Bone Density as a Marker of Response to Radiotherapy in Bone Metastatic Lesions: A Review of the Published Data

Kouloulias, Vassilis; Liakouli, Zoi; Zygogianni, Anna; Mystakidou, Kyriaki; Kouvaris, John

doi:10.3390/ijms17091391

Cited by 9 publications

(10 citation statements)

References 24 publications

(41 reference statements)

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“…Although conventional RT is most commonly utilized for spinal SREs, the occurrence of new VBC during RT has not been fully investigated previously (10,11,(15)(16)(17)(18)(19)(20)(21)(22)(23). Shi (10).…”

Section: Discussionmentioning

confidence: 99%

Vertebral body collapse after radiotherapy for spinal metastases

et al. 2023

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Spinal metastases are common in patients with advanced stages of cancer and frequently cause vertebral body collapse (VBC). Although conventional radiotherapy (RT) is used for spinal metastases, the rates of occurrence of new VBC and progression of VBC at RT initiation have not been fully investigated. The present retrospective study assessed VBC and its associated risk factors after RT over time and evaluated new VBC and progression of VBC in patients who presented with VBC at RT initiation. The study evaluated 177 patients who received RT for vertebral metastases without paralysis between July 2012 and November 2016. Radiological responses of the irradiated vertebrae were assessed using computed tomography. Follow-up assessments were performed at RT initiation and 1, 2, 3, 4 and 6 months after RT. New VBC occurred in 12% of patients with no prior VBC within 1 month of RT. Multivariate analysis revealed that numeric rating scale (NRS) score (≥4) [relative risk (RR), 27.1; 95% confidence interval (CI), 1.86 to 394.9; P= 0.016] was associated with the occurrence of new VBC at the 1 month follow-up time point. VBC progression occurred in 51% of the patients with collapse at RT initiation. Multivariate analysis revealed that bone quality (lytic metastases) (RR, 3.1; 95% CI, 1.28 to 7.70; P=0.013), NRS score (≥4) (RR, 3.0; 95% CI, 1.18 to 7.45; P=0.021) and tumor involvement of posterolateral elements of the spine (RR, 2.7; 95% CI, 1.03 to 7.29; P=0.04) were associated with the progression of VBC at the 1 month follow-up time point. The current study findings suggested that clinicians should pay attention to the factors that predict the occurrence of new VBC and VBC progression to ensure proper evaluation of conservative treatment effectiveness and facilitate the determination of patients who need close monitoring.

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Section: Discussionmentioning

confidence: 99%

Vertebral body collapse after radiotherapy for spinal metastases

et al. 2023

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“…In this study, pain disappeared in 93% of patients at three months after RT. Lytic lesions that have been successfully treated by RT subsequently appear normal or sclerotic on CT due to the reparative process called re-ossi cation [14][15][16] . In this study, the improvement of BQ was obtained by re-calci cation which could be facilitated by combined therapy of RT and BMAs.…”

Section: Discussionmentioning

confidence: 99%

“…BQ is classi ed as lytic, mixed, or blastic. Lytic lesions that have been successfully treated by RT subsequently appear normal or sclerotic on CT due to the reparative process called re-ossi cation [14][15][16] .…”

Section: Radiological Assessmentmentioning

confidence: 99%

Changes in Spinal Instability After Combined Therapy of Conventional Radiotherapy and Bone Modifying Agents for Painful Vertebral Bone Metastases

Nakata

Sugihara

Sugawara

et al. 2021

Preprint

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Precise assessment of spinal instability is critical at the beginning and after radiotherapy for selection of the treatment and evaluating the effectiveness of radiotherapy. We investigated changes of spinal instability after radiotherapy and examined potential risk factors for the difference of the outcome of spinal instability for painful spinal metastases. We evaluated 81 patients who received radiotherapy for painful vertebral metastases in our institution between 2012 and 2016. The pain at the vertebrae was assessed. Radiological responses of irradiated vertebrae were assessed by computed tomography. Spinal instability was assessed by Spinal Instability Neoplastic Score (SINS). Follow-up assessments were done at the start of radiotherapy and at 1, 2, 3, 4, and 6 months after radiotherapy. At each of one to six months, pain disappeared in 62%, 84%, 93%, 98%, and 100% of patients. The median SINS were 8, 7, 6, 5, 5, and 4 at the beginning of radiotherapy and after 1, 2, 3, 4, and 6 months, respectively, which significantly decreased over time (P < 0.001). Multivariate analysis revealed that PLISE was the only risk factor for spinal instability at one month. In conclusion, spinal instability significantly improved over time after radiotherapy. Clinicians should take attention to PLISE in the radiotherapy of vertebral metastases.

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“…In this scoping review, we aimed to comprehensively survey quantified methods of radiologic evaluation in patients receiving palliative radiotherapy for metastatic bone lesions. Although a study published in 2016 specifically reviewed published data regarding quantitative measures of bone density in patients receiving radiotherapy for bone metastases, 27 our study aimed to be inclusive of any variable acquired through imaging means that could be quantitatively represented. Bone metastases have historically been more challenging to assess than other solid tumors because they are irregularly shaped and difficult to measure with rulers.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Imaging Modalities to Assess Treatment Response of Bone Metastasis in Patients Receiving Palliative Radiotherapy: A Scoping Review of the Literature

et al. 2020

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Purpose: Several studies have used objective radiologic data to assess the effect of palliative radiotherapy on tumor burden. The purpose of this literature review was to survey the various metrics that have been used to quantify bone tumor response to palliative radiotherapy by radiographical means and to determine whether any of these metrics were associated with clinical palliative outcomes. Methods: In accordance with PRISMA extension for Scoping Reviews guidelines, a literature search Ovid Medline and OldMedline from 1946 to February 6, 2019, Embase Classic/Embase from 1947 to 2019 week 5, and Cochrane Central Register of Controlled Trials February 2019 to extract articles related to quantified radiologic evaluation of bone metastases following palliative radiotherapy. Imaging modality, quantification metric, and association between imaging modality and clinical response were recorded. Results: Fourteen articles selected for full-text review utilized computed tomography (10 studies), fluorodeoxyglucose-positron emission tomography (3 studies), magnetic resonance imaging (1 study), diffusion-weighted magnetic resonance imaging (3 studies), and X-ray (1 study) imaging modalities. Variables assessed included tumor volume regression, bone density, metabolic activity, and signal intensity. Studies differed both in the type of imaging modality used and metric derived to quantify the radiologic findings. Fifty percent of the included studies aimed to identify a relationship between a quantified radiologic metric and clinical palliative response. Of these studies, 86% reported a correlation. Conclusion: Quantified radiologic metrics can provide an objective measure of response to palliative radiotherapy and may be useful in predicting clinical palliative response. More studies are needed to validate these metrics and develop a standardized protocol for radiologic evaluation that can be implemented into a clinical workflow.

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Bone Density as a Marker of Response to Radiotherapy in Bone Metastatic Lesions: A Review of the Published Data

Cited by 9 publications

References 24 publications

Vertebral body collapse after radiotherapy for spinal metastases

Vertebral body collapse after radiotherapy for spinal metastases

Changes in Spinal Instability After Combined Therapy of Conventional Radiotherapy and Bone Modifying Agents for Painful Vertebral Bone Metastases

Diagnostic Imaging Modalities to Assess Treatment Response of Bone Metastasis in Patients Receiving Palliative Radiotherapy: A Scoping Review of the Literature

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