Vertebral compression fracture risk after stereotactic body radiotherapy for spinal metastases Clinical article
Vertebral compression fracture risk after stereotactic body radiotherapy for spinal metastases Clinical article
复制标题
DOI：
10.3171/2011.11.spine116
复制
发表时间：
2012-04-01
影响因子：
2.8
通讯作者：
Chang, Eric L.
中科院分区：
文献类型：
--
作者：
Boehling, Nicholas S.;Grosshans, David R.;Chang, Eric L.
object.本研究的目的是确定潜在的危险因素，并确定椎体压缩性骨折（VCF）的发生率后，调强，近同步，CT图像引导立体定向体部放射治疗（SBRT）的脊椎骨。研究组包括93例患者的123个椎体（VB），这些患者入组了转移性疾病的前瞻性方案。对这些患者的数据进行回顾性分析。立体定向体部放射治疗包括1、3或5次分割，总体中位剂量分别为18、27和30戈伊。在基线和每次随访时获得的磁共振成像研究评估VCF、肿瘤累及和放射学进展。在基线和随访时，根据11分（0 - 10）简明疼痛量表对自我报告的平均疼痛水平进行评分。肥胖定义为体重指数a ≥ 30。中位影像学随访时间为14.9个月（范围1 - 71个月）。确定了25例新发或进展性骨折（20%），中位进展时间为SBRT后3个月。最常见的组织学包括肾癌（36例VB，10例骨折，10例肿瘤进展）、乳腺癌（20例VB，0例骨折，5例肿瘤进展）、甲状腺癌（14例VB，1例骨折，2例肿瘤进展）、非小细胞肺癌（13例VB，3例骨折，3例肿瘤进展）和肉瘤（9例VB，2例骨折，2例肿瘤进展）。15例VB在SBRT后接受椎体后凸成形术或椎体成形术治疗，其中5例手术是针对既存VCF。在32个部位（26%）观察到肿瘤进展，中位进展时间为5个月。在观察到骨折进展时，平均疼痛评分有升高的趋势，但中位值无显著变化。单因素Logistic回归分析显示，年龄> 55岁（HR 6.05，95%CI 2.1 - 17.47），既存骨折（HR 5.05，95% CI 1.94 - 13.16），基线疼痛和SBRT前麻醉剂使用（疼痛：HR 1.31，95% CI 1.06 - 1.62;麻醉药：HR 2.98，95% CI 1.17 - 7.56）和SBRT后（疼痛：HR 1.34，95%CI 1.06 - 1.70;麻醉药：HR 3.63，95%CI 1.41 - 9.29）是骨折进展的统计学显著预测因素。多变量分析发现，年龄> 55岁（HR 10.66，95%CI 2.81 - 40.36）、既往骨折（HR 9.17，95%CI 2.31 - 36.43）和基线疼痛（HR 1.41，95%CI 1.05 - 1.9）是显著风险因素，而肥胖（HR 0.02，95%CI 0 - 0.2）具有保护作用。立体定向体部放疗与VCF的显著风险（20%）相关。VCF的风险因素包括年龄> 55岁，先前存在的骨折和基线疼痛。这些风险因素可能有助于选择哪些脊柱SBRT患者应考虑进行预防性椎体稳定或增强手术。临床试验注册号：NCT 00508443。(http：//thejns.org/doi/abs/10.3171/2011.11.SPINE116）
Object. The aim of this study was to identify potential risk factors for and determine the rate of vertebral compression fracture (VCF) after intensity-modulated, near-simultaneous, CT image guided stereotactic body radiotherapy (SBRT) for spinal metastases.Methods. The study group consisted of 123 vertebral bodies (VBs) in 93 patients enrolled in prospective protocols for metastatic disease. Data from these patients were retrospectively analyzed. Stereotactic body radiotherapy consisted of 1, 3, or 5 fractions for overall median doses of 18, 27, and 30 Gy, respectively. Magnetic resonance imaging studies, obtained at baseline and at each follow-up, were evaluated for VCFs, tumor involvement, and radiographic progression. Self-reported average pain levels were scored based on the 11-point (0-10) Brief Pain Inventory both at baseline and at follow-up. Obesity was defined as a body mass index a >= 30.Results. The median imaging follow-up was 14.9 months (range 1-71 months). Twenty-five new or progressing fractures (20%) were identified, and the median time to progression was 3 months after SBRT. The most common histologies included renal cancer (36 VBs, 10 fractures, 10 tumor progressions), breast cancer (20 VBs, 0 fractures, 5 tumor progressions), thyroid cancer (14 VBs, 1 fracture, 2 tumor progressions), non small cell lung cancer (13 VBs, 3 fractures, 3 tumor progressions), and sarcoma (9 VBs, 2 fractures, 2 tumor progressions). Fifteen VBs were treated with kyphoplasty or vertebroplasty after SBRT, with 5 procedures done for preexisting VCFs. Tumor progression was noted in 32 locations (26%) with 5 months' median time to progression. At the time of noted fracture progression there was a trend toward higher average pain scores but no significant change in the median value. Univariate logistic regression showed that an age >55 years (HR 6.05,95% CI 2.1-17.47), a preexisting fracture (HR 5.05,95% CI 1.94-13.16), baseline pain and narcotic use before SBRT (pain: HR 1.31,95% CI 1.06-1.62; narcotic: HR 2.98, 95% CI 1.17-7.56) and after SBRT (pain: HR 1.34,95% CI 1.06-1.70; narcotic: HR 3.63,95% CI 1.41-9.29) were statistically significant predictors of fracture progression. On multivariate analysis an age >55 years (HR 10.66,95% CI 2.81-40.36), a preexisting fracture (HR 9.17,95% CI 2.31-36.43), and baseline pain (HR 1.41,95% CI 1.05-1.9) were found to be significant risks, whereas obesity (HR 0.02,95% CI 0-0.2) was protective.Conclusions. Stereotactic body radiotherapy is associated with a significant risk (20%) of VCF. Risk factors for VCF include an age >55 years, a preexisting fracture, and baseline pain. These risk factors may aid in the selection of which spinal SBRT patients should be considered for prophylactic vertebral stabilization or augmentation procedures. Clinical trial registration no.: NCT00508443. (http://thejns.org/doi/abs/10.3171/2011.11.SPINE116)