Diana D Shi1, Lauren M Hertan2, Tai Chung Lam3, Sonia Skamene4, John H Chi5, Michael Groff6, Charles H Cho7, Marco L Ferrone8, Mitchel Harris8, Yu-Hui Chen9, Tracy A Balboni10. 1. Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. 2. Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts. 3. Tuen Mun Hospital, Tuen Mun, Hong Kong. 4. Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts. 5. Harvard Medical School, Boston, Massachusetts; Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts. 6. Harvard Medical School, Boston, Massachusetts; Tuen Mun Hospital, Tuen Mun, Hong Kong. 7. Harvard Medical School, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts. 8. Harvard Medical School, Boston, Massachusetts; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts. 9. Dana-Farber Cancer Institute, Boston, Massachusetts. 10. Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts. Electronic address: tbalboni@bwh.harvard.edu.
Abstract
PURPOSE: Assessing the stability of spinal metastases is critical for making treatment decisions. The spinal instability neoplastic score (SINS) was developed by the Spine Oncology Study Group to categorize tumor-related lesions; however, data describing its utility in predicting fractures in patients with spinal metastases are limited. The purpose of this study is to assess the validity of SINS in predicting new or worsening fracture after radiation therapy (RT) to spine metastases. METHODS AND MATERIALS: This is a retrospective analysis of patients treated with conventional RT alone (median total dose, 30 Gy; range, 8-47 Gy; median number of fractions, 10; range, 1-25) for spinal metastasis at Dana-Farber/Brigham and Women's Cancer Center from 2006 to 2013. SINS was calculated for each lesion (range, 0-18). The primary endpoint was time from RT start to radiographically documented new or worsening fracture or last disease assessment. RESULTS: A total of 203 patients and 250 lesions were included in analysis. The percentages of lesions with SINS of 0 to 6, 7 to 12, and 13 to 18 were 38.8%, 54.8%, and 6.4%, respectively. Of 250 lesions, 20.4% developed new or worsening fractures; 14.4% for SINS 0 to 6, 21.2% for SINS 7 to 12, and 50.0% for SINS 13 to 18. Multivariate analysis adjusted for sex, age, Eastern Cooperative Oncology Group, histology, and total dose indicated that, compared with stable lesions (SINS 0-6), potentially unstable lesions (SINS 7-12) demonstrated a greater likelihood of new or worsening fracture that was not statistically significant (hazard ratio, 1.66; 95% confidence interval, 0.85-3.22; P = .14), and unstable lesions (SINS 13-18) were significantly more likely to develop to new or worsening fracture (hazard ratio, HR,4.37, 95% confidence interval, 1.80-10.61; P = .001). CONCLUSIONS: In this study of patients undergoing RT for spinal metastases, 20.4% developed new or worsening vertebral fractures. SINS is demonstrated to be a useful tool to assess fracture risk after RT.
PURPOSE: Assessing the stability of spinal metastases is critical for making treatment decisions. The spinal instability neoplastic score (SINS) was developed by the Spine Oncology Study Group to categorize tumor-related lesions; however, data describing its utility in predicting fractures in patients with spinal metastases are limited. The purpose of this study is to assess the validity of SINS in predicting new or worsening fracture after radiation therapy (RT) to spine metastases. METHODS AND MATERIALS: This is a retrospective analysis of patients treated with conventional RT alone (median total dose, 30 Gy; range, 8-47 Gy; median number of fractions, 10; range, 1-25) for spinal metastasis at Dana-Farber/Brigham and Women's Cancer Center from 2006 to 2013. SINS was calculated for each lesion (range, 0-18). The primary endpoint was time from RT start to radiographically documented new or worsening fracture or last disease assessment. RESULTS: A total of 203 patients and 250 lesions were included in analysis. The percentages of lesions with SINS of 0 to 6, 7 to 12, and 13 to 18 were 38.8%, 54.8%, and 6.4%, respectively. Of 250 lesions, 20.4% developed new or worsening fractures; 14.4% for SINS 0 to 6, 21.2% for SINS 7 to 12, and 50.0% for SINS 13 to 18. Multivariate analysis adjusted for sex, age, Eastern Cooperative Oncology Group, histology, and total dose indicated that, compared with stable lesions (SINS 0-6), potentially unstable lesions (SINS 7-12) demonstrated a greater likelihood of new or worsening fracture that was not statistically significant (hazard ratio, 1.66; 95% confidence interval, 0.85-3.22; P = .14), and unstable lesions (SINS 13-18) were significantly more likely to develop to new or worsening fracture (hazard ratio, HR,4.37, 95% confidence interval, 1.80-10.61; P = .001). CONCLUSIONS: In this study of patients undergoing RT for spinal metastases, 20.4% developed new or worsening vertebral fractures. SINS is demonstrated to be a useful tool to assess fracture risk after RT.
Authors: Nicolas Serratrice; Joe Faddoul; Bilal Tarabay; Christian Attieh; Moussa A Chalah; Samar S Ayache; Georges N Abi Lahoud Journal: Front Oncol Date: 2022-01-27 Impact factor: 6.244