Imaging response assessment following stereotactic body radiotherapy for solid tumour metastases of the spine: Current challenges and future directions

O'Sullivan, Steven; McDermott, Rónán; Keys, Maeve; O'sullivan, Maeve; Armstrong, John G.; Faul, C.

doi:10.1111/1754-9485.13032

Cited by 7 publications

(4 citation statements)

References 103 publications

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“…Vertebral compression fractures following radiotherapy of spinal metastases occur in up to 9.4–12% [ 156 , 157 ] of cases, and are the most common and serious side effect of stereotactic body radiotherapy. It is often difficult to assess whether a compression fracture is related to tumour progression or radiation induced fibrosis or necrosis [ 158 , 159 ]. To date, there are no published radiomics studies differentiating vertebral compression fractures as a result of radiotherapy versus those related to tumour progression.…”

Section: Discussionmentioning

confidence: 99%

Application of Artificial Intelligence Methods for Imaging of Spinal Metastasis

Ong

Zhu

Zhang

et al. 2022

Cancers

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Spinal metastasis is the most common malignant disease of the spine. Recently, major advances in machine learning and artificial intelligence technology have led to their increased use in oncological imaging. The purpose of this study is to review and summarise the present evidence for artificial intelligence applications in the detection, classification and management of spinal metastasis, along with their potential integration into clinical practice. A systematic, detailed search of the main electronic medical databases was undertaken in concordance with the PRISMA guidelines. A total of 30 articles were retrieved from the database and reviewed. Key findings of current AI applications were compiled and summarised. The main clinical applications of AI techniques include image processing, diagnosis, decision support, treatment assistance and prognostic outcomes. In the realm of spinal oncology, artificial intelligence technologies have achieved relatively good performance and hold immense potential to aid clinicians, including enhancing work efficiency and reducing adverse events. Further research is required to validate the clinical performance of the AI tools and facilitate their integration into routine clinical practice.

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Section: Discussionmentioning

confidence: 99%

Application of Artificial Intelligence Methods for Imaging of Spinal Metastasis

Ong

Zhu

Zhang

et al. 2022

Cancers

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“…While several studies have proposed a role of PET/CT in distinguishing benign and malignant compression fractures, these generally were not performed in the post-SBRT setting. Radiation-induced inflammatory changes may result in variably increased uptake on PET/CT in the immediate 6 months post SBRT and limit its diagnostic utility in such settings [150,162]. On perfusion/DCE MRI, vertebral metastases with or without associated pathological fracture were noted to demonstrate a significantly steeper enhancement slope and greater peak enhancement percentage than chronic compression fractures in a previous study involving 42 patients by Chen et al (2002).…”

Section: Post-treatment Follow-upmentioning

confidence: 93%

“…More recently, Choi et al (2018) noted that >70% reduction in maximum SUV post SBRT in 42 patients with spinal metastasis who underwent 18F-FDG PET/CT before and after treatment was predictive of good progression-free-survival [149]. It should be noted however, that there is a possibility of a flare response post SBRT with variable increased radiotracer uptake that may persist up to 6 months [150]. While further research is needed to validate these findings, they suggest that post SBRT follow-up imaging may require a combination of functional and structural MRI for greater diagnostic accuracy.…”

Section: Post-treatment Follow-upmentioning

confidence: 99%

State-of-the-Art Imaging Techniques in Metastatic Spinal Cord Compression

Kuah

Vellayappan

Makmur

et al. 2022

Cancers

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Metastatic Spinal Cord Compression (MSCC) is a debilitating complication in oncology patients. This narrative review discusses the strengths and limitations of various imaging modalities in diagnosing MSCC, the role of imaging in stereotactic body radiotherapy (SBRT) for MSCC treatment, and recent advances in deep learning (DL) tools for MSCC diagnosis. PubMed and Google Scholar databases were searched using targeted keywords. Studies were reviewed in consensus among the co-authors for their suitability before inclusion. MRI is the gold standard of imaging to diagnose MSCC with reported sensitivity and specificity of 93% and 97% respectively. CT Myelogram appears to have comparable sensitivity and specificity to contrast-enhanced MRI. Conventional CT has a lower diagnostic accuracy than MRI in MSCC diagnosis, but is helpful in emergent situations with limited access to MRI. Metal artifact reduction techniques for MRI and CT are continually being researched for patients with spinal implants. Imaging is crucial for SBRT treatment planning and three-dimensional positional verification of the treatment isocentre prior to SBRT delivery. Structural and functional MRI may be helpful in post-treatment surveillance. DL tools may improve detection of vertebral metastasis and reduce time to MSCC diagnosis. This enables earlier institution of definitive therapy for better outcomes.

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“…The SPIne response assessment in Neuro-Oncology (SPINO) group consensus uniforms the various criteria for radiological assessment of therapy response after spinal SBRT [ 13 ]. Still, few studies have evaluated the detailed radiological changes in bone metastases after SBRT [ 14 – 16 ]. For bone metastases, there are specific aspects to consider in the interpretation of radiological changes after SBRT, including pseudo-progression, vertebral compression fracture (VCF), epidural progression, changes in bone density depending on the nature of metastasis and altered vascularization.…”

Section: Introductionmentioning

confidence: 99%

Response assessment after stereotactic body radiation therapy for spine and non-spine bone metastases: results from a single institutional study

et al. 2022

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Background The use of stereotactic body radiation therapy (SBRT) for tumor and pain control in patients with bone metastases is increasing. We report response assessment after bone SBRT using radiological changes through time and clinical examination of patients. Methods We analyzed retrospectively oligo-metastatic/progressive patients with bony lesions treated with SBRT between 12/2008 and 10/2018, without in-field re-irradiation, in our institution. Radiological data were obtained from imaging modalities used for SBRT planning and follow-up purposes in picture archiving and communication system and assessed by two independent radiologists blind to the time of treatment. Several radiological changes were described. Radiographic response assessment was classified according to University of Texas MD Anderson Cancer Center criteria. Pain response and the neurological deficit were captured before and at least 6 months after SBRT. Results A total of 35 of the 74 reviewed patients were eligible, presenting 43 bone metastases, with 51.2% (n = 22) located in the vertebral column. Median age at the time of SBRT was 66 years (range 38–84) and 77.1% (n = 27) were male. Histology was mainly prostate (51.4%, n = 18) and breast cancer (14.3%, n = 5). Median total radiation dose delivered was 24 Gy (range 24–42), in three fractions (range 2–7), prescribed to 70–90% isodose-line. After a median follow-up of 1.8 years (range < 1–8.2) for survivors, complete or partial response, stable, and progressive disease occurred in 0%, 11.4% (n = 4), 68.6% (n = 24), and 20.0% (n = 7) of the patients, respectively. Twenty patients (57.1%) died during the follow-up time, all from disease progression, yet 70% (n = 14) from this population with local stable disease after SBRT. From patients who were symptomatic and available for follow-up, almost half (44.4%) reported pain reduction after SBRT. Conclusions Eighty percent of the patients showed local control after SBRT for bone metastases. Pain response was favorable. For more accurate response assessment, comparing current imaging modalities with advanced imaging techniques such as functional MRI and PET/CT, in a prospective and standardized way is warranted. Trial registration Retrospectively registered.

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Imaging response assessment following stereotactic body radiotherapy for solid tumour metastases of the spine: Current challenges and future directions

Cited by 7 publications

References 103 publications

Application of Artificial Intelligence Methods for Imaging of Spinal Metastasis

Application of Artificial Intelligence Methods for Imaging of Spinal Metastasis

State-of-the-Art Imaging Techniques in Metastatic Spinal Cord Compression

Response assessment after stereotactic body radiation therapy for spine and non-spine bone metastases: results from a single institutional study

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