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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-year cumulative incidences of Fracture were 12.35% and 13.49%, respectively. Multivariable analysis identified dose per fraction (greatest risk for 24 Gy v 20 to 23 Gy v 19 Gy), in addition to three of the six original SINS criteria: baseline VCF, lytic tumor, and spinal deformity, as significant predictors of VCF.
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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...
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...
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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de novo versus progression of an existing Vertebral Compression Fracture vcf following spine stereotactic body radiation therapy sbrt separate risk profiles to consider
International Journal of Radiation Oncology Biology Physics, 2014Co-Authors: Chialin Tseng, Ameen Alomair, Nicholas S Boehling, Isabelle Thibault, Eshetu G Atenafu, Samuel T Chao, E H Balagamwala, Marcelo Cunha, Lilyana Angelov, Paul D BrownAbstract:progression was 12.5 months (range, 2.1-41.9 months), and the median time from this local failure to salvage SBRT was 1.2 months (range, 0.425.6 months). At the time of salvage (2 SBRT course), 41% (24/58) were treated following surgery (post-operative SBRT), 5% (3/58) had high grade epidural disease, 78% (45/58) had paraspinal tumor extension, and 57% (33/58) had a baseline Vertebral Compression Fracture (VCF). Specific to salvage SBRT, the median total dose/fx was 30 Gy/4 fx (range, 20-35 Gy/2-5 fx). The median follow-up following salvage SBRT was 6.2 months (range 0.2-39.1 months). The median OS following salvage SBRT was 10.0 months (range, 0.9-39.1 months). Thirteen of 40 (33%) patients were alive at the time of analysis and the median follow-up for these patients was 7.1 months. Local control was achieved in 78% (45/58) of spinal segments at last follow-up, and the median time to local failure was 3.0 months (range, 2.7-16.7 months). Patterns of failure indicated that the majority (11/13, 85%) had a component of epidural disease progression, and 46% (6/13) had a component of paraspinal tumor progression. No radiation-induced VCF or myelopathy were observed. Conclusions: Salvage SBRT is feasible and preliminary data support efficacy for SBRT failures. The most common treatment regimen was 30 Gy in 4 fractions. No serious adverse events were observed but long-term follow-up is required before definitive conclusions can be drawn. Author Disclosure: I. Thibault: None. M. Campbell: None. C. Tseng: None. A. Al-Omair: None. F. Lochray: None. D. Letourneau: None. E. Yu: None. Y.K. Lee: None. M.G. Fehlings: None. A. Sahgal: None.
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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-year cumulative incidences of Fracture were 12.35% and 13.49%, respectively. Multivariable analysis identified dose per fraction (greatest risk for 24 Gy v 20 to 23 Gy v 19 Gy), in addition to three of the six original SINS criteria: baseline VCF, lytic tumor, and spinal deformity, as significant predictors of VCF.
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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...
Cari M Whyne - One of the best experts on this subject based on the ideXlab platform.
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Vertebral Compression Fracture after spine stereotactic body radiation therapy a review of the pathophysiology and risk factors
Neurosurgery, 2018Co-Authors: Salman Faruqi, Cari M Whyne, Chialin Tseng, Majed Alghamdi, Jefferson R Wilson, Sten Myrehaug, Hany Soliman, Young Lee, Pejman Jabehdar Maralani, Victor X D YangAbstract:BACKGROUND Vertebral Compression Fracture (VCF) is a challenging and not infrequent complication observed following spine stereotactic body radiation therapy (SBRT). OBJECTIVE To summarize the data from the multiple studies that have been published, addressing the risk and predictive factors for VCF post-SBRT. METHODS A systematic literature review was conducted. Studies were selected if they specifically addressed risk factors for post-SBRT VCF in their analyses. RESULTS A total of 11 studies were identified, reporting both the risk of VCF post-SBRT and an analysis of risk factors based on univariate and multivariate analysis. A total of 2911 spinal segments were treated with a crude VCF rate of 13.9%. The most frequently identified risk factors on multivariate analysis were: lytic disease (hazard ratio [HR] range, 2.76-12.2), baseline VCF prior to SBRT (HR range, 1.69-9.25), higher dose per fraction SBRT (HR range, 5.03-6.82), spinal deformity (HR range, 2.99-11.1), older age (HR range, 2.15-5.67), and more than 40% to 50% of Vertebral body involved by tumor (HR range, 3.9-4.46). In the 9 studies that specifically reported on the use of post-SBRT surgical procedures, 37% of VCF had undergone an intervention (range, 11%-60%). CONCLUSION VCF is an important adverse effect following SBRT. Risk factors have been identified to guide the selection of high-risk patients. Evidence-based algorithms with respect to patient selection and intervention are needed.
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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.
Nicholas S Boehling - One of the best experts on this subject based on the ideXlab platform.
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risk of Vertebral Compression Fracture specific to osteolytic renal cell carcinoma spinal metastases after stereotactic body radiotherapy a multi institutional study
Journal of radiosurgery and SBRT, 2015Co-Authors: Isabelle Thibault, Nicholas S Boehling, Eric L Chang, Eshetu G Atenafu, Samuel T Chao, Alomair Ameen, Stephanie Zhou, E H Balagamwala, Marcelo Cunha, John ChoAbstract:Purpose Determine the risk of Vertebral Compression Fracture (VCF) following stereotactic body radiotherapy (SBRT), specific to osteolytic renal cell carcinoma (RCC) spinal metastases, and associated predictive factors. Methods 187 RCC osteolytic spinal tumor segments in 116 patients obtained from a multi-institutional pooled database were reviewed. Each segment was evaluated according to the Spinal Instability Neoplastic Score (SINS). Results The median follow-up was 8.0 months. 34 VCF (34/187, 18%) were observed and median time to VCF was 2.4 months. VCF was observed in 43% (10/23), 24% (4/17) and 14% (20/147) of segments treated with 24Gy/fraction (fx), 20-23Gy/fx and ≤19Gy/fx, respectively. Multivariate analysis identified dose per fx (p=0.005), baseline VCF (p<0.001) and spinal misalignment (p=0.002) as predictors of VCF. Prior conventional radiotherapy (p=0.029) was found to be protective. Conclusions 18% of osteolytic RCC spinal metastases Fractured post-SBRT. The presence of a baseline Fracture, spinal mal-alignment and treatment with ≥20Gy/fx predicted for VCF.
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de novo versus progression of an existing Vertebral Compression Fracture vcf following spine stereotactic body radiation therapy sbrt separate risk profiles to consider
International Journal of Radiation Oncology Biology Physics, 2014Co-Authors: Chialin Tseng, Ameen Alomair, Nicholas S Boehling, Isabelle Thibault, Eshetu G Atenafu, Samuel T Chao, E H Balagamwala, Marcelo Cunha, Lilyana Angelov, Paul D BrownAbstract:progression was 12.5 months (range, 2.1-41.9 months), and the median time from this local failure to salvage SBRT was 1.2 months (range, 0.425.6 months). At the time of salvage (2 SBRT course), 41% (24/58) were treated following surgery (post-operative SBRT), 5% (3/58) had high grade epidural disease, 78% (45/58) had paraspinal tumor extension, and 57% (33/58) had a baseline Vertebral Compression Fracture (VCF). Specific to salvage SBRT, the median total dose/fx was 30 Gy/4 fx (range, 20-35 Gy/2-5 fx). The median follow-up following salvage SBRT was 6.2 months (range 0.2-39.1 months). The median OS following salvage SBRT was 10.0 months (range, 0.9-39.1 months). Thirteen of 40 (33%) patients were alive at the time of analysis and the median follow-up for these patients was 7.1 months. Local control was achieved in 78% (45/58) of spinal segments at last follow-up, and the median time to local failure was 3.0 months (range, 2.7-16.7 months). Patterns of failure indicated that the majority (11/13, 85%) had a component of epidural disease progression, and 46% (6/13) had a component of paraspinal tumor progression. No radiation-induced VCF or myelopathy were observed. Conclusions: Salvage SBRT is feasible and preliminary data support efficacy for SBRT failures. The most common treatment regimen was 30 Gy in 4 fractions. No serious adverse events were observed but long-term follow-up is required before definitive conclusions can be drawn. Author Disclosure: I. Thibault: None. M. Campbell: None. C. Tseng: None. A. Al-Omair: None. F. Lochray: None. D. Letourneau: None. E. Yu: None. Y.K. Lee: None. M.G. Fehlings: None. A. Sahgal: None.
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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-year cumulative incidences of Fracture were 12.35% and 13.49%, respectively. Multivariable analysis identified dose per fraction (greatest risk for 24 Gy v 20 to 23 Gy v 19 Gy), in addition to three of the six original SINS criteria: baseline VCF, lytic tumor, and spinal deformity, as significant predictors of VCF.
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Vertebral Compression Fracture risk after stereotactic body radiotherapy for spinal metastases clinical article
Journal of Neurosurgery, 2012Co-Authors: Nicholas S Boehling, David R Grosshans, Pamela K Allen, Mary Frances Mcaleer, Allen W Burton, Syed Azeem, Laurence D Rhines, Eric L ChangAbstract: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 ≥ 30. Results The median imaging follow-up was 14.9 months (range 1–71 months). Twenty-five new or progressing fractu...
