Salman Faruqi1, Chia-Lin Tseng1, Cari Whyne2, Majed Alghamdi1, Jefferson Wilson3, Sten Myrehaug1, Hany Soliman1, Young Lee1, Pejman Maralani4, Victor Yang5, Charles Fisher6, Arjun Sahgal1. 1. Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada. 2. Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. 3. Department of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. 4. Department of Radiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. 5. Department of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. 6. Department of Neurosurgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
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.
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.
Authors: Gustavo N Marta; Fernando F de Arruda; Fabiana A Miranda; Alice R N S Silva; Wellington F P Neves-Junior; Anselmo Mancini; Samir A Hanna; Carlos E C V Abreu; João Luis F da Silva; Jose Eduardo V Nascimento; Cecília Maria K Haddad; Fabio Y Moraes; Rafael Gadia Journal: Rep Pract Oncol Radiother Date: 2021-09-30
Authors: Marc A Stadelmann; Denis E Schenk; Ghislain Maquer; Christopher Lenherr; Florian M Buck; Dieter D Bosshardt; Sven Hoppe; Nicolas Theumann; Ron N Alkalay; Philippe K Zysset Journal: Bone Date: 2020-08-20 Impact factor: 4.626
Authors: Michael J Morris; Eva Corey; Theresa A Guise; James L Gulley; William Kevin Kelly; David I Quinn; Arne Scholz; George Sgouros Journal: Nat Rev Urol Date: 2019-11-11 Impact factor: 14.432