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.

scholarly journals Logistic regression analysis on risk factors of augmented vertebra recompression after percutaneous vertebral augmentation

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Zhongcheng An ◽  
Chen Chen ◽  
Junjie Wang ◽  
Yuchen Zhu ◽  
Liqiang Dong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Bone Cement ◽  
Vertebral Compression Fracture ◽  
Univariate Analysis ◽  
Compression Fracture ◽  
Osteoporotic Vertebral Compression Fracture ◽  
Vertebral Augmentation ◽  
Surgical Methods

Abstract Objective To explore the high-risk factors of augmented vertebra recompression after percutaneous vertebral augmentation (PVA) in the treatment of osteoporotic vertebral compression fracture (OVCF) and analyze the correlation between these factors and augmented vertebra recompression after PVA. Methods A retrospective analysis was conducted on 353 patients who received PVA for a single-segment osteoporotic vertebral compression fracture from January 2017 to December 2018 in our department according to the inclusion criteria. All cases meeting the inclusion and exclusion criteria were divided into two groups: 82 patients in the recompression group and 175 patients in the non-compression group. The following covariates were reviewed: age, gender, body mass index (BMI), injured vertebral segment, bone mineral density (BMD) during follow-up, intravertebral cleft (IVC) before operation, selection of surgical methods, unilateral or bilateral puncture, volume of bone cement injected, postoperative leakage of bone cement, distribution of bone cement, contact between the bone cement and the upper or lower endplates, and anterior height of injured vertebrae before operation, after surgery, and at the last follow-up. Univariate analysis was performed on these factors, and the statistically significant factors were substituted into the logistic regression model to analyze their correlation with the augmented vertebra recompression after PVA. Results A total of 257 patients from 353 patients were included in this study. The follow-up time was 12–24 months, with an average of 13.5 ± 0.9 months. All the operations were successfully completed, and the pain of patients was relieved obviously after PVA. Univariate analysis showed that in the early stage after PVA, the augmented vertebra recompression was correlated with BMD, surgical methods, volume of bone cement injected, preoperative IVC, contact between bone cement and the upper or lower endplates, and recovery of anterior column height. The difference was statistically significant (P < 0.05). Among them, multiple factors logistic regression elucidated that more injected cement (P < 0.001, OR = 0.558) and high BMD (P = 0.028, OR = 0.583) were negatively correlated with the augmented vertebra recompression after PVA, which meant protective factors (B < 0). Preoperative IVC (P < 0.001, OR = 3.252) and bone cement not in contact with upper or lower endplates (P = 0.006, OR = 2.504) were risk factors for the augmented vertebra recompression after PVA. The augmented vertebra recompression after PVP was significantly less than that of PKP (P = 0.007, OR = 0.337). Conclusions The augmented vertebra recompression after PVA is due to the interaction of various factors, such as surgical methods, volume of bone cement injected, osteoporosis, preoperative IVC, and whether the bone cement is in contact with the upper or lower endplates.

The risk of debilitating falls in Manitobans living with prostate cancer (pc).

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 244-244
Author(s):  
Joel Roger Gingerich ◽  
Pascal Lambert ◽  
Malcolm Doupe ◽  
Paul Joseph Daeninck ◽  
Marshall W. Pitz ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Cumulative Incidence ◽  
Large Population ◽  
Univariate Analysis ◽  
Population Based ◽  
Community Dwelling ◽  
Low Grade ◽  
Population Based Study ◽  
Increased Risk

244 Background: Falls and fall-related injuries are important patient safety problems. Some studies suggest that pc patients have higher fall rates, however the severity of these falls is unknown. We sought to measure if pc patients are at increased risk of a debilitating fall requiring hospitalization. Methods: This is a retrospective population-based study utilizing the Manitoba Cancer Registry and Manitoba Health administrative databases. Our cohort consists of all community-dwelling patients living in Manitoba Canada who were diagnosed with pc between 2004 and 2008. These individuals were matched by age, sex, and time of diagnosis with up to three cancer-free controls. Debilitating falls were defined as falls/fractures requiring hospitalization and were identified using ICD-9 and -10 billing codes. A competing risk model was used to compare debilitating falls between the pc and cancer-free cohorts and expressed as sub-hazard ratios. Follow-up ended December 31, 2009. Results: 2,903 pc patients were identified along with 8,686 matched controls. The mean age was 69.3 and 68.8 respectively. The median follow-up was 3.05 years. Debilitating falls were identified in 109 patients (3.8%) with pc and 345 (4%) matched controls. The cumulative incidence of debilitating falls for those with pc vs cancer-free controls were: 1.08% vs. 1.13% at 1-year and 5.25% vs. 5.96% at five years of follow-up (SHR = 0.95, 95% CI = 0.77 – 1.18, p = 0.65). On univariate analysis, patients with stage IV pc were at higher risk of falls compared to matched controls. This difference was not significant on multivariate analysis though (SHR = 1.19, 95% CI = 0.74 – 1.89, p = 0.48). On multivariate analysis, patients with a Gleason score of ≤6 experienced a reduced risk of debilitating falls compared to matched controls (SHR = 0.44, 95% CI = 0.27 – 0.72, p = 0.001), whereas patients with other Gleason scores did not. The analysis was similar when patients with fractures were excluded. Conclusions: In this large population-based study, the 1- and 5-year cumulative incidence of debilitating falls did not differ significantly for patients with vs without pc. In fact, compared to matched controls, low grade pc patients were less likely to experience a debilitating fall.

scholarly journals Logistic regression analysis on risk factors of augmented vertebra recompression after percutaneous vertebral augmentation

2021 ◽  
Author(s):  
Zhongcheng An ◽  
Chen Chen ◽  
Junjie Wang ◽  
Yuchen Zhu ◽  
Liqiang Dong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Bone Cement ◽  
Vertebral Compression Fracture ◽  
Univariate Analysis ◽  
Compression Fracture ◽  
Osteoporotic Vertebral Compression Fracture ◽  
Vertebral Augmentation ◽  
Surgical Methods

Abstract Objective: To explore the high-risk factors of augmented vertebra recompression after percutaneous vertebral augmentation (PVA) in the treatment of osteoporotic vertebral compression fracture (OVCF), and analyze the correlation between these factors and augmented vertebra recompression after PVA.Methods: A retrospective analysis was conducted on 353 patients who received PVA for a single-segment osteoporotic vertebral compression fracture from January 2017 to December 2018 in our department according to inclusion criteria. All cases meeting inclusion and exclusion criteria were divided into two groups: 82 patients in recompression group and 175 patients in non-compression group. The following covariates were reviewed: age, gender, body mass index (BMI), injured vertebral segment, bone mineral density(BMD) during follow-up, intravertebral cleft（IVC）before operation, selection of surgical methods, unilateral or bilateral puncture, volume of bone cement injected, postoperative leakage of bone cement, distribution of bone cement, contact between the bone cement and the upper or lower endplates, and anterior height of injured vertebrae before operation, after surgery and at the last follow-up. Univariate analysis was performed on these factors, and the statistically significant factors were substituted into the logistic regression model to analyze their correlation with the augmented vertebra recompression after PVA. Results: A total of 257 patients from 353 patients were included in this study. The follow-up time was 12-24 months, with an average of (13.5±0.9) months. All the operations were successfully completed, and the pain of patients was relieved obviously after PVA. Univariate analysis showed that in the early stage after PVA, the augmented vertebra recompression was correlated with BMD, surgical methods, volume of bone cement injected, preoperative IVC, contact between bone cement and the upper or lower endplates, and recovery of anterior column height. The difference was statistically significant (P<0.05). Among them, multiple factors logistic regressioin elucidated that more injected cement (P<0.001,OR=0.558) and high BMD (P=0.028, OR=0.583) were negatively correlated with the augmented vertebra recompression after PVA, which meant protective factors (B<0). Preoperative IVC (P<0.001, OR=3.252) and bone cement not in contact with upper or lower endplates (P=0.006, OR=2.504) were risk factors for the augmented vertebra recompression after PVA. The augmented vertebra recompression after PVP was significantly less than that of PKP (P=0.007, OR=0.337).Conclusions: The augmented vertebra recompression after PVA is due to the interaction of various factors, such as surgical methods, volume of bone cement injected, osteoporosis, preoperative IVC, and whether the bone cement is in contact with the upper or lower endplates.

Incidence and predictive factors of late relapse in patients with soft tissue sarcomas: Implications for prolonged follow-up.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 10574-10574
Author(s):  
Maud Toulmonde ◽  
Axel Le Cesne ◽  
Jean Mendiboure ◽  
Jean-Yves Blay ◽  
Sophie Piperno-Neumann ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Soft Tissue ◽  
Univariate Analysis ◽  
Local Relapse ◽  
Late Relapse ◽  
Histological Subtype ◽  
Initial Management ◽  
Increased Risk ◽  
Metastatic Relapse

10574 Background: There is no consensus on how to follow soft-tissue sarcoma (STS) patients after their initial management. In particular, the incidence of late relapse which would justify prolonged surveillance is unknown. Methods: Follow-up data were reviewed from 719 patients with localized STS, included in the French Sarcoma Group database from January 1990 to June 2005, and who achieved complete remission maintained for at least five years after their initial management. The outcomes of interest were the cumulative probabilities of late (> 5 years) local and metastatic relapse with death as a competing event. Estimations and 95% confidence intervals (CIs) were computed with the cumulative incidence function. Patients who did not experience the event of interest or death over the course of the study were censored at their last follow-up. Results: 67 (9.3%) and 42 (5.8%) patients had late local and metastatic relapse respectively. On univariate analysis, internal trunk location, liposarcoma histological subtype, tumor size > 10 cm, R1 margins, no adjuvant radiotherapy were significantly associated with increased risk of late local relapse. On multivariate analysis, internal trunk location (HR= 3.9, 95% CI 2.2-6.7, p<0.001) and tumor size > 10 cm (HR= 2.1, 95% CI 1.1-4, p=0.03) were the two factors independently associated with local relapse. On univariate analysis, leiomyosarcoma histological subtype, and grade > 1 were significantly associated with increased risk of late metastatic relapse. On multivariate analysis, grade > 1 (HR= 4.7, 95% CI 1.1-21, p=0.04) was the sole factor independently associated with the risk of late metastatic relapse. Conclusions: Late relapse of STS (> 5 years after initial management) is relatively uncommon. However, its existence and our results emphasize the critical role of long-term follow-up to detect late local recurrence in patients with retroperitoneal or very large STS and late metastatic recurrence in patients with high grade disease.

scholarly journals Vertebral Compression Fracture After Spine Stereotactic Body Radiation Therapy: A Review of the Pathophysiology and Risk Factors

Neurosurgery ◽  
2017 ◽  
Vol 83 (3) ◽  
pp. 314-322 ◽  
Author(s):  
Salman Faruqi ◽  
Chia-Lin Tseng ◽  
Cari Whyne ◽  
Majed Alghamdi ◽  
Jefferson Wilson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Radiation Therapy ◽  
Vertebral Compression Fracture ◽  
Stereotactic Body Radiation Therapy ◽  
Compression Fracture ◽  
Stereotactic Body Radiation ◽  
Risk Patients ◽  
Spinal Segments ◽  
Selection Of

Abstract BACKGROUND Vertebral compression fracture (VCF) is a challenging and not infrequent complication observed following spine stereotactic body radiation therapy (SBRT). OBJECTIVE To summarize the data from the multiple studies that have been published, addressing the risk and predictive factors for VCF post-SBRT. METHODS A systematic literature review was conducted. Studies were selected if they specifically addressed risk factors for post-SBRT VCF in their analyses. RESULTS A total of 11 studies were identified, reporting both the risk of VCF post-SBRT and an analysis of risk factors based on univariate and multivariate analysis. A total of 2911 spinal segments were treated with a crude VCF rate of 13.9%. The most frequently identified risk factors on multivariate analysis were: lytic disease (hazard ratio [HR] range, 2.76-12.2), baseline VCF prior to SBRT (HR range, 1.69-9.25), higher dose per fraction SBRT (HR range, 5.03-6.82), spinal deformity (HR range, 2.99-11.1), older age (HR range, 2.15-5.67), and more than 40% to 50% of vertebral body involved by tumor (HR range, 3.9-4.46). In the 9 studies that specifically reported on the use of post-SBRT surgical procedures, 37% of VCF had undergone an intervention (range, 11%-60%). CONCLUSION VCF is an important adverse effect following SBRT. Risk factors have been identified to guide the selection of high-risk patients. Evidence-based algorithms with respect to patient selection and intervention are needed.

Breast Implant-Associated Anaplastic Large Cell Lymphoma: Treatment Experience In 53 Patients

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5089-5089 ◽  
Author(s):  
Alexandra Hart ◽  
Mary Jo Lechowicz
Keyword(s):  
Bone Marrow ◽  
Multivariate Analysis ◽  
Cell Lymphoma ◽  
Breast Implant ◽  
Univariate Analysis ◽  
Large Cell ◽  
Increased Risk ◽  
Disease Extension ◽  
Large Cell Lymphoma

Purpose Primary breast lymphomas are exceedingly rare; yet, recent reports continue to describe cases of breast implant-associated anaplastic large cell lymphoma (bi-ALCL). Every year over 250,000 women receive breast implants for cosmetic and reconstructive purposes making it necessary to explore the potential consequences of this emerging disease. Although the majority of cases follow an indolent clinical course, there have been several patient (pt) deaths reported, emphasizing the importance of investigation into variables associated with poor clinical outcomes. The purpose of this study is to describe pts diagnosed with bi-ALCL in order to enhance our management and treatment of this disease. Methods A review of the literature using search engines PubMed and MEDLINE were conducted using search terms “Anaplastic” AND “Lymphoma” AND “Breast,” “ALCL” AND “Breast” AND “Implants,” and “Anaplastic” AND “Breast” AND “Implant.” Articles were analyzed for accurate diagnoses excluding any duplicate pts. Two pts at our institution were reviewed using medical records. Univariate analysis determined significant associations (p<0.05). Multivariate analysis was performed when adequate pt data available. Results Sixty-two pts with bi-ALCL were identified from 29 publications, and two additional pts from our clinical practice were included. Eleven pts were excluded secondary to lack of treatment data. Clinical variables are summarized in Table 1. Twelve pts presented with extracapsular disease. Sixteen of 53 (23.1%) pts presented with a mass. Only nine pts (17%) were adequately staged for NHL. Twenty-one pts received a PET scan, and 9 received a bone marrow biopsy. Twenty one pts (39.6%) received surgery alone, 5 pts (9.4%) received surgery and radiation, 10 pts (18.9%) received surgery and chemotherapy, and 16 pts (30.2%) received surgery, chemotherapy, and radiation, and one pt (1.9%) received chemotherapy alone. CHOP (n=23, 43.4%) was the most common chemotherapy regimen. One pt received a bone marrow transplant (BMT) for upfront consolidative therapy. The median follow up is 15 months (3.6-90 months). Fifteen pts (28.3%) had recurrent disease. Eleven of those 15 pts (73.3%) were treated with salvage chemotherapy. Of those six received CHOP, two received ICE salvage, and three had an autologous BMT. Four patients died from their disease. Univariate analysis demonstrated extracapsular disease extension is associated with increased risk for recurrence (p<.0001) and pt death (p=0.0008). B symptoms at presentation were associated with pt death (p=0.012). Pts presenting with a mass were not at increased odds for recurrence (p=0.36) but were at increased odds for death (p=0.043). Multivariate analysis did not show any significant difference in the odds for recurrence among different treatment modalities. Conclusion This represents the largest series of pts with bi-ALCL described to date. Our analysis confirms extracapsular disease extension is associated with increased risk for recurrence and patient death. Established protocols for NHL staging have not been routinely utilized. More detailed follow-up is necessary for prognostic data in this patient population. Future treatment guidelines will require a multi-disciplinary unified approach. Disclosures: No relevant conflicts of interest to declare.

scholarly journals PROGNOSTIC FACTORS OF RENAL TUMOR RECURRENCE AFTER RADICAL NEPHRECTOMY

2021 ◽  
Vol 108 (Supplement_3) ◽  
Author(s):  
G Martínez Izquierdo ◽  
A R Arnaiz Pérez ◽  
E Escolano Fernández ◽  
M Merayo Álvarez ◽  
B Carrasco Aguilera ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Radical Nephrectomy ◽  
Univariate Analysis ◽  
Malignant Neoplasms ◽  
Histopathological Analysis ◽  
Chi Square ◽  
Renal Sinus ◽  
Chi Square Test

Abstract INTRODUCTION Renal cell carcinoma (RCC) represents 3% of overall malignant neoplasms in adults. However, its aetiology has not been clearly established. Although surgery represents the cornerstone in treatment, recurrence postoperative rates are around 20-30%, what implies prognostic factors search must be mandatory in order to help to plan de follow-up and the different adjuvant therapy possibilities available in case they were necessary. MATERIAL AND METHODS A retrospective observational study was carried out in 110 patients who underwent radical nephrectomy between 2004 and 2018, with the aim of identifying possible prognostic factors of recurrence of RCC after these surgeries. Preoperative data (epidemiological, comorbidities and laboratory tests), surgical, pathological and variables related to follow-up were taken into account. A univariate and multivariate analysis were performed, using chi-square test and logistic regression, respectively. RESULTS The median follow-up time was 53.5 months (SD = 35.8), time in which 19 patients had a recurrence of RCC after radical nephrectomy (17.2%). Histopathological items such as the surgical piece size, the nodal and microvascular invasion, the renal sinus invasion and the presence of necrosis in the surgical piece were associated with RCC recurrence in the univariate analysis, while only the presence of necrosis in the surgical piece showed a significant result in the multivariate analysis (p = 0.004). CONCLUSIONS Histopathological analysis, highlighting the presence of necrosis in the histological sample, was proved to be the main risk factor of RCC recurrence.

scholarly journals Cement bridging phenomenon in percutaneous vertebroplasty for adjacent vertebral compression fracture

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yun-Da Li ◽  
Tsung-Ting Tsai ◽  
Chi-Chien Niu ◽  
Po-Liang Lai
Keyword(s):  
Vertebral Compression Fracture ◽  
Body Height ◽  
Compression Fracture ◽  
Plain Film ◽  
Imaging Features ◽  
Height Ratio ◽  
Kyphotic Angle ◽  
Anterior Body ◽  
New Onset

AbstractIn some cases of vertebroplasty for adjacent fractures, we observed a cement bridging phenomenon, in which the injected cement flowed from the newly fractured vertebra to the previously cement-augmented vertebra through the space between the abutting anterior longitudinal ligament and the vertebral column. The purpose of this retrospective study was to investigate this phenomenon. From January 2012 to December 2014, patients who sustained new-onset adjacent vertebral compression fracture and who were again treated with vertebroplasty were enrolled. We divided the patients into two groups, the bridging group and the nonbridging group, to analyze the difference between them. Results showed that the cement bridging phenomenon occurred in 18 (22.8%) of the 79 patients. Significant differences between the bridging and nonbridging groups were identified in the following 3 imaging features: severe loss of the anterior vertebral body height at the new-onset adjacent vertebra on plain film (odds ratio [OR] = 4.46, p = 0.014), fluid accumulation (OR = 36.27, p < 0.001) and hypointense signaling (OR = 15.67, p < 0.001) around the space anterior to the abutting vertebral bodies and the corresponding intervertebral disc on MRI. After a 2-year follow-up, both the mean value of the focal kyphotic angle and anterior body height ratio were significantly better in the cement bridging group than in the nonbridging group. The cement bridging phenomenon, which has never been reported in the literature, is not rare in clinical practice. This phenomenon was associated with better maintenance of focal kyphotic angle and anterior body height ratio during the 2-year follow-up.

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