fractures were observed, with a 12-month cumulative incidence of VCF of 14.8%. Results of multivariable analysis indicated sex (p = 0.023) and SINS class II/III (p < 0.001) as risk factors related to development of a VCF in metastatic spinal segments. Among the SINS criteria, a lytic tumor and the presence of a baseline VCF were identified as predictors of VCF in metastatic spinal segments.CONCLUSIONSIn osteolytic or mixed lesions that were predominant in spinal metastases of CRC, the incidence of VCF was not negligible, even in patients treated with conventional spinal RT. This was especially evident in patients with spinal metastases with a SINS score ≥ 7. Presence of a baseline VCF after spinal RT is a predictor of VCF development and should be observed carefully.

scholarly journals Evaluation of Risk Factors for Vertebral Compression Fracture after Carbon-Ion Radiotherapy for Primary Spinal and Paraspinal Sarcoma

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Yoshihiro Matsumoto ◽  
Makoto Shinoto ◽  
Makoto Endo ◽  
Nokitaka Setsu ◽  
Keiichiro Iida ◽  
...  
Keyword(s):  
Risk Factors ◽  
Operating Characteristic ◽  
Vertebral Compression Fracture ◽  
Characteristic Curve ◽  
Compression Fracture ◽  
Carbon Ion Radiotherapy ◽  
Vertebral Compression Fractures ◽  
Spinal Instability ◽  
Carbon Ion ◽  
Spine Surgeon

Background and Purpose. Carbon-ion radiotherapy (C-ion RT) was effective therapy for inoperable spinal and paraspinal sarcomas. However, a significant adverse event following radiotherapies is vertebral compression fractures (VCFs). In this study, we investigated the incidence of and risk factors for post-C-ion RT VCFs in patients with spinal or paraspinal sarcomas. Material and Methods. Thirty consecutive patients with spinal or paraspinal sarcomas treated with C-ion RT were retrospectively reviewed. Various clinical parameters and the Spinal Instability Neoplastic Score (SINS) were used to evaluate the risk factors for post-C-ion RT VCFs. Results. The overall incidence of VCFs was 23% (median time: 7 months). Patients with VCFs showed a markedly higher SINS score (median value, 9 points) than those without VCF (5 points). The area under the receiver operating characteristic curve for the SINS score was 0.88, and the optimum SINS cut-off score was 8 points. The cumulative incidence of VCFs at 1 year was 9% for patients with a SINS score under 8 points, versus 80% for those with a SINS score of 8 points or higher (p<0.0001). Conclusions. In patients with a SINS score of 8 points or higher, referral to a spine surgeon for stabilization and multidisciplinary discussion is appropriate.

scholarly journals Radiological and clinical effect of balloon kyphoplasty for the management of rheumatoid arthritis patients with osteoporotic vertebral compression fracture

2020 ◽  
Author(s):  
Ji Guo ◽  
Weifeng Zhai ◽  
Licheng Wei ◽  
Jianpo Zhang ◽  
Lang Jin ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Vertebral Compression Fracture ◽  
Compression Fracture ◽  
Balloon Kyphoplasty ◽  
Cement Leakage ◽  
Osteoporotic Vertebral Compression Fracture ◽  
Control Group ◽  
Compression Rate ◽  
Kyphotic Angle ◽  
Vertebral Bodies

Abstract Objective: This study was conducted to investigate the outcome of percutaneous balloon kyphoplasty (KP) for the treatment of osteoporotic vertebral compression fracture(OVCF) in patients with rheumatoid arthritis (RA) and analyze the influence of erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), injected cement volume and duration of taking glucocorticoid on the outcome of KP procedure. Methods: A total of 39 RA patients (63 vertebral bodies) and 38 patients (50 vertebral bodies) without RA received KP management for OVCF. Changes in vertebral compression rate, local kyphotic angle, conditions of bone cement leakage, visual analogue scale (VAS) and Oswestry disability index (ODI) scores were evaluated for radiological and clinical outcomes of KP procedure. In addition, 39 OVCF patients with RA were divided into different groups according to the value of ESR, CRP, injected cement volume and duration of taking glucocorticoid to evaluate their influence on the outcomes of KP procedure.Results: The KP procedure significantly improved the compression rate, local kyphotic angle, VAS and ODI scores in both RA group and control group. The compression rate increased 11.56±3.8% in RA group which is significantly larger than the control group(p<0.05). The change of local kyphotic angle in RA group was 3.77±1.9, which is also larger than that in control group(p<0.05). Whereas, the changes of VAS and ODI scores were not significantly different between the two groups. Besides, radiological and clinical outcomes were not significantly different among the groups of different ESR, CRP, injected cement volume and duration of taking glucocorticoid no matter before or 1 year after the KP procedure, but 44% RA patients who take glucocorticoid for over 10 years had cement leakage after the KP procedure which is significantly higher than the group of RA patients with less than 10 years glucocorticoid use(p<0.05). In addition, 7 intradiscal cement leakage occurred in patients take glucocorticoid over 10 years where as no intradiscal leakage showed up in its control group(p<0.01).Conclusion: KP procedure was effective for OVCF patients with or without RA, for restoring vertebral body height, reducing local kyphotic angle, relieving pain and recovering spinal function. Compared to the control group, RA patients received more improvement in compression rate and local kyphotic angle after the operation. Intradiscal leakage occurred more in patients who take glucocorticoid for over 10 years.

scholarly journals Risk Factors Analysis of Pulmonary Cement Embolism during Percutaneous Vertebroplasty or Kyphoplasty for Osteoporotic Vertebral Compression Fracture.

2021 ◽  
Author(s):  
Dexin Zou ◽  
Shengjie Dong ◽  
Wei Du ◽  
Bing Sun ◽  
Xifa Wu
Keyword(s):  
Risk Factors ◽  
Vertebral Compression Fracture ◽  
Demographic Data ◽  
Multiple Logistic Regression Analysis ◽  
Compression Fracture ◽  
Osteoporotic Vertebral Compression Fracture ◽  
Increased Risk ◽  
Significant Difference ◽  
Cement Embolism ◽  
Pulmonary Ct

Abstract Objective: The purpose of this research is to evaluate the risk factors and incidence of PCE during PKP or PVP for osteoporotic vertebral compression fracture (OVCF) based on postoperative computed tomography (CT).Methods: A total of 2344 patients who underwent PVP or PKP due to OVCF in our spine centre were analyzed retrospectively. According to the detection of postoperative pulmonary CT, the patients were divided into two groups: pulmonary cement embolism group (PCE group) and non pulmonary cement embolism group (NPCE group). Demographic data in both groups were compared using the χ2 test for qualitative data and the unpaired t test for quantitative data. Multiple logistic regression analysis was carried out to identify risk factors that were significantly related to the PCE resulting from cement leakage.Results: PCE was found in 34 patients (1.9% 34/1782) with pulmonary CT examination after operation. There was no statistically significant difference in the parameters such as age, gender, body mass index (BMI) and cement volume in the two groups. Patients with three or more involved vertebrae had a significantly increased risk to suffer from PCE than those with one involved vertebra (p=0.046 OR 2.412 [95% CI 1.017-5.722]). Patients who suffered thoracic fracture had a significantly increased risk to suffer from PCE than those suffered thoracolumbar fracture (p=0.001 OR 0.241 [95% CI 0.105-0.550]). And significantly increased PCE risk also was observed in thoracic fracture compared with Lumbar fracture patients (p=0.028 OR 0.094 [95% CI 0.114-0.779]). The risk of PCE within two weeks after fracture was significantly higher than that after two weeks of fracture (p=0.000 OR 0.178 [95% CI 0.074-0.429]). Patients who underwent PVP surgery had a significantly increased PCE risk than those underwent PKP surgery (p=0.001 OR 0.187 [95% CI 0.069-0.509])Conclusion: The real incidence of PCE is underestimated due to the lack of routine postoperative pulmonary imaging examination. The number of Involved vertebrae, fracture location, operation timing and operation methods are independent risk factors for PCE.

scholarly journals Vertebral Compression Fracture Rates after Stereotactic Radiosurgery for Spinal Metastases

2019 ◽  
Vol 105 (1) ◽  
pp. E126-E127
Author(s):  
M. Usoz ◽  
J. Dhillon ◽  
K.A. Kumar ◽  
R. Von Eyben ◽  
E.C. White ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Vertebral Compression Fracture ◽  
Spinal Metastases ◽  
Compression Fracture

Clinical outcome of vertebral compression fracture after single fraction spine radiosurgery for spinal metastases.

2015 ◽  
Vol 33 (15_suppl) ◽  
pp. e13017-e13017 ◽  
Author(s):  
Isabelle M. Germano ◽  
Andrea Carai ◽  
Seth Blacksburg ◽  
Puneet Pawha ◽  
yeh-Chi Lo ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Vertebral Compression Fracture ◽  
Spinal Metastases ◽  
Compression Fracture ◽  
Single Fraction ◽  
Spine Radiosurgery

RADT-10. DEVELOPMENT AND INTERNAL VALIDATION OF A PREDICTIVE SCORE FOR VERTEBRAL COMPRESSION FRACTURE AFTER STEREOTACTIC BODY RADIATION THERAPY FOR SPINAL METASTASES

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi43-vi43
Author(s):  
Roman Kowalchuk ◽  
Benjamin Johnson-Tesch ◽  
Joseph Marion ◽  
Trey Mullikin ◽  
William Harmsen ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
High Risk ◽  
Vertebral Compression Fracture ◽  
Stereotactic Body Radiation Therapy ◽  
Cox Model ◽  
Spinal Metastases ◽  
Compression Fracture ◽  
Predictive Score ◽  
Internal Validation ◽  
Stereotactic Body Radiation

Abstract PURPOSE Vertebral compression fracture (VCF) is a potential adverse effect following stereotactic body radiation therapy (SBRT) for spinal metastases. In this analysis, we developed and internally validated a risk stratification model for VCF. METHODS From an initial set of 680 treatments, we excluded those with proton therapy, prior surgical intervention, or missing data. The final dataset had 464 treatments in 313 patients. Delineations of VCF and all radiographic components of the spinal instability neoplastic score (SINS) were determined by a radiologist. Recursive partitioning analysis (RPA) was conducted using separate training (70%), internal validation (15%), and test (15%) sets. The log-rank test was used as the criterion for node splitting. RESULTS With a median follow-up of 21 months, we identified 84 VCF (18%), including 65 (77%) de novo and 19 (23%) progressive fractures. There was a median 9 months (IQR: 3 – 21) to VCF. From an initial set of 15 candidate variables, six were identified using the backwards selection method, feature importance testing, and a correlation heatmap. Four were then selected in the highest-fidelity RPA models: epidural tumor extension, lumbar location, gross tumor volume &gt; 10 cc, and SINS &gt; 6. One point was assigned to each variable, and the resulting multivariate Cox model had a concordance of 0.760. Each one point increase in score was associated with increasing rates of VCF. Low-risk lesions (score: 0-1, n=273) had 2-year freedom from VCF of 92%, compared to 80% for intermediate-risk (score: 2, n=99) and 56% (score: 3-4, n=92) for high-risk lesions (p &lt; 0.0001). Cumulative incidence curves with death as a competing risk showed increased VCF with higher scores via Gray’s test (p &lt; 0.001). CONCLUSIONS Our internally-validated model identifies a subgroup of patients with high risk for VCF who may benefit from prophylactic surgical stabilization or vertebroplasty.

Vertebral compression fracture risk after stereotactic body radiotherapy for spinal metastases

2012 ◽  
Vol 16 (4) ◽  
pp. 379-386 ◽  
Author(s):  
Nicholas S. Boehling ◽  
David R. Grosshans ◽  
Pamela K. Allen ◽  
Mary F. McAleer ◽  
Allen W. Burton ◽  
...  
Keyword(s):  
Risk Factors ◽  
Median Time ◽  
Stereotactic Body Radiotherapy ◽  
Vertebral Compression Fracture ◽  
Significant Risk ◽  
Spinal Metastases ◽  
Compression Fracture ◽  
Time To Progression ◽  
Average Pain

Object The aim of this study was to identify potential risk factors for and determine the rate of vertebral compression fracture (VCF) after intensity-modulated, near-simultaneous, CT image–guided stereotactic body radiotherapy (SBRT) for spinal metastases. Methods The study group consisted of 123 vertebral bodies (VBs) in 93 patients enrolled in prospective protocols for metastatic disease. Data from these patients were retrospectively analyzed. Stereotactic body radiotherapy consisted of 1, 3, or 5 fractions for overall median doses of 18, 27, and 30 Gy, respectively. Magnetic resonance imaging studies, obtained at baseline and at each follow-up, were evaluated for VCFs, tumor involvement, and radiographic progression. Self-reported average pain levels were scored based on the 11-point (0–10) Brief Pain Inventory both at baseline and at follow-up. Obesity was defined as a body mass index ≥ 30. Results The median imaging follow-up was 14.9 months (range 1–71 months). Twenty-five new or progressing fractures (20%) were identified, and the median time to progression was 3 months after SBRT. The most common histologies included renal cancer (36 VBs, 10 fractures, 10 tumor progressions), breast cancer (20 VBs, 0 fractures, 5 tumor progressions), thyroid cancer (14 VBs, 1 fracture, 2 tumor progressions), non–small cell lung cancer (13 VBs, 3 fractures, 3 tumor progressions), and sarcoma (9 VBs, 2 fractures, 2 tumor progressions). Fifteen VBs were treated with kyphoplasty or vertebroplasty after SBRT, with 5 procedures done for preexisting VCFs. Tumor progression was noted in 32 locations (26%) with 5 months' median time to progression. At the time of noted fracture progression there was a trend toward higher average pain scores but no significant change in the median value. Univariate logistic regression showed that an age > 55 years (HR 6.05, 95% CI 2.1–17.47), a preexisting fracture (HR 5.05, 95% CI 1.94–13.16), baseline pain and narcotic use before SBRT (pain: HR 1.31, 95% CI 1.06–1.62; narcotic: HR 2.98, 95% CI 1.17–7.56) and after SBRT (pain: HR 1.34, 95% CI 1.06–1.70; narcotic: HR 3.63, 95% CI 1.41–9.29) were statistically significant predictors of fracture progression. On multivariate analysis an age > 55 years (HR 10.66, 95% CI 2.81–40.36), a preexisting fracture (HR 9.17, 95% CI 2.31–36.43), and baseline pain (HR 1.41, 95% CI 1.05–1.9) were found to be significant risks, whereas obesity (HR 0.02, 95% CI 0–0.2) was protective. Conclusions Stereotactic body radiotherapy is associated with a significant risk (20%) of VCF. Risk factors for VCF include an age > 55 years, a preexisting fracture, and baseline pain. These risk factors may aid in the selection of which spinal SBRT patients should be considered for prophylactic vertebral stabilization or augmentation procedures. Clinical trial registration no.: NCT00508443.

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