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Clinical outcome of vertebral compression fracture after single fraction spine radiosurgery for spinal metastases

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Abstract

Vertebral compression fracture (VCF) occurs after stereotactic body radiation therapy (SBRT) for spine metastasis. Recently, single fraction radiosurgery (sfSRS) is used more frequently. The aim of this study is to determine the clinical outcome of VCF after sfSRS. Spinal instability neoplastic score (SINS) criteria were used to retrospectively score 143 consecutive vertebral segments in 79 patients treated with SRS. Follow-up MRI, pain, and neurologic assessments obtained every 3–6 months. Pain also scored at 7, 14, and 30 days after sfSRS. Follow up was 16 ± 18 months ±SD, range 3–78. Long-term radiographic control occurred in 94 % of cases. Pain improvement resulted within 7 days in 100 % of cases with severe pain and sustained long-term in 95 %. VCF occurred in 21 % of segments: 30 % were de novo VCF. The overall 1 year fracture free probability (1yFFP) was 76 %. Pre-existing VCF resulted in higher probability to progress: 1yFFP 90 versus 60 %. Symptoms presented in 6 % of cases with de novo VCF and 39 % with progressive. The former were treated with vertebral augmentation (VA), the latter with open surgery. Surgery/VA prior to SRS did not change risk of progressive VCF. Univariate but not multivariate analysis identified histology (colorectal), pre-existing VCF, and pain (severe) as significant predictors of VCF. In conclusion, sfSRS compares favourably to SBRT for radiographic and pain control with similar VCF risk. Patients with pre-existing VCF have a higher probability to progress, become symptomatic, and require surgery. These results may help discussing risk and benefits with patients undergoing sfSRS for spinal metastasis and developing new treatment algorithms.

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Abbreviations

CT:

Computer tomography

CTV:

Clinical tumor volume

EBRT:

External beam radiation

FFP:

Fracture-free probability

GTV:

Gross tumor volume

HCC:

Hepatocellular carcinoma

MRI:

Magnetic resonance imaging

OAR:

Organs at risk

RCC:

Renal cell carcinoma

SBRT:

Stereotactic body radiation

SINS:

Spine instability neoplastic score

SRS:

Stereotactic radiosurgery

sfSRS:

Single fraction stereotactic radiosurgery

VA:

Vertebral augmentation

VAS:

Visual analogue score

VCF:

Vertebral compression fracture

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Authors and Affiliations

  1. Departments of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Isabelle M. Germano & Andrea Carai

  2. Departments of Radiology (Neuro-radiology), Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Puneet Pawha

  3. Departments of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Seth Blacksburg, Yeh-Chi Lo & Sheryl Green

  4. Department of Neurosurgery, The Mount Sinai Medical Center, 5 East 98th Street 7th Floor, New York, NY, 10029, USA

    Isabelle M. Germano

Authors
  1. Isabelle M. Germano
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  2. Andrea Carai
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  3. Puneet Pawha
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  4. Seth Blacksburg
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  5. Yeh-Chi Lo
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  6. Sheryl Green
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Correspondence to Isabelle M. Germano.

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Germano, I.M., Carai, A., Pawha, P. et al. Clinical outcome of vertebral compression fracture after single fraction spine radiosurgery for spinal metastases. Clin Exp Metastasis 33, 143–149 (2016). https://doi.org/10.1007/s10585-015-9764-8

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  • DOI: https://doi.org/10.1007/s10585-015-9764-8

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