Evaluation of predictive factors of vertebral compression fracture after conventional palliative radiotherapy for spinal metastasis from colorectal cancer

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Delayed consequences of spinal radiotherapy (RT), including vertebral compression fracture (VCF), are critical complications. However, the predisposing factors that contribute to VCF after conventional RT are unclear. The aim of this study was to assess the incidence of VCF and to determine the predictors of VCF following conventional spinal RT specific to colorectal cancer (CRC).</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The authors retrospectively reviewed 237 spinal segments (147 metastatic and 90 nonmetastatic) in 53 patients with CRC who underwent RT with a median total dose of 30 Gy in 10 fractions between January 2007 and December 2014. The primary end point was the development of a VCF following RT, either de novo VCF or the progression of a baseline VCF. VCFs were assessed using the spinal instability neoplastic score (SINS) criteria.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Among all 237 spinal segments, 22 VCFs (9.3%) were observed following RT, including 13 de novo and 9 progressive fractures, and the median time to VCF was 4 months. All VCFs developed in metastatic spines. Among 147 metastatic spinal segments, 22 fractures were observed, with a 12-month cumulative incidence of VCF of 14.8%. Results of multivariable analysis indicated sex (p = 0.023) and SINS class II/III (p &lt; 0.001) as risk factors related to development of a VCF in metastatic spinal segments. Among the SINS criteria, a lytic tumor and the presence of a baseline VCF were identified as predictors of VCF in metastatic spinal segments.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>In osteolytic or mixed lesions that were predominant in spinal metastases of CRC, the incidence of VCF was not negligible, even in patients treated with conventional spinal RT. This was especially evident in patients with spinal metastases with a SINS score ≥ 7. Presence of a baseline VCF after spinal RT is a predictor of VCF development and should be observed carefully.</jats:p></jats:sec>

Massive Spondylectomy for Metastatic Spinal Cord Compression From Non–Small-Cell Lung Cancer With Local Failure After Radiotherapy

“…Surgical treatment has been applied extensively in spinal metastasis. It was reported 21 that direct decompressive surgery combined with local radiotherapy could achieve better functional preservation compared with radiotherapy alone. It has been reported that separation surgery followed by postoperative radiotherapy were recommended for the treatment of patients with spinal metastasis.…”

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

“…reported the occurrence of new VBC as 9% in colorectal cancer 13 . But the investigation of occurrence of VBC in these studies limited to all patient.…”

“…The conventional RT is the most common treatment for spinal SREs. However, the rate of occurrence and progression of new VBC after RT has not been fully investigated 12,13 . Furthermore, to the best of our knowledge, no studies have focused on the evaluation of time course of spinal instability after RT and potential risk factors for differences in spinal instability in patients with painful vertebral bone metastases without paralysis by MSCC by SINS.…”

Is the Spinal Instability Neoplastic Score Accurate and Reliable in Predicting Vertebral Compression Fractures for Spinal Metastasis? A Systematic Review and Qualitative Analysis

“…Among 13 studies, 11 studies agreed that the categories of the SINS described statistical significance in predicting VCFs. Eight studies reported accuracy of each item of the SINS 3,5,6,12,19,28,29,33) . Six studies agreed that body collapse was effective in predicting VCFs.…”