Isabelle Thibault1, Eshetu G Atenafu2, Eric Chang3, Sam Chao4, Al-Omair Ameen1,5, Stephanie Zhou1, Nicholas Boehling6, Ehsan H Balagamwala4, Marcelo Cunha1, John Cho5, Lilyana Angelov7, Paul D Brown6, John Suh4, Laurence D Rhines8, Michael G Fehlings9, Arjun Sahgal1,5. 1. Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, Ontario, M4N 3M5, Canada. 2. Department of Biostatistics, University Health Network, University of Toronto, 610 University Ave, Toronto, Ontario, M5T 2M9, Canada. 3. Department of Radiation Oncology, University of Southern California, Los Angeles, California, USA, 930033. 4. Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio, 44195, USA. 5. Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, 610 University Ave, Toronto, Ontario, M5T 2M9, Canada. 6. Department of Radiation Oncology, M.D. Anderson Cancer Center, The University of Texas, Houston, Texas, USA, 77030. 7. Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, 44195, USA. 8. Department of Neurosurgery, M.D. Anderson Cancer Center, The University of Texas, Houston, Texas, 77030, USA. 9. Department of Neurosurgery and Spinal Program, Toronto Western Hospital, University of Toronto, 399 Bathurst St, Toronto, Ontario, M5T 2S8, Canada.
Abstract
PURPOSE: Determine the risk of vertebral compression fracture (VCF) following stereotactic body radiotherapy (SBRT), specific to osteolytic renal cell carcinoma (RCC) spinal metastases, and associated predictive factors. METHODS: 187 RCC osteolytic spinal tumor segments in 116 patients obtained from a multi-institutional pooled database were reviewed. Each segment was evaluated according to the Spinal Instability Neoplastic Score (SINS). RESULTS: The median follow-up was 8.0 months. 34 VCF (34/187, 18%) were observed and median time to VCF was 2.4 months. VCF was observed in 43% (10/23), 24% (4/17) and 14% (20/147) of segments treated with 24Gy/fraction (fx), 20-23Gy/fx and ≤19Gy/fx, respectively. Multivariate analysis identified dose per fx (p=0.005), baseline VCF (p<0.001) and spinal misalignment (p=0.002) as predictors of VCF. Prior conventional radiotherapy (p=0.029) was found to be protective. CONCLUSIONS: 18% of osteolytic RCC spinal metastases fractured post-SBRT. The presence of a baseline fracture, spinal mal-alignment and treatment with ≥20Gy/fx predicted for VCF.
PURPOSE: Determine the risk of vertebral compression fracture (VCF) following stereotactic body radiotherapy (SBRT), specific to osteolytic renal cell carcinoma (RCC) spinal metastases, and associated predictive factors. METHODS: 187 RCC osteolytic spinal tumor segments in 116 patients obtained from a multi-institutional pooled database were reviewed. Each segment was evaluated according to the Spinal Instability Neoplastic Score (SINS). RESULTS: The median follow-up was 8.0 months. 34 VCF (34/187, 18%) were observed and median time to VCF was 2.4 months. VCF was observed in 43% (10/23), 24% (4/17) and 14% (20/147) of segments treated with 24Gy/fraction (fx), 20-23Gy/fx and ≤19Gy/fx, respectively. Multivariate analysis identified dose per fx (p=0.005), baseline VCF (p<0.001) and spinal misalignment (p=0.002) as predictors of VCF. Prior conventional radiotherapy (p=0.029) was found to be protective. CONCLUSIONS: 18% of osteolytic RCC spinal metastases fractured post-SBRT. The presence of a baseline fracture, spinal mal-alignment and treatment with ≥20Gy/fx predicted for VCF.
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