Risk of Fracture After Single Fraction Image-Guided Intensity-Modulated Radiation Therapy to Spinal Metastases
Risk of Fracture After Single Fraction Image-Guided Intensity-Modulated Radiation Therapy to Spinal Metastases
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DOI：
10.1200/jco.2008.19.3508
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发表时间：
2009-10-20
影响因子：
45.3
通讯作者：
Lis, Eric
中科院分区：
文献类型：
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作者：
Rose, Peter S.;Laufer, Ilya;Lis, Eric
目的单次影像引导调强放射治疗（IG-IMRT）可对传统的放射抵抗性肿瘤进行杀瘤治疗，同时保留重要的邻近结构。IG-IMRT脊柱转移瘤后椎体骨折的风险尚未defined.Patients和MethodsWe评估了62例连续患者接受单分数IG-IMRT在71个网站的实体器官转移。神经放射科医生和三个脊柱外科医生评估前瞻性获得的磁共振/计算机断层扫描（CT）成像研究治疗后骨折的发展和肿瘤recombination.ResultsFracture进展，注意到在27椎骨（39%）。多变量logistic回归分析显示CT表现、病变位置和椎体受累百分比独立预测骨折进展。位于T10和骶骨之间的病变发生骨折的可能性是T10以上病变的4.6倍（95%CI，1.1 - 19.7）。溶解性病变发生骨折的可能性是硬化性和混合性病变的6.8倍（95%CI，1.4 - 33.3）。随着椎体受累百分比的增加，骨折的几率也增加。骨折进展的患者麻醉剂使用显著增加，Karnofsky表现评分改变，疼痛评分有明显升高趋势。7例患者发生局部肿瘤进展，导致1例骨折。肥胖，后部元素参与，双膦酸盐的使用，和局部脊柱后凸并没有赋予增加risk. ConclusionVertebralfraction IG-IMRT脊柱转移性病变后骨折是常见的。溶解性病变累及超过40%的椎体，且位于T10或以下，骨折风险高，其存在导致临床结局显著较差。这些结果可能有助于临床医生识别高危患者，这些患者将从预防性椎体成形术或椎体后凸成形术中获益。
PurposeSingle-fraction image-guided intensity-modulated radiation therapy (IG-IMRT) allows for tumoricidal treatment of traditionally radioresistant cancers while sparing critical adjacent structures. Risk of vertebral fracture after IG-IMRT for spinal metastases has not been defined.Patients and MethodsWe evaluated 62 consecutive patients undergoing single fraction IG-IMRT at 71 sites for solid organ metastases. A neuroradiologist and three spine surgeons evaluated prospectively obtained magnetic resonance/computed tomography (CT) imaging studies for post-treatment fracture development and tumor recurrence.ResultsFracture progression was noted in 27 vertebrae (39%). Multivariate logistic regression analysis showed that CT appearance, lesion location, and percent vertebral body involvement independently predicted fracture progression. Lesions located between T10 and the sacrum were 4.6 times more likely to fracture than were lesions above T10 (95% CI, 1.1 to 19.7). Lytic lesions were 6.8 times more likely to fracture than were sclerotic and mixed lesions (95% CI, 1.4 to 33.3). As percent vertebral body involvement increased, odds of fracture also increased. Patients with fracture progression had significantly higher narcotic use, change in Karnofsky performance score, and a strong trend toward higher pain scores. Local tumor progression occurred in seven patients and contributed to one fracture. Obesity, posterior element involvement, bisphosphonate use, and local kyphosis did not confer increased risk.ConclusionVertebral fracture is common after single fraction IG-IMRT for metastatic spine lesions. Lytic disease involving more than 40% of the vertebral body and location at or below T10 confer a high risk of fracture, the presence of which yields significantly poorer clinical outcomes. These results may help clinicians identify high-risk patients who would benefit from prophylactic vertebro- or kyphoplasty.