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Vertebral compression fracture rate following stereotactic ablative body radiotherapy for spine oligometastases: a UK experience

Published online by Cambridge University Press:  14 April 2021

Sameed Hussain*
Affiliation:
Hall-Edwards Radiotherapy Research Group, Cancer Centre, Queen Elizabeth Hospital, Birmingham, UK
Anjali Zarkar
Affiliation:
Hall-Edwards Radiotherapy Research Group, Cancer Centre, Queen Elizabeth Hospital, Birmingham, UK
Ahmed Elmodir
Affiliation:
Hall-Edwards Radiotherapy Research Group, Cancer Centre, Queen Elizabeth Hospital, Birmingham, UK
Daniel Ford
Affiliation:
Hall-Edwards Radiotherapy Research Group, Cancer Centre, Queen Elizabeth Hospital, Birmingham, UK
Sundus Yahya
Affiliation:
Hall-Edwards Radiotherapy Research Group, Cancer Centre, Queen Elizabeth Hospital, Birmingham, UK
Geoff Heyes
Affiliation:
Hall-Edwards Radiotherapy Research Group, Cancer Centre, Queen Elizabeth Hospital, Birmingham, UK
Timothy Jackson
Affiliation:
Hall-Edwards Radiotherapy Research Group, Cancer Centre, Queen Elizabeth Hospital, Birmingham, UK
Ruth Stange
Affiliation:
Hall-Edwards Radiotherapy Research Group, Cancer Centre, Queen Elizabeth Hospital, Birmingham, UK
Hannah Augustus
Affiliation:
Hall-Edwards Radiotherapy Research Group, Cancer Centre, Queen Elizabeth Hospital, Birmingham, UK
Jenny Sherriff
Affiliation:
Hall-Edwards Radiotherapy Research Group, Cancer Centre, Queen Elizabeth Hospital, Birmingham, UK
*
Author for correspondence: Dr Sameed Hussain, Hall-Edwards Radiotherapy Research Group, Cancer Centre, Queen Elizabeth Hospital, 6 Mindelsohn Way, Birmingham B15 2TH, UK. Tel: 00923005160974. E-mail: [email protected]

Abstract

Aim:

Stereotactic ablative body radiotherapy (SABR) for spine metastases is associated with a risk of vertebral compression fracture (VCF). The aim of this study was to determine the rate of VCF at one UK institution and evaluate the use of the Spinal Instability Neoplastic Score (SINS) to predict these.

Materials and methods:

A retrospective analysis of all patients who underwent SABR for spinal metastases between 2014 and 2018 at one UK institution was performed. Basic demographic data were collected, and SINS prior to SABR was calculated. The primary outcome was VCF rate. Secondary outcomes included time to VCF and need for surgical intervention following VCF.

Results:

A total of 48 oligometastases were treated with a median follow-up of 20·5 months. A maximum of two vertebral bodies were treated. The median baseline SINS was calculated as 3. The median dose was 26 Gy in three fractions. Two patients were reported to have VCF and both were successfully conservatively managed.

Findings:

SABR for spine oligometastases is being performed safely with low VCF rates which are comparable with those in international publications. This may be as a result of strict adherence to criteria for delivery of SABR with low pre-treatment SINS.

Type
Original Article
Copyright
© The Author(s), 2021. Published by Cambridge University Press

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References

Sahgal, A, Bilsky, M, Chang, E L et al. Stereotactic body radiotherapy for spinal metastases: current status, with a focus on its application in the postoperative patient. A review. J Neurosurg Spine 2011; 14: 151166.CrossRefGoogle Scholar
Sahgal, A, Chou, D, Ames, C et al. Image-guided robotic stereotactic body radiotherapy for benign spinal tumors: the University of California San Francisco preliminary experience. Technol Cancer Res Treat 2007; 6: 595604.CrossRefGoogle ScholarPubMed
Osborn, V W, Lee, A, Yamada, Y. Stereotactic body radiation therapy for spinal malignancies. Technol Cancer Res Treat 2018; 17: 1533033818802304.CrossRefGoogle ScholarPubMed
Commissioning through Evaluation. 2020. https://www.england.nhs.uk/commissioning/spec-services/npc-crg/comm-eval/. Accessed on 8th November 2020.Google Scholar
Foote, M, Letourneau, D, Hyde, D et al. Technique for stereotactic body radiotherapy for spinal metastases. J Clin Neurosci 2011; 18: 276279.CrossRefGoogle ScholarPubMed
Hyde, D, Lochray, F, Korol, R et al. Spine stereotactic body radiotherapy utilizing cone-beam CT image-guidance with a robotic couch: intrafraction motion analysis accounting for all six degrees of freedom. Int J Radiat Oncol Biol Phys 2012; 82: e555e562.CrossRefGoogle ScholarPubMed
Sahgal, A, Roberge, D, Schellenberg, D et al. The Canadian Association of Radiation Oncology scope of practice guidelines for lung, liver and spine stereotactic body radiotherapy. Clin Oncol (R Coll Radiol) 2012; 24: 629639.CrossRefGoogle ScholarPubMed
A randomised trial of conventional care versus radioablation (stereotactic body radiotherapy) for extracranial oligometastases. https://www.icr.ac.uk/our-research/centres-and-collaborations/centres-at-the-icr/clinical-trials-and-statistics-unit/clinical-trials/core. Accessed on 8th November 2020.Google Scholar
Palma, D A, Olson, R, Harrow, S et al. Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): a randomised, phase 2, open-label trial. Lancet 2019; 393 (10185): 20512058.CrossRefGoogle ScholarPubMed
Chiang, A, Zeng, L, Zhang, L et al. Pain flare is a common adverse event in steroid-naïve patients after spine stereotactic body radiation therapy: a prospective clinical trial. J Radiat Oncol Biol Phys 2013; 86 (4): 638642.CrossRefGoogle ScholarPubMed
Sahgal, A, Whyne, C M, Ma, L et al. Vertebral compression fracture after stereotactic body radiotherapy for spinal metastases. Lancet Oncol 2013; 14: e310e320.CrossRefGoogle ScholarPubMed
Currey, J D, Brear, K, Zioupos, P. The effects of ageing and changes in mineral content in degrading the toughness of human femora. J Biomech 1996; 29: 257260.CrossRefGoogle ScholarPubMed
Guo, X E, Kim, C H. Mechanical consequence of trabecular bone loss and its treatment: a three-dimensional model simulation. Bone 2002; 30: 404411.CrossRefGoogle ScholarPubMed
Currey, J D, Foreman, J, Laketic, I, Mitchell, J, Pegg, D E, Reilly, G C. Effects of ionizing radiation on the mechanical properties of human bone. J Orthop Res 1997; 15: 111117.CrossRefGoogle ScholarPubMed
Rose, P S, Laufer, I, Boland, P J et al. Risk of fracture after single fraction image-guided intensity modulated radiation therapy to spinal metastases. J Clin Oncol 2009; 27: 50755079.CrossRefGoogle ScholarPubMed
Cunha, M V, Al-Omair, A, Atenafu, E G et al. Vertebral compression fracture (VCF) after spine stereotactic body radiation therapy (SBRT): analysis of predictive factors. Int J Radiat Oncol Biol Phys 2012; 84: e343e349.CrossRefGoogle ScholarPubMed
Boehling, N S, Grosshans, D R, Allen, P K et al. Vertebral compression fracture risk after stereotactic body radiotherapy for spinal metastases. J Neurosurg Spine 2012; 16: 379386.CrossRefGoogle ScholarPubMed
Sahgal, A, Atenafu, E G, Chao, S et al. Vertebral compression fracture after spine stereotactic body radiotherapy: a multi-institutional analysis with a focus on radiation dose and the spinal instability neoplastic score. JCO 2013; 31 (27): 34263431.CrossRefGoogle ScholarPubMed
Fisher, C G, DiPaola, C P, Ryken, T C et al. A novel classification system for spinal instability in neoplastic disease. Spine 2010; 35 (22): e1221e1229.CrossRefGoogle ScholarPubMed
Common Terminology Criteria for Adverse Events. https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/ctcae_v5_quick_reference_5x7.pdf. Assessed on 12th December 2020.Google Scholar
Chow, E, Harris, K, Fan, G et al. Palliative radiotherapy trials for bone metastases: a systematic review. J Clin Oncol 2007; 25: 14231436.CrossRefGoogle ScholarPubMed
Abbouchie, H, Chow, M, Tacy, M et al. Vertebral fracture following stereotactic body radiotherapy for spinal oligometastases: a multi- institutional analysis of patient outcome. Clin Oncol 2020; 32: 433441.CrossRefGoogle Scholar