Tai-Chung Lam1, Hajime Uno2, Monica Krishnan3, Steven Lutz4, Michael Groff5, Matthew Cheney6, Tracy Balboni7. 1. Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts. Electronic address: lamtaichung@gmail.com. 2. Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts. 3. Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts. 4. Department of Radiation Oncology, Blanchard Valley Regional Medical Center, Findlay, Ohio. 5. Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts. 6. Harvard Radiation Oncology Program, Boston, Massachusetts. 7. Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.
Abstract
PURPOSE: Level I evidence demonstrates equivalent pain response after single-fraction (SF) or multifraction (MF) radiation therapy (RT) for bone metastases. The purpose of this study is to provide additional data to inform the incidence and predictors of adverse outcomes after RT for spine metastases. METHODS AND MATERIALS: At a single institution, 299 uncomplicated spine metastases (without cord compression, prior RT, or surgery) treated with RT from 2008 to 2013 were retrospectively reviewed. The spinal instability neoplastic score (SINS) was used to assess spinal instability. The primary outcome was time to first spinal adverse event (SAE) at the site, including symptomatic vertebral fracture, hospitalization for site-related pain, salvage surgery, interventional procedure, new neurologic symptoms, or cord compression. Fine and Gray's multivariable model assessed associations of the primary outcome with SINS, SF RT, and other significant baseline factors. Propensity score matched analysis further assessed the relationship of SF RT to first SAEs. RESULTS: The cumulative incidence of first SAE after SF RT (n=66) was 6.8% at 30 days, 16.9% at 90 days, and 23.6% at 180 days. For MF RT (n=233), the incidence was 3.5%, 6.4%, and 9.2%, respectively. In multivariable analysis, SF RT (hazard ratio [HR] = 2.8, 95% confidence interval [CI] 1.5-5.2, P=.001) and SINS ≥ 11 (HR=2.5 , 95% CI 1.3-4.9, P=.007) were predictors of the incidence of first SAE. In propensity score matched analysis, first SAEs had developed in 22% of patients with SF RT versus 6% of those with MF RT cases (HR=3.9, 95% CI 1.6-9.6, P=.003) at 90 days after RT. CONCLUSION: In uncomplicated spinal metastases treated with RT alone, spinal instability with SINS ≥ 11 and SF RT were associated with a higher rate of SAEs.
PURPOSE: Level I evidence demonstrates equivalent pain response after single-fraction (SF) or multifraction (MF) radiation therapy (RT) for bone metastases. The purpose of this study is to provide additional data to inform the incidence and predictors of adverse outcomes after RT for spine metastases. METHODS AND MATERIALS: At a single institution, 299 uncomplicated spine metastases (without cord compression, prior RT, or surgery) treated with RT from 2008 to 2013 were retrospectively reviewed. The spinal instability neoplastic score (SINS) was used to assess spinal instability. The primary outcome was time to first spinal adverse event (SAE) at the site, including symptomatic vertebral fracture, hospitalization for site-related pain, salvage surgery, interventional procedure, new neurologic symptoms, or cord compression. Fine and Gray's multivariable model assessed associations of the primary outcome with SINS, SF RT, and other significant baseline factors. Propensity score matched analysis further assessed the relationship of SF RT to first SAEs. RESULTS: The cumulative incidence of first SAE after SF RT (n=66) was 6.8% at 30 days, 16.9% at 90 days, and 23.6% at 180 days. For MF RT (n=233), the incidence was 3.5%, 6.4%, and 9.2%, respectively. In multivariable analysis, SF RT (hazard ratio [HR] = 2.8, 95% confidence interval [CI] 1.5-5.2, P=.001) and SINS ≥ 11 (HR=2.5 , 95% CI 1.3-4.9, P=.007) were predictors of the incidence of first SAE. In propensity score matched analysis, first SAEs had developed in 22% of patients with SF RT versus 6% of those with MF RT cases (HR=3.9, 95% CI 1.6-9.6, P=.003) at 90 days after RT. CONCLUSION: In uncomplicated spinal metastases treated with RT alone, spinal instability with SINS ≥ 11 and SF RT were associated with a higher rate of SAEs.
Authors: Joanne M van der Velden; Anne L Versteeg; Helena M Verkooijen; Charles G Fisher; Edward Chow; F Cumhur Oner; Marco van Vulpen; Lorna Weir; Jorrit-Jan Verlaan Journal: Oncologist Date: 2017-05-03
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Authors: Chia-Lin Tseng; Wietse Eppinga; Raphaele Charest-Morin; Hany Soliman; Sten Myrehaug; Pejman Jabehdar Maralani; Mikki Campbell; Young K Lee; Charles Fisher; Michael G Fehlings; Eric L Chang; Simon S Lo; Arjun Sahgal Journal: Global Spine J Date: 2017-04-06