scholarly journals Preoperative evaluation of basal free triiodothyronine in patients undergoing coronary artery bypass grafting surgery. Does it help?

2015 ◽  
Vol 11 (2) ◽  
pp. 1-7
Author(s):  
Kaushal Kishore Tiwari ◽  
Alfredo Guiseppe Cerillo ◽  
Simona Storti ◽  
Stefano Bevilacqua ◽  
Aldo Clerico ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Cardiac Output ◽  
Univariate Analysis ◽  
Hospital Death ◽  
Base Line ◽  
Low T3 Syndrome ◽  
Low Cardiac Output ◽  
Low T3 ◽  
Increased Risk ◽  
The Impact

noBackground & Objectives: The postoperative Low T3 syndrome has been considered as a possible source of reduced myocardial contractility, resulting in increased mortality after CABG. Effect of preoperative Low T3 has not been well studied in patients undergoing CABG surgery. Aim of our study is to evaluate effect of preoperative Low T3 syndrome in patients undergoing CABG surgery.Materials & Methods: Six hundred and six patients undergoing CABG were included in this prospective study. The impact of the base-line FT3 concentration and of preoperative low T3 syndrome on the risk of postoperative low cardiac output and hospital death was analyzed.Results: Fifteen patients (2.3%) postoperatively and 159 (26.2%) developed major complications. At univariate analysis a reduced EF, the presence of peripheral vascular disease, the NYHA class, the surgical urgency, the aortic cross-clamp time, the CPB time and the FT3 concentration at admission were significantly associated with low CO and higher mortality. At multivariate analysis, the CPB time, an emergency procedure, a reduced LVEF, and the fT3 concentration were independently related to the development of low CO. However, in multivariate analysis low EF, and the fT3 concentration were the only predictors of hospital death.Conclusion: We conclude that preoperative low EF and low T3 syndrome independently causes low cardiac output and higher mortality in patients undergoing CABG. Therefore, all patients undergoing CABG should be evaluated for low T3 syndrome and patients with low T3 syndrome should be considered at increased risk. Appropriate preoperative T3 replacement therapy could decrease the postoperative complications in patients undergoing CABG.JCMS Nepal. 2015; 11(2):1-7

Effect of chronic treatment of combined statins and aspirin on the risk of prostate cancer detection.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 185-185
Author(s):  
Cristina Suarez ◽  
Rafael Morales ◽  
Jose Placer ◽  
Isaac Nunez ◽  
Jacques Planas ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Multivariate Analysis ◽  
Chronic Treatment ◽  
Univariate Analysis ◽  
Combined Treatment ◽  
Adult Men ◽  
Cancer Aggressiveness ◽  
Increased Risk ◽  
The Impact

185 Background: The role of chronic treatment (ChT) with statins and aspirin on prostate cancer (PC) carcinogenesis is controversial. Both drugs are frequently used in adult men who are at risk of PC, and many of them receive both drugs simultaneously. The impact of the combined treatment (CT) with statins and aspirin on PC risk has never been reported. We proposed to explore the influence of ChT with statins and aspirin in the PC risk detection and their aggressiveness. Methods: 2408 men were consecutively biopsied for cause: PSA > 4 ng/mL (64.4%), abnormal DRE (9%) or both (26.6%). ChT with statins and aspirin (>1 year) was controlled. Median age was 68 years (46–86) and median PSA 7.0 ng/mL (0.7-1279). At least 10 cores, plus 1 to 8 additional cores, were obtained. The PC detection rate was 35.2% and the Gleason score was < 7 in 20.8%, 7 in 50.9% and > 7 (HGPC) in 28.3%. Multivariate and univariate analysis were done and OR calculated to analyze the strength of the relationships. Results: 440 men (18.3%) were receiving statins alone (SA), 160 (6.6%) aspirin alone (AA), and 304 (12.6%) both drugs simultaneously. Multivariate analysis showed that CT was the only independent predictor of a reduced risk of PC detection, p=0.025, (OR 0.589, 95%CI 0.370-0-936). PC was detected in 552 of 1502 men (36.7%) not receiving statins or aspirin, 34.5% (152/440) receiving SA, 40% (64/160) receiving AA, and in 26.3% (80/304) receiving statins and aspirin simultaneously. Related to cancer aggressiveness, multivariate analysis showed that combined treatment predicted significantly an increased risk of HGPC, p=0.013, (OR 2.672, 95%CI 1.226-5.825). HGPC was detected in 136 of 552 (24.6%) PCs detected in men not receiving statins or aspirin, in 40 of 152 (26.3%) PCs detected in men receiving SA, in 24 of 64 (37.7%) PCs detected in men receiving AA, and in 40 of 80 (50%) PCs detected in men receiving statins and aspirin simultaneously. Conclusions: This study suggests that ChT with the combination of statins and aspirin reduce significantly the risk of PC detection in men subjected to prostate biopsy for cause. However, this reduction of PC detection is accompanied by a significant increase of PC aggressiveness.

Impact of Early Factor VIII Exposure, Prophylaxis and Prenatal/Perinatal Events on Inhibitor Risk in Children with Hemophilia A: A Case-Control Study.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 37-37 ◽  
Author(s):  
Elena Santagostino ◽  
Angiola Rocino ◽  
Maria E. Mancuso ◽  
Maria G. Mazzucconi ◽  
Giacomo Mancuso ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Case Control Study ◽  
Hemophilia A ◽  
Univariate Analysis ◽  
Case Control ◽  
Inhibitor Development ◽  
Intron 22 Inversion ◽  
Increased Risk ◽  
The Impact ◽  
Control Study

Abstract In a multicenter case-control study we investigated the impact of prenatal/perinatal events and early FVIII exposure on the inhibitor risk in hemophiliacs. Patients: 102 children (age:13–196 months) with hemophilia A (FVIII≤2%) exclusively treated with recombinant FVIII and evaluated for inhibitors every 3 months were included. Forty-seven patients who developed inhibitors at the median age of 26 months (4–80) after a median of 16 exposure days (ED, 5–150), 37 high-responders (6–500 BU/mL) and 10 low-responders (<5 BU/mL), were compared with 55 children who did not develop inhibitors after at least 20 ED (5<50, 4<100, 10<200 and 36>200 ED). Results: by univariate analysis, family history of inhibitors, intron 22 inversion and prophylaxis started after the first 20 ED were significantly associated with an increased risk of inhibitor development (OR 9.5, 95%CI 1.1–79.9; OR 2.7, 95%CI 1.1–6.6; OR 3.7, 95%CI 1.1–12.1, respectively). No statistically significant differences were found for variables such as villocentesis/amniocentesis, premature/caesarian birth, breast-feeding, surgery, central venous devices and FVIII infusions associated with infections/vaccinations. By multivariate analysis, the inhibitor risk was 2.8-folds (95%CI 1.1–7.3) in children with intron 22 inversion and 4.5-folds (95%CI 1.1–17.5) in patients who started prophylaxis after the first 20 ED. By univariate and multivariate analysis, there was not a linear trend in the inhibitor development according to the age at first FVIII exposure (≤6, 7–12, 13–18, 19–24, >24 months). Conclusions: this study showed that starting prophylaxis within the first 20 ED had a favourable impact on the inhibitor risk independently from the age at first FVIII exposure.

153 Prognostic Role of the Low Tri-Iodothyronine Syndrome in Brain Tumor Patients

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 237-237
Author(s):  
Adomas Bunevicius ◽  
Sarunas Tamasauskas ◽  
Vytenis Deltuva ◽  
Edward R Laws ◽  
Arimantas Tamasauskas
Keyword(s):  
Brain Tumor ◽  
Health Status ◽  
Adjuvant Treatment ◽  
Extent Of Resection ◽  
Histological Diagnosis ◽  
Low T3 Syndrome ◽  
Tumor Patients ◽  
Low T3 ◽  
Increased Risk ◽  
Discharge Outcomes

Abstract INTRODUCTION Reduced triiodothyronine (T3) concentrations were implicated in worse prognosis of brain tumor patients. We investigated the association of thyroid hormone concentrations with health-related quality of life (HRQoL), discharge outcomes and prognosis of brain tumor patients. METHODS Two-hundred and thirty brain tumor patients (70% women) before brain tumor surgery were evaluated for HRQoL (ERTC QLQ-C30 and QLQ-BN20 questionnaires); and thyroid function profile. The Low tri-iodothyronine (T3) syndrome was defined as T3 concentration below the reference range. Unfavorable hospital discharge outcomes were determined as Glasgow outcome scale score of = 3. Follow-up continued until November, 2015. RESULTS &gt;Seventy-four percent of patients had Low T3 syndrome. After adjusting for the brain tumor histological diagnosis, patients' age, gender and functional status, lower free T3 concentrations were associated with worse HRQOL on the QLQ-C30 Global health status (ß = 0.302, P = 0.017), Emotional functioning (ß = 0.422, p&lt;.001) and Cognitive functioning (ß = 0.259, P = 0.042) domains, and with greater symptom severity on the QLQ-BN20 Fatigue (ß = −0.238, p = .041), Motor dysfunction (ß = −0.283, P = 0.013) and Weakness of legs (ß = −0.269. P = 0.027) domains. Preoperative Low T3 syndrome increased risk for unfavorable discharge outcomes adjusting for age, gender and histological diagnosis (OR = 2.944, 95%CI [1.314-6.597], p = .009). In all patients, lower total (p = .038) and free (p = .014) T3 concentrations were associated with greater mortality adjusting for age, gender, extent of resection, adjuvant treatment and histological diagnosis. The Low T3 syndrome was associated with greater 5-year mortality for glioma patients (HR = 2.197; 95%CI [1.160-4.163], p = .016) and with shorter survival (249 [260] vs. 352 [399] days; p = .029) of high grade glioma patients independent of age, gender, extent of resection and adjuvant treatment. CONCLUSION The Low T3 syndrome is common in brain tumor patients and is associated with worse health status, impaired emotional and physical aspects of HRQoL and worse discharge outcomes. The Low T3 syndrome is associated with shorter survival of glioma patients.

scholarly journals Impact on hospital mortality and morbidity of right ventricular involvement among patients with acute left ventricular infarction

2006 ◽  
Vol 124 (4) ◽  
pp. 186-191 ◽  
Author(s):  
Afonso Celso Pereira ◽  
Roberto Alexandre Franken ◽  
Sandra Regina Schwarzwälder Sprovieri ◽  
Valdir Golin
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Hospital Death ◽  
Inferior Wall ◽  
Mortality And Morbidity ◽  
Killip Class ◽  
Increased Risk ◽  
The Impact

CONTEXT AND OBJECTIVE: There is uncertainty regarding the risk of major complications in patients with left ventricular (LV) infarction complicated by right ventricular (RV) involvement. The aim of this study was to evaluate the impact on hospital mortality and morbidity of right ventricular involvement among patients with acute left ventricular myocardial infarction. DESIGN AND SETTING: Prospective cohort study, at Emergency Care Unit of Hospital Central da Irmandade da Santa Casa de Misericórdia de São Paulo. METHODS: 183 patients with acute myocardial infarction participated in this study: 145 with LV infarction alone and 38 with both LV and RV infarction. The presence of complications and hospital death were compared between groups. RESULTS: 21% of the patients studied had LV + RV infarction. In this group, involvement of the dorsal and/or inferior wall was predominant on electrocardiogram (p < 0.0001). The frequencies of Killip class IV upon admission and 24 hours later were greater in the LV + RV group, along with electrical and hemodynamic complications, among others, and death. The probability of complications among the LV + RV patients was 9.7 times greater (odds ratio, OR = 9.7468; 95% confidence interval, CI: 2.8673 to 33.1325; p < 0.0001) and probability of death was 5.1 times greater (OR = 5.13; 95% CI: 2.2795 to 11.5510; p = 0.0001), in relation to patients with LV infarction alone. CONCLUSIONS: Patients with LV infarction with RV involvement present increased risk of early morbidity and mortality.

scholarly journals Clinical Role of Lung Ultrasound for the Diagnosis and Prognosis of Coronavirus Disease Pneumonia in Elderly Patients: A Pivotal Study

Gerontology ◽  
2020 ◽  
pp. 1-9
Author(s):  
Guerino Recinella ◽  
Giovanni Marasco ◽  
Manuel Tufoni ◽  
Mara Brizi ◽  
Eleonora Evangelisti ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Elderly Patients ◽  
Lung Ultrasound ◽  
Univariate Analysis ◽  
Hospital Death ◽  
Clinical Role ◽  
Diagnosis And Prognosis ◽  
Hospitalized Elderly ◽  
Novel Coronavirus

<b><i>Background:</i></b> Lung ultrasound (LUS) showed a promising role in the diagnosis and monitoring of patients hospitalized for novel coronavirus disease (COVID-19). However, no data are available on its role in elderly patients. <b><i>Aims:</i></b> The aim of this study was to evaluate the diagnostic and prognostic role of LUS in elderly patients hospitalized for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pneumonia. <b><i>Methods:</i></b> Consecutive elderly patients (age &#x3e;65 years) hospitalized for COVID-19 were enrolled. Demographics, laboratory, comorbidity, and the clinical features of the patients were collected. All patients underwent LUS on admission to the ward. LUS characteristics have been analyzed. Uni- and multivariate analyses to evaluate predictors for in-hospital death were performed. <b><i>Results:</i></b> Thirty-seven hospitalized elderly patients (19 men) with a diagnosis of SARS-CoV-2 infection were consecutively enrolled. The median age was 82 years (interquartile range 74.5–93.5). Ultrasound alterations were found in all patients enrolled; inhomogeneous interstitial syndrome with spared areas (91.9%) and pleural alterations (100%) were the most frequent findings. At univariate analysis, LUS score (hazard ratio [HR] 1.168, 95% CI 1.049–1.301) and pleural effusions (HR 3.995, 95% CI 1.056–15.110) were associated with in-hospital death. At multivariate analysis, only LUS score (HR 1.168, 95% CI 1.049–1.301) was independelty associated with in-hospital death. The LUS score’s best cutoff for distinguishing patients experiencing in-hospital death was 17 (at multivariate analysis LUS score ≥17, HR 4.827, 95% CI 1.452–16.040). In-hospital death was significantly different according to the LUS score cutoff of 17 (<i>p</i> = 0.0046). <b><i>Conclusion:</i></b> LUS could play a role in the diagnosis and prognosis in elderly patients hospitalized for SARS-CoV-2 infection.

scholarly journals Biological Markers Predictive of Invasive Recurrence in DCIS

2008 ◽  
Vol 2 ◽  
pp. 117955490800200 ◽  
Author(s):  
Sharon Nofech-Mozes ◽  
Jacqueline Spayne ◽  
Eileen Rakovitch ◽  
Harriette J Kahn ◽  
Arun Seth ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Biological Markers ◽  
Pearson Correlation ◽  
Univariate Analysis ◽  
Breast Conserving Surgery ◽  
Invasive Disease ◽  
Current Approach ◽  
Time To Recurrence ◽  
Pathologic Features ◽  
Increased Risk

DCIS is a heterogeneous group of non-invasive cancers of the breast characterized by various degrees of differentiation and unpredictable propensity for transformation into invasive carcinoma. We examined the expression and prognostic value of 9 biological markers with a potential role in tumor progression in 133 patients with pure DCIS treated with breast conserving surgery alone, between 1982–2000. Histology was reviewed and immunohistochemical staining was performed. Pearson correlation coefficient was used to determine the associations between markers and histopathological features. Univariate and multivariate analysis examined associations between time to recurrence and clinico-pathologic features and biological markers. Median age at diagnosis was 55 years (25–85). With a median follow up of 8.91 years, 41/133 patients recurred (21 as invasive recurrence). In this cohort 13.5% had low, 43% intermediate and 42% high nuclear grade. Comedo necrosis was found in 65% of cases. Expression of ER (62.4%), PR (55.6%), HER2/neu (31.6%), MIB1 (39.8%), p53 (22.6%), p21 (39.8%), Cyclin D1 (95.5%) calgranulin (20.5%), psoriasin (12%), was found in DCIS. HER2/neu was overexpressed in 45% that recurred as DCIS and 42.9% that recurred as invasive cancer, and only in 26.1% in cases that never recurred. On univariate analysis, HER2/neu overexpression was the only marker associated with an increased risk for any recurrence (p = 0.044). The hazard ratio for recurrence for HER2/neu positive DCIS was 1.927 (confidence interval 1.016–3.653) compared to HER2 negative DCIS. On multivariate analysis, HER2/neu overexpression remained the only independent variable significantly associated with any recurrence (p = 0.014) and with invasive recurrence (p = 0.044). This data suggest that HER2/neu testing may become an important parameter in the management of DCIS and the treatment of cases with positive HER2/neu status could be modified accordingly, similar to the current approach for HER2/neu positive invasive disease.

scholarly journals Loneliness amongst Low-Socioeconomic Status Elderly Singaporeans and its Association with Perceptions of the Neighbourhood Environment

2019 ◽  
Vol 16 (6) ◽  
pp. 967 ◽  
Author(s):  
Liang Wee ◽  
Tammy Tsang ◽  
Huso Yi ◽  
Sue Toh ◽  
Geok Lee ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Public Housing ◽  
Low Socioeconomic Status ◽  
Physical Environment ◽  
Home Ownership ◽  
Univariate Analysis ◽  
Rental Housing ◽  
Neighbourhood Environment ◽  
Chi Square ◽  
The Impact

In Singapore, a densely urbanised Asian city state, more than 80% of the population stays in public housing estates and the majority (90%) own their own homes. For the needy who cannot afford home ownership, public rental flats are available. We were interested in exploring social-environmental factors that are associated with loneliness among elderly residents of public rental housing in Singapore. We surveyed residents aged ≥60 in two Singapore public housing precincts in 2016. Loneliness was measured using a three-item scale. Sociodemographic information was obtained via standardised questionnaires. We used chi-square to identify associations between loneliness and sociodemographic characteristics, as well as neighbourhood perceptions (safety, convenience and the physical environment), on univariate analysis; and logistic regression for multivariate analysis. The response rate was 62.1% (528/800). On multivariate analysis, staying in a rental flat block was independently associated with loneliness (adjusted odds ratio, aOR = 2.10, 95% confidence interval (CI) = 1.32–3.36), as was staying in a poorer physical environment (aOR = 1.92, 95% CI = 1.15–3.22). Although needy Singapore residents share the same built environment as more well-to-do neighbours, differences in the impact of loneliness do exist.

The Impact of Pancreatic Resection on Exocrine Homeostasis

2014 ◽  
Vol 80 (7) ◽  
pp. 704-709 ◽  
Author(s):  
Swapnil D. Kachare ◽  
Timothy L. Fitzgerald ◽  
Olga Schuth ◽  
Nasreen A. Vohra ◽  
Emmanuel E. Zervos
Keyword(s):  
Enzyme Replacement Therapy ◽  
Replacement Therapy ◽  
Pancreatic Resection ◽  
Univariate Analysis ◽  
Pancreatic Head ◽  
Exocrine Insufficiency ◽  
Enzyme Replacement ◽  
Increased Risk ◽  
The Impact ◽  
Exocrine Dysfunction

Patients undergoing pancreatic resection are at risk for developing postoperative exocrine dysfunction. We sought to determine the incidence of and clinical factors associated with exocrine dysfunction after pancreatectomy. A retrospective review of a prospective database composed of patients undergoing pancreatic resection between 2004 and 2013 was performed. Logistic regression was used to identify preoperative factors that influenced postoperative exocrine insufficiency. One hundred sixty-one patients with complete follow-up were identified. The mean age was 64.1 ± 12.65 years. The majority were: female (51%), white (66%), tobacco users (61%), nondrinkers (68%), nondiabetic (71%), and without preoperative exocrine dysfunction (96%). Average body mass index was 27.8 ± 6.32 kg/m2. Most underwent a pancreaticoduodenectomy (67.3%) for pancreatic cancer (59.6%). Pancreatic fistula occurred in 6.8 per cent. Seven patients were on enzyme replacement therapy preoperatively. Forty-four patients (27%) had postoperative exocrine dysfunction (five of whom were on enzyme replacement therapy preoperatively). Two of seven (29%) of patients with preoperative exocrine dysfunction had complete resolution of their exocrine dysfunction. On univariate analysis, only the type of operation (Whipple) was significantly associated with exocrine dysfunction ( P = 0.04). On multivariate analysis, both female gender and type of operation were independently associated with postoperative exocrine dysfunction ( P = 0.05). Pancreatic exocrine dysfunction occurred less frequently in this population than what is commonly reported in the literature. Female patients undergoing resection of the pancreatic head have significantly increased risk of exocrine dysfunction.

scholarly journals Exceeding Pitch Count Recommendations In Youth Baseball Increases The Elbow Injuries

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0012
Author(s):  
Tetsuya Matsuura ◽  
Toshiyuki Iwame ◽  
Koichi Sairyo
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Multivariate Analysis ◽  
Univariate Analysis ◽  
The United States ◽  
Injury Incidence ◽  
Elbow Pain ◽  
Increased Risk ◽  
Youth Baseball ◽  
Elbow Injuries

Objectives: With the incidence of Little League elbow increasing, pitch limit recommendations for preventing throwing injuries have been developed in the United States and Japan. In 1995, the Japanese Society of Clinical Sports Medicine announced limits of 50 pitches per day and 200 pitches per week to prevent throwing injuries in younger than 12 years old. However the relationship between pitch limit recommendation and elbow injuries among pitchers has not been adequately studied. The aim of our study was to evaluate the association between pitch counts and elbow injuries in youth pitchers. Methods: A total of 149 pitchers without prior elbow pain were observed prospectively for 1 season to study injury incidence in relation to specific risk factors. Average age was 10.1 years (range, 7-11 years). One year later, all pitchers were examined by questionnaire. Subjects were asked whether they had experienced any episodes of elbow pain during the season. The questionnaire was also used to gather data on pitch counts per day and per week, age, number of training days per week, and number of games per year. We investigated the following risk factors for elbow injury: pitch counts, age, position, number of training days per week, and number of games per year. Data were analyzed by multivariate logistic regression models and presented as odds ratio (OR) and profile likelihood 95% confidence interval (CI) values. The likelihood-ratio test was also performed. A two-tailed P value of less than .05 was considered significant. All analysis was done in the SAS software package (version 8.2). Results: Of the 149 subjects, 66 (44.3%) reported episodes of pain in the throwing elbow during the season. 1. Analysis for pitch count per day Univariate analysis showed that elbow pain was significantly associated with more than 50 pitches per day. Multivariate analysis showed that more than 50 pitches per day (OR, 2.44; 95% CI, 1.22-4.94), and more than 70 games per year (OR, 2.47; 95% CI, 1.24-5.02) were risk factors significantly associated with elbow pain. Age and number of training days per week were not significantly associated with elbow pain. 1. Analysis for pitch count per week Univariate analysis showed that elbow pain was significantly associated with more than 200 pitches per week. Multivariate analysis showed that more than 200 pitches per week (OR, 2.04; 95% CI, 1.03-4.10), and more than 70 games per year (OR, 2.41; 95% CI, 1.22-4.87) were risk factors significantly associated with elbow pain. Age was not significantly associated with elbow pain. Conclusion: A total of 44.3% of youth baseball pitchers had elbow pain during the season. Multivariable logistic regression revealed that elbow pain was associated with more than 50 pitches per day, more than 200 pitches per week, and more than 70 games per year. Previous studies have revealed the risk factor with the strongest association to injury is pitcher. Our data suggest that compliance with pitch limit recommendations including limits of 50 pitches per day and 200 pitches per week may be protective against elbow injuries. Those who played more than 70 games per year had a notably increased risk of injury. With increasing demand on youth pitchers to play more, there is less time for repair of bony and soft tissues in the elbow. In conclusion, among youth pitchers, limits of 50 pitches per day, 200 pitches per week, and limits of 70 games per year may protect elbow injuries.

scholarly journals Vertebral compression fractures after stereotactic body radiation therapy: a large, multi-institutional, multinational evaluation

2016 ◽  
Vol 24 (6) ◽  
pp. 928-936 ◽  
Author(s):  
Maha Saada Jawad ◽  
Daniel K. Fahim ◽  
Peter C. Gerszten ◽  
John C. Flickinger ◽  
Arjun Sahgal ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Vertebral Compression Fracture ◽  
Stereotactic Body Radiation Therapy ◽  
Univariate Analysis ◽  
Compression Fracture ◽  
Target Delineation ◽  
Solitary Metastasis ◽  
Increased Risk ◽  
Prescription Dose

OBJECTIVE The purpose of this study was to identify factors contributing to an increased risk for vertebral compression fracture (VCF) following stereotactic body radiation therapy (SBRT) for spinal tumors. METHODS A total of 594 tumors were treated with spinal SBRT as primary treatment or re-irradiation at 8 different institutions as part of a multi-institutional research consortium. Patients underwent LINAC-based, image-guided SBRT to a median dose of 20 Gy (range 8–40 Gy) in a median of 1 fraction (range 1–5 fractions). Median patient age was 62 years. Seventy-one percent of tumors were osteolytic, and a preexisting vertebral compression fracture (VCF) was present in 24% of cases. Toxicity was assessed following treatment. Univariate and multivariate analyses were performed using a logistic regression method to determine parameters predictive for post-SBRT VCF. RESULTS At a median follow-up of 10.1 months (range 0.03–57 months), 80% of patients had local tumor control. At the time of last imaging follow-up, at a median of 8.8 months after SBRT, 3% had a new VCF, and 2.7% had a progressive VCF. For development of any (new or progressive) VCF following SBRT, the following factors were predictive for VCF on univariate analysis: short interval from primary diagnosis to SBRT (less than 36.8 days), solitary metastasis, no additional bone metastases, no prior chemotherapy, preexisting VCF, no MRI used for target delineation, tumor volume of 37.3 cm3 or larger, equivalent 2-Gy-dose (EQD2) tumor of 41.8 Gy or more, and EQD2 spinal cord Dmax of 46.1 Gy or more. Preexisting VCF, solitary metastasis, and prescription dose of 38.4 Gy or more were predictive on multivariate analysis. The following factors were predictive of a new VCF on univariate analysis: solitary metastasis, no additional bone metastases, and no MRI used for target delineation. Presence of a solitary metastasis and lack of MRI for target delineation remained significant on multivariate analysis. CONCLUSIONS A VCF following SBRT is more likely to occur following treatment for a solitary spinal metastasis, reflecting a more aggressive treatment approach in patients with adequately controlled systemic disease. Higher prescription dose and a preexisting VCF also put patients at increased risk for post-SBRT VCF. In these patients, pre-SBRT cement augmentation could be considered to decrease the risk of subsequent VCF.

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