Histopathological Findings After Reirradiation Compared to First Irradiation of Spinal Bone Metastases With Stereotactic Body Radiotherapy: A Cohort Study

Forster, R. E.; Cho, B C John; Fahim, Daniel K.; Gerszten, Peter C.; Flíckinger, John C.; Grills, I.S.; Jawad, M.S.; Kersh, C.R.; Létourneau, D.; Mantel, Frederick; Sahgal, Arjun; Shin, John H.; Winey, B.; Gückenberger, Matthias

doi:10.1093/neuros/nyy059

Cited by 9 publications

(5 citation statements)

References 28 publications

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“…In-human pathologic data of radiotherapy damage on bone metastases are few. In general, RT effect is mediated by sublethal damage from free radical generated by water molecules or, in case of high doses, also direct lethal damage on DNA [ 37 ]. In fact, higher doses for fraction, as in stereotactic radiotherapy (SBRT), can promote direct cytotoxic, endothelial disruption with vascular death [ 38 , 39 ] ( Figure 1 ).…”

Section: Radiotherapy Treatments Options and New Drugsmentioning

confidence: 99%

Diagnosis and Treatment of Bone Metastases in Breast Cancer: Radiotherapy, Local Approach and Systemic Therapy in a Guide for Clinicians

Marazzi

Orlandi

Manfrida

et al. 2020

Cancers

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The standard care for metastatic breast cancer (MBC) is systemic therapies with imbrication of focal treatment for symptoms. Recently, thanks to implementation of radiological and metabolic exams and development of new target therapies, oligometastatic and oligoprogressive settings are even more common—paving the way to a paradigm change of focal treatments role. In fact, according to immunophenotype, radiotherapy can be considered with radical intent in these settings of patients. The aim of this literature review is to analyze available clinical data on prognosis of bone metastases from breast cancer and benefits of available treatments for developing a practical guide for clinicians.

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Section: Radiotherapy Treatments Options and New Drugsmentioning

confidence: 99%

Diagnosis and Treatment of Bone Metastases in Breast Cancer: Radiotherapy, Local Approach and Systemic Therapy in a Guide for Clinicians

Marazzi

Orlandi

Manfrida

et al. 2020

Cancers

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“…More recently, Foerster et al showed that the incidence of osteonecrosis, soft tissue necrosis and viable tumour in VCF specimens was not significantly increased compared with non-VCF specimens. 37 In contrast, VCF specimens showed greater bone marrow fibrosis, leading to the hypothesis that fractures occur from disruption in bone remodelling due to marrow fibrosis and collagen damage from high-dose radiation. 37,38 Bone is a metabolically active tissue with ongoing deposition of collagen and matrix, and this disruption may compromise its structural integrity.…”

Section: Relationship Between Sbrt and Vcfmentioning

confidence: 99%

“…37 In contrast, VCF specimens showed greater bone marrow fibrosis, leading to the hypothesis that fractures occur from disruption in bone remodelling due to marrow fibrosis and collagen damage from high-dose radiation. 37,38 Bone is a metabolically active tissue with ongoing deposition of collagen and matrix, and this disruption may compromise its structural integrity. 39 The effect of SBRT on bone density and VCF risk has also been investigated.…”

Section: Relationship Between Sbrt and Vcfmentioning

confidence: 99%

Vertebral fractures following stereotactic body radiotherapy for spine metastases

et al. 2020

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Stereotactic body radiotherapy has emerged as one of the preferred treatments for patients with spine metastases, with the potential for long-term control from lesion irradiation. Post-treatment vertebral compression fractures are a known complication of this therapy, contributing to worsening pain and reduced quality of life, sometimes requiring surgical intervention. This review explores the current knowledge of post-radiotherapy fractures, in terms of the rates and associated predictive factors. A search of databases including Medline, Embase and the Cochrane Library was conducted using keywords such as 'vertebral compression fracture', 'stereotactic body radiotherapy' and 'spine metastases'. The search was limited to published studies up to March 2019, reporting clinical outcomes including both the post-treatment fracture rate and statistical identification of associated risk factors. Rates of post-treatment fractures ranged from 4 to 39%. A variety of factors were found to increase the risk, including the appearance of lytic vertebral disease, degree of pre-existing compression, spinal malalignment, increased dose per fraction and a Spinal Instability Neoplastic Score >6. This knowledge can enable clinicians to counsel patients when considering management options for spine metastases, maintaining the balance between local tumour control and the risk of subsequent fracture.

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“…In-human data of pathological damage by radiotherapy on bone metastases are few. Tissue damage by radiotherapy is mediated by sub-lethal damage of free radical generated by free-radical or, in case of high doses, also direct damage on DNA [33]. In fact, higher doses for fraction, as in stereotactic radiotherapy (SBRT), can promote direct cytotoxic, endothelial disruption with vascular death [34], [35] (Figure 1).…”

Section: Radiotherapy Treatments Options and New Drugsmentioning

confidence: 99%

Actualities on Diagnosis, Targeting and Treating Bone Metastases in Breast Cancer with Radiotherapy and New Drugs

Marazzi¹,

Orlandi²,

Manfrida³

et al. 2020

Preprint

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The standard of care for metastatic breast cancer (MBC) is systemic therapies with imbrication of focal treatment in case of symptomatology onset. Recently, thanks to implementation of radiological and metabolic exams and development of new target therapies, oligometastatic and oligoprogressive disease presentations are even more common, leading to a change of paradigm of focal treatments. In fact, acknowledgement of behaviour of disease in these setting of patients is carrying aim of radiotherapy towards modalities with radical intent. The aim of this literature review is to analyse available clinical data regarding disease behaviour, imaging, radiotherapy and chemo-radiotherapy integration outcomes for understanding bone metastasis from breast cancer and the potential impact of targeting it.

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Histopathological Findings After Reirradiation Compared to First Irradiation of Spinal Bone Metastases With Stereotactic Body Radiotherapy: A Cohort Study

Abstract: For both, sSBRT and pSBRT, histopathological changes were similar. Neurological symptoms were attributable to tumor progression and pathological fractures were not associated with osteonecrosis or tumor progression.

Cited by 9 publications

References 28 publications

Diagnosis and Treatment of Bone Metastases in Breast Cancer: Radiotherapy, Local Approach and Systemic Therapy in a Guide for Clinicians

Diagnosis and Treatment of Bone Metastases in Breast Cancer: Radiotherapy, Local Approach and Systemic Therapy in a Guide for Clinicians

Vertebral fractures following stereotactic body radiotherapy for spine metastases

Actualities on Diagnosis, Targeting and Treating Bone Metastases in Breast Cancer with Radiotherapy and New Drugs

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