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Arjun Sahgal - One of the best experts on this subject based on the ideXlab platform.
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tumor extravasation following a cement augmentation procedure for vertebral Compression Fracture in metastatic spinal disease
Journal of Neurosurgery, 2014Co-Authors: Juan Pablo Cruz, Arjun Sahgal, Cari M Whyne, Michael G Fehlings, Roger A SmithAbstract:Balloon kyphoplasty (BKP) has been proven to be safe and effective in the management of pathological vertebral Compression Fracture (VCF) due to metastatic spinal disease. The most common serious complications related to BKP include cement extravasation and new Fractures at adjacent levels. Although the potential for "tumor extravasation" has been discussed as a potential iatrogenic complication, it has yet to be confirmed. The authors report on 2 cases of tumor extravasation following BKP, which they base on an observed unusual rapid tumor spread pattern into the adjacent tissues. They postulate that by increasing the vertebral body internal pressure and disrupting the tissues during balloon inflation and cement application, a soft-tissue tumor can be forced beyond the vertebral bony boundaries through pathological cortical defects. This phenomenon can manifest radiologically as subligamentous spread and/or extension into venous sinusoids, resulting in epidural venous plexus involvement, with subsequent tumor migration into the adjacent vertebral segments. Accordingly, the authors advise caution in using BKP when significant epidural tumor is present. The complication they encountered has caused them to modify their preference such that they now first use radiosurgery and subsequently BKP to ensure the target is appropriately treated, and they are currently developing possible modifications of procedural technique to reduce the risk.
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vertebral Compression Fracture after spine stereotactic body radiotherapy a multi institutional analysis with a focus on radiation dose and the spinal instability neoplastic score
Journal of Clinical Oncology, 2013Co-Authors: Arjun Sahgal, Ameen Alomair, Nicholas S Boehling, Isabelle Thibault, Eshetu G Atenafu, Samuel T Chao, E H Balagamwala, Marcelo Cunha, Lilyana Angelov, Paul D BrownAbstract:Purpose Vertebral Compression Fracture (VCF) is increasingly recognized as an adverse event after spine stereotactic body radiotherapy (SBRT). We report a multi-institutional study aimed at clarifying the risk and predictive factors associated with VCF. Patients and Methods A total of 252 patients with 410 spinal segments treated with SBRT were included. The primary outcome was the development of VCF (a new VCF or progression of a baseline VCF). In addition to various patient-, treatment-, and tumor-specific factors, the Spinal Instability Neoplastic Scoring (SINS) system was applied to determine predictive value. Results The median follow-up was 11.5 months (range, 0.03 to 113 months). The median and mean overall survival rates were 16 and 26 months, respectively. We observed 57 Fractures (57 of 410, 14%), with 47% (27 of 57) new Fractures and 53% (30 of 57) Fracture progression. The median time to VCF was 2.46 months (range, 0.03 to 43.01 months), and 65% occurred within the first 4 months. The 1- and 2...
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vertebral Compression Fracture after stereotactic body radiotherapy for spinal metastases
Lancet Oncology, 2013Co-Authors: Arjun Sahgal, Cari M Whyne, David A Larson, Michael G FehlingsAbstract:Summary The use of stereotactic body radiotherapy for metastatic spinal tumours is increasing. Serious adverse events for this treatment include vertebral Compression Fracture (VCF) and radiation myelopathy. Although VCF is a fairly low-risk adverse event (approximately 5% risk) after conventional radiotherapy, crude risk estimates for VCF after spinal SBRT range from 11% to 39%. In this Review, we summarise the evidence and predictive factors for VCF induced by spinal SBRT, review the pathophysiology of VCF in the metastatic spine, and discuss strategies used to prevent and manage this potentially disabling complication.
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radiation induced vertebral Compression Fracture following spine stereotactic radiosurgery clinicopathological correlation
Journal of Neurosurgery, 2013Co-Authors: Ameen Alomair, Arjun Sahgal, Michael G Fehlings, Roger A Smith, Timrasmus Kiehl, Louis Lao, Eric M Massicotte, Julia KeithAbstract:Spine stereotactic radiosurgery (SRS) is increasingly being used to treat metastatic spinal tumors. As the experience matures, high rates of vertebral Compression Fracture (VCF) are being observed. What is unknown is the mechanism of action; it has been postulated but not confirmed that radiation itself is a contributing factor. This case report describes 2 patients who were treated with spine SRS who subsequently developed signal changes on MRI consistent with tumor progression and VCF; however, biopsy confirmed a diagnosis of radiation-induced necrosis in 1 patient and fibrosis in the other. Radionecrosis is a rare and serious side effect of high-dose radiation therapy and represents a diagnostic challenge, as the authors have learned from years of experience with brain SRS. These cases highlight the issues in the new era of spine SRS with respect to relying on imaging alone as a means of determining true tumor progression. In those scenarios in which it is unclear based on imaging if true tumor progres...
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radiation induced vertebral Compression Fracture following spine stereotactic radiosurgery clinicopathological correlation
Journal of Neurosurgery, 2013Co-Authors: Ameen Alomair, Arjun Sahgal, Michael G Fehlings, Roger A Smith, Timrasmus Kiehl, Louis Lao, Eric M Massicotte, Julia KeithAbstract:Spine stereotactic radiosurgery (SRS) is increasingly being used to treat metastatic spinal tumors. As the experience matures, high rates of vertebral Compression Fracture (VCF) are being observed. What is unknown is the mechanism of action; it has been postulated but not confirmed that radiation itself is a contributing factor. This case report describes 2 patients who were treated with spine SRS who subsequently developed signal changes on MRI consistent with tumor progression and VCF; however, biopsy confirmed a diagnosis of radiation-induced necrosis in 1 patient and fibrosis in the other. Radionecrosis is a rare and serious side effect of high-dose radiation therapy and represents a diagnostic challenge, as the authors have learned from years of experience with brain SRS. These cases highlight the issues in the new era of spine SRS with respect to relying on imaging alone as a means of determining true tumor progression. In those scenarios in which it is unclear based on imaging if true tumor progression has occurred, the authors recommend biopsy to rule out radiation-induced effects within the bone prior to initiating salvage therapies.
Michael G Fehlings - One of the best experts on this subject based on the ideXlab platform.
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spine stereotactic body radiotherapy for renal cell cancer spinal metastases analysis of outcomes and risk of vertebral Compression Fracture
Journal of Neurosurgery, 2014Co-Authors: Isabelle Thibault, Michael G Fehlings, Ameen Alomair, Giuseppina Laura Masucci, Laurence Massoncote, F Lochray, Renee Korol, Lu Cheng, Albert Yee, Georg A BjarnasonAbstract:Object The aim of this study was to evaluate local control (LC) and the risk of vertebral Compression Fracture (VCF) after stereotactic body radiotherapy (SBRT) in patients with renal cell cancer spinal metastases. Methods Prospectively collected data on 71 spinal segments treated with SBRT in 37 patients were reviewed. The median follow-up was 12.3 months (range 1.2–55.4 months). The LC rate was assessed based on each spinal segment treated and overall survival (OS) according to each patient treated. Sixty of 71 segments (85%) were radiation naive, 11 of 71 (15%) were previously irradiated, and 10 of 71 (14%) were treated with postoperative SBRT. The median SBRT total dose and number of fractions were 24 Gy and 2, respectively. The VCF analysis also included evaluation of the Spinal Instability Neoplastic Score criteria. Results The 1-year OS and LC rates were 64% and 83%, respectively. Multivariate analysis identified oligometastatic disease (13 of 37 patients) as a positive prognostic factor (p = 0.018...
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tumor extravasation following a cement augmentation procedure for vertebral Compression Fracture in metastatic spinal disease
Journal of Neurosurgery, 2014Co-Authors: Juan Pablo Cruz, Arjun Sahgal, Cari M Whyne, Michael G Fehlings, Roger A SmithAbstract:Balloon kyphoplasty (BKP) has been proven to be safe and effective in the management of pathological vertebral Compression Fracture (VCF) due to metastatic spinal disease. The most common serious complications related to BKP include cement extravasation and new Fractures at adjacent levels. Although the potential for "tumor extravasation" has been discussed as a potential iatrogenic complication, it has yet to be confirmed. The authors report on 2 cases of tumor extravasation following BKP, which they base on an observed unusual rapid tumor spread pattern into the adjacent tissues. They postulate that by increasing the vertebral body internal pressure and disrupting the tissues during balloon inflation and cement application, a soft-tissue tumor can be forced beyond the vertebral bony boundaries through pathological cortical defects. This phenomenon can manifest radiologically as subligamentous spread and/or extension into venous sinusoids, resulting in epidural venous plexus involvement, with subsequent tumor migration into the adjacent vertebral segments. Accordingly, the authors advise caution in using BKP when significant epidural tumor is present. The complication they encountered has caused them to modify their preference such that they now first use radiosurgery and subsequently BKP to ensure the target is appropriately treated, and they are currently developing possible modifications of procedural technique to reduce the risk.
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vertebral Compression Fracture after stereotactic body radiotherapy for spinal metastases
Lancet Oncology, 2013Co-Authors: Arjun Sahgal, Cari M Whyne, David A Larson, Michael G FehlingsAbstract:Summary The use of stereotactic body radiotherapy for metastatic spinal tumours is increasing. Serious adverse events for this treatment include vertebral Compression Fracture (VCF) and radiation myelopathy. Although VCF is a fairly low-risk adverse event (approximately 5% risk) after conventional radiotherapy, crude risk estimates for VCF after spinal SBRT range from 11% to 39%. In this Review, we summarise the evidence and predictive factors for VCF induced by spinal SBRT, review the pathophysiology of VCF in the metastatic spine, and discuss strategies used to prevent and manage this potentially disabling complication.
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radiation induced vertebral Compression Fracture following spine stereotactic radiosurgery clinicopathological correlation
Journal of Neurosurgery, 2013Co-Authors: Ameen Alomair, Arjun Sahgal, Michael G Fehlings, Roger A Smith, Timrasmus Kiehl, Louis Lao, Eric M Massicotte, Julia KeithAbstract:Spine stereotactic radiosurgery (SRS) is increasingly being used to treat metastatic spinal tumors. As the experience matures, high rates of vertebral Compression Fracture (VCF) are being observed. What is unknown is the mechanism of action; it has been postulated but not confirmed that radiation itself is a contributing factor. This case report describes 2 patients who were treated with spine SRS who subsequently developed signal changes on MRI consistent with tumor progression and VCF; however, biopsy confirmed a diagnosis of radiation-induced necrosis in 1 patient and fibrosis in the other. Radionecrosis is a rare and serious side effect of high-dose radiation therapy and represents a diagnostic challenge, as the authors have learned from years of experience with brain SRS. These cases highlight the issues in the new era of spine SRS with respect to relying on imaging alone as a means of determining true tumor progression. In those scenarios in which it is unclear based on imaging if true tumor progres...
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radiation induced vertebral Compression Fracture following spine stereotactic radiosurgery clinicopathological correlation
Journal of Neurosurgery, 2013Co-Authors: Ameen Alomair, Arjun Sahgal, Michael G Fehlings, Roger A Smith, Timrasmus Kiehl, Louis Lao, Eric M Massicotte, Julia KeithAbstract:Spine stereotactic radiosurgery (SRS) is increasingly being used to treat metastatic spinal tumors. As the experience matures, high rates of vertebral Compression Fracture (VCF) are being observed. What is unknown is the mechanism of action; it has been postulated but not confirmed that radiation itself is a contributing factor. This case report describes 2 patients who were treated with spine SRS who subsequently developed signal changes on MRI consistent with tumor progression and VCF; however, biopsy confirmed a diagnosis of radiation-induced necrosis in 1 patient and fibrosis in the other. Radionecrosis is a rare and serious side effect of high-dose radiation therapy and represents a diagnostic challenge, as the authors have learned from years of experience with brain SRS. These cases highlight the issues in the new era of spine SRS with respect to relying on imaging alone as a means of determining true tumor progression. In those scenarios in which it is unclear based on imaging if true tumor progression has occurred, the authors recommend biopsy to rule out radiation-induced effects within the bone prior to initiating salvage therapies.
Ameen Alomair - One of the best experts on this subject based on the ideXlab platform.
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spine stereotactic body radiotherapy for renal cell cancer spinal metastases analysis of outcomes and risk of vertebral Compression Fracture
Journal of Neurosurgery, 2014Co-Authors: Isabelle Thibault, Michael G Fehlings, Ameen Alomair, Giuseppina Laura Masucci, Laurence Massoncote, F Lochray, Renee Korol, Lu Cheng, Albert Yee, Georg A BjarnasonAbstract:Object The aim of this study was to evaluate local control (LC) and the risk of vertebral Compression Fracture (VCF) after stereotactic body radiotherapy (SBRT) in patients with renal cell cancer spinal metastases. Methods Prospectively collected data on 71 spinal segments treated with SBRT in 37 patients were reviewed. The median follow-up was 12.3 months (range 1.2–55.4 months). The LC rate was assessed based on each spinal segment treated and overall survival (OS) according to each patient treated. Sixty of 71 segments (85%) were radiation naive, 11 of 71 (15%) were previously irradiated, and 10 of 71 (14%) were treated with postoperative SBRT. The median SBRT total dose and number of fractions were 24 Gy and 2, respectively. The VCF analysis also included evaluation of the Spinal Instability Neoplastic Score criteria. Results The 1-year OS and LC rates were 64% and 83%, respectively. Multivariate analysis identified oligometastatic disease (13 of 37 patients) as a positive prognostic factor (p = 0.018...
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vertebral Compression Fracture after spine stereotactic body radiotherapy a multi institutional analysis with a focus on radiation dose and the spinal instability neoplastic score
Journal of Clinical Oncology, 2013Co-Authors: Arjun Sahgal, Ameen Alomair, Nicholas S Boehling, Isabelle Thibault, Eshetu G Atenafu, Samuel T Chao, E H Balagamwala, Marcelo Cunha, Lilyana Angelov, Paul D BrownAbstract:Purpose Vertebral Compression Fracture (VCF) is increasingly recognized as an adverse event after spine stereotactic body radiotherapy (SBRT). We report a multi-institutional study aimed at clarifying the risk and predictive factors associated with VCF. Patients and Methods A total of 252 patients with 410 spinal segments treated with SBRT were included. The primary outcome was the development of VCF (a new VCF or progression of a baseline VCF). In addition to various patient-, treatment-, and tumor-specific factors, the Spinal Instability Neoplastic Scoring (SINS) system was applied to determine predictive value. Results The median follow-up was 11.5 months (range, 0.03 to 113 months). The median and mean overall survival rates were 16 and 26 months, respectively. We observed 57 Fractures (57 of 410, 14%), with 47% (27 of 57) new Fractures and 53% (30 of 57) Fracture progression. The median time to VCF was 2.46 months (range, 0.03 to 43.01 months), and 65% occurred within the first 4 months. The 1- and 2...
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radiation induced vertebral Compression Fracture following spine stereotactic radiosurgery clinicopathological correlation
Journal of Neurosurgery, 2013Co-Authors: Ameen Alomair, Arjun Sahgal, Michael G Fehlings, Roger A Smith, Timrasmus Kiehl, Louis Lao, Eric M Massicotte, Julia KeithAbstract:Spine stereotactic radiosurgery (SRS) is increasingly being used to treat metastatic spinal tumors. As the experience matures, high rates of vertebral Compression Fracture (VCF) are being observed. What is unknown is the mechanism of action; it has been postulated but not confirmed that radiation itself is a contributing factor. This case report describes 2 patients who were treated with spine SRS who subsequently developed signal changes on MRI consistent with tumor progression and VCF; however, biopsy confirmed a diagnosis of radiation-induced necrosis in 1 patient and fibrosis in the other. Radionecrosis is a rare and serious side effect of high-dose radiation therapy and represents a diagnostic challenge, as the authors have learned from years of experience with brain SRS. These cases highlight the issues in the new era of spine SRS with respect to relying on imaging alone as a means of determining true tumor progression. In those scenarios in which it is unclear based on imaging if true tumor progres...
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radiation induced vertebral Compression Fracture following spine stereotactic radiosurgery clinicopathological correlation
Journal of Neurosurgery, 2013Co-Authors: Ameen Alomair, Arjun Sahgal, Michael G Fehlings, Roger A Smith, Timrasmus Kiehl, Louis Lao, Eric M Massicotte, Julia KeithAbstract:Spine stereotactic radiosurgery (SRS) is increasingly being used to treat metastatic spinal tumors. As the experience matures, high rates of vertebral Compression Fracture (VCF) are being observed. What is unknown is the mechanism of action; it has been postulated but not confirmed that radiation itself is a contributing factor. This case report describes 2 patients who were treated with spine SRS who subsequently developed signal changes on MRI consistent with tumor progression and VCF; however, biopsy confirmed a diagnosis of radiation-induced necrosis in 1 patient and fibrosis in the other. Radionecrosis is a rare and serious side effect of high-dose radiation therapy and represents a diagnostic challenge, as the authors have learned from years of experience with brain SRS. These cases highlight the issues in the new era of spine SRS with respect to relying on imaging alone as a means of determining true tumor progression. In those scenarios in which it is unclear based on imaging if true tumor progression has occurred, the authors recommend biopsy to rule out radiation-induced effects within the bone prior to initiating salvage therapies.
Timrasmus Kiehl - One of the best experts on this subject based on the ideXlab platform.
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radiation induced vertebral Compression Fracture following spine stereotactic radiosurgery clinicopathological correlation
Journal of Neurosurgery, 2013Co-Authors: Ameen Alomair, Arjun Sahgal, Michael G Fehlings, Roger A Smith, Timrasmus Kiehl, Louis Lao, Eric M Massicotte, Julia KeithAbstract:Spine stereotactic radiosurgery (SRS) is increasingly being used to treat metastatic spinal tumors. As the experience matures, high rates of vertebral Compression Fracture (VCF) are being observed. What is unknown is the mechanism of action; it has been postulated but not confirmed that radiation itself is a contributing factor. This case report describes 2 patients who were treated with spine SRS who subsequently developed signal changes on MRI consistent with tumor progression and VCF; however, biopsy confirmed a diagnosis of radiation-induced necrosis in 1 patient and fibrosis in the other. Radionecrosis is a rare and serious side effect of high-dose radiation therapy and represents a diagnostic challenge, as the authors have learned from years of experience with brain SRS. These cases highlight the issues in the new era of spine SRS with respect to relying on imaging alone as a means of determining true tumor progression. In those scenarios in which it is unclear based on imaging if true tumor progres...
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radiation induced vertebral Compression Fracture following spine stereotactic radiosurgery clinicopathological correlation
Journal of Neurosurgery, 2013Co-Authors: Ameen Alomair, Arjun Sahgal, Michael G Fehlings, Roger A Smith, Timrasmus Kiehl, Louis Lao, Eric M Massicotte, Julia KeithAbstract:Spine stereotactic radiosurgery (SRS) is increasingly being used to treat metastatic spinal tumors. As the experience matures, high rates of vertebral Compression Fracture (VCF) are being observed. What is unknown is the mechanism of action; it has been postulated but not confirmed that radiation itself is a contributing factor. This case report describes 2 patients who were treated with spine SRS who subsequently developed signal changes on MRI consistent with tumor progression and VCF; however, biopsy confirmed a diagnosis of radiation-induced necrosis in 1 patient and fibrosis in the other. Radionecrosis is a rare and serious side effect of high-dose radiation therapy and represents a diagnostic challenge, as the authors have learned from years of experience with brain SRS. These cases highlight the issues in the new era of spine SRS with respect to relying on imaging alone as a means of determining true tumor progression. In those scenarios in which it is unclear based on imaging if true tumor progression has occurred, the authors recommend biopsy to rule out radiation-induced effects within the bone prior to initiating salvage therapies.
Roger A Smith - One of the best experts on this subject based on the ideXlab platform.
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tumor extravasation following a cement augmentation procedure for vertebral Compression Fracture in metastatic spinal disease
Journal of Neurosurgery, 2014Co-Authors: Juan Pablo Cruz, Arjun Sahgal, Cari M Whyne, Michael G Fehlings, Roger A SmithAbstract:Balloon kyphoplasty (BKP) has been proven to be safe and effective in the management of pathological vertebral Compression Fracture (VCF) due to metastatic spinal disease. The most common serious complications related to BKP include cement extravasation and new Fractures at adjacent levels. Although the potential for "tumor extravasation" has been discussed as a potential iatrogenic complication, it has yet to be confirmed. The authors report on 2 cases of tumor extravasation following BKP, which they base on an observed unusual rapid tumor spread pattern into the adjacent tissues. They postulate that by increasing the vertebral body internal pressure and disrupting the tissues during balloon inflation and cement application, a soft-tissue tumor can be forced beyond the vertebral bony boundaries through pathological cortical defects. This phenomenon can manifest radiologically as subligamentous spread and/or extension into venous sinusoids, resulting in epidural venous plexus involvement, with subsequent tumor migration into the adjacent vertebral segments. Accordingly, the authors advise caution in using BKP when significant epidural tumor is present. The complication they encountered has caused them to modify their preference such that they now first use radiosurgery and subsequently BKP to ensure the target is appropriately treated, and they are currently developing possible modifications of procedural technique to reduce the risk.
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radiation induced vertebral Compression Fracture following spine stereotactic radiosurgery clinicopathological correlation
Journal of Neurosurgery, 2013Co-Authors: Ameen Alomair, Arjun Sahgal, Michael G Fehlings, Roger A Smith, Timrasmus Kiehl, Louis Lao, Eric M Massicotte, Julia KeithAbstract:Spine stereotactic radiosurgery (SRS) is increasingly being used to treat metastatic spinal tumors. As the experience matures, high rates of vertebral Compression Fracture (VCF) are being observed. What is unknown is the mechanism of action; it has been postulated but not confirmed that radiation itself is a contributing factor. This case report describes 2 patients who were treated with spine SRS who subsequently developed signal changes on MRI consistent with tumor progression and VCF; however, biopsy confirmed a diagnosis of radiation-induced necrosis in 1 patient and fibrosis in the other. Radionecrosis is a rare and serious side effect of high-dose radiation therapy and represents a diagnostic challenge, as the authors have learned from years of experience with brain SRS. These cases highlight the issues in the new era of spine SRS with respect to relying on imaging alone as a means of determining true tumor progression. In those scenarios in which it is unclear based on imaging if true tumor progres...
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radiation induced vertebral Compression Fracture following spine stereotactic radiosurgery clinicopathological correlation
Journal of Neurosurgery, 2013Co-Authors: Ameen Alomair, Arjun Sahgal, Michael G Fehlings, Roger A Smith, Timrasmus Kiehl, Louis Lao, Eric M Massicotte, Julia KeithAbstract:Spine stereotactic radiosurgery (SRS) is increasingly being used to treat metastatic spinal tumors. As the experience matures, high rates of vertebral Compression Fracture (VCF) are being observed. What is unknown is the mechanism of action; it has been postulated but not confirmed that radiation itself is a contributing factor. This case report describes 2 patients who were treated with spine SRS who subsequently developed signal changes on MRI consistent with tumor progression and VCF; however, biopsy confirmed a diagnosis of radiation-induced necrosis in 1 patient and fibrosis in the other. Radionecrosis is a rare and serious side effect of high-dose radiation therapy and represents a diagnostic challenge, as the authors have learned from years of experience with brain SRS. These cases highlight the issues in the new era of spine SRS with respect to relying on imaging alone as a means of determining true tumor progression. In those scenarios in which it is unclear based on imaging if true tumor progression has occurred, the authors recommend biopsy to rule out radiation-induced effects within the bone prior to initiating salvage therapies.