Risk factors for vertebral compression fracture after spine stereotactic body radiation therapy: Long-term results of a prospective phase 2 study

Mantel, Frederick; Sweeney, Reinhart A.; Klement, Rainer J.; Hawkins, M.; Belderbos, J.; Ahmed, Merina; Toussaint, A.; Polat, Bülent; Flentje, Michael; Gückenberger, Matthias

doi:10.1016/j.radonc.2019.08.026

Cited by 20 publications

(15 citation statements)

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“…31 In a previous study, we reported a relatively high rate of VCF: 35% of patients developed progressive or new VCF in that study. 32 However, this needs to be put into the context that almost one-fourth of the patients had VCF before SBRT. Additionally, fractures were asymptomatic in most patients, although 2 patients required stabilization surgery after SBRT.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Results of Dose-Intensified Fractionated Stereotactic Body Radiation Therapy (SBRT) for Painful Spinal Metastases

Gückenberger

Mantel

Sweeney

et al. 2021

International Journal of Radiation Oncology*Biology*Physics

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Purpose: To report long-term outcome of fractionated stereotactic body radiation therapy (SBRT) for painful spinal metastases. Methods and Materials: This prospective, single-arm, multicenter phase 2 clinical trial enrolled 57 patients with 63 painful, unirradiated spinal metastases between March 2012 and July 2015. Patients were treated with 48.5 Gy in 10 SBRT fractions (long life expectancy [Mizumoto score 4]) or 35 Gy in 5 SBRT fractions (intermediate life expectancy [Mizumoto score 5-9]). Pain response was defined as pain improvement of a minimum of 2 points on a visual analog scale, and net pain relief was defined as the sum of time with pain response (complete and partial) divided by the overall follow-up time. Results: All 57 patients received treatment per protocol; 32 and 25 patients were treated with 10-and 5-fraction SBRT, respectively. The median follow-up of living patients was 60 months (range, 33-74 months). Of evaluable patients, 82% had complete or partial pain response (responders) at 3 months' follow-up (primary endpoint), and pain response remained stable over 5 years. Net pain relief was 74% (95% CI, 65%-80%). Overall survival rates of 1, 3, and 5 years were 59.6% (95% CI, 47%-72%), 33.3% (95% CI, 21%-46%), and 21% (95% CI, 10%-32%), respectively. Freedom from local spinal-metastasis progression was 82% at the last imaging follow-up. Late

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Section: Discussionmentioning

confidence: 99%

Long-Term Results of Dose-Intensified Fractionated Stereotactic Body Radiation Therapy (SBRT) for Painful Spinal Metastases

Gückenberger

Mantel

Sweeney

et al. 2021

International Journal of Radiation Oncology*Biology*Physics

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“…In this regard, Mantel et al have recently identified frequency, clinical relevance, and risk factors for VCF after spine SBRT with long-term follow-up in 56 patients (61 lesions) within a prospective multicenter phase 2 study (NCT01594892). 37 Post-SBRT VCF developed in 21 lesions (34.4%): of these, 10 lesions (16.4%) showed a progressive VCF, while a new VCF occurred in 11 lesions (18.0%). If on the one hand, SBRT dose did not significantly correlate to VCF in the univariate analysis, receiver operating characteristics analysis revealed that a relative involvement of !34.5% of the vertebral body best predicted a post-SBRT VCF with an area under the curve of 0.864, a sensitivity of 77.8%, and a specificity of 89.7%.…”

Section: Discussionmentioning

confidence: 90%

Stereotactic Body Radiation Therapy With Simultaneous Integrated Boost in Patients With Spinal Metastases

Pontoriero

Iatì

Cacciola

et al. 2020

Technol Cancer Res Treat

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Stereotactic body radiation therapy in patients with spine metastases maximizes local tumor control and preserves neurologic function. A novel approach could be the use of stereotactic body radiation therapy with simultaneous integrated boost delivering modality. The aim of the present study is to report our experience in the treatment of spine metastases using a frameless radiosurgery system delivering stereotactic body radiation therapy–simultaneous integrated boost technique. The primary endpoints were the pain control and the time to local progression; the secondary ones were the overall survival and toxicity. A total of 20 patients with spine metastases and 22 metastatic sites were treated in our center with stereotactic body radiation therapy–simultaneous integrated boost between December 2007 and July 2018. Stereotactic body radiation therapy–simultaneous integrated boost treatments were delivered doses of 8 to 10 Gy in 1 fraction to isodose line of 50%. The median follow-up was 35 months (range: 12-110). The median time to local progression for all patients was not reached and the actuarial 1-, 2-, and 3-years local free progression rate was 86.36%. In 17 of 20 patients, a complete pain remission was observed and 3 of 20 patients had a partial pain remission (complete pain remission + partial pain remission: 100%). The median overall survival was 38 months (range 12-83). None of the patients experienced neither radiation adverse events (grade 1-4) nor reported pain flair reaction. None of the patients included in our series experienced vertebral compression fracture. Spine radiosurgery with stereotactic body radiation therapy–simultaneous integrated boost is safe. The use of this modality in spine metastases patients provides an excellent local control.

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“…SBRT to spinal lesions frequently results in flare-up of pain (20-70%) before pain relief but shows higher local control rates than those achieved with EBRT [12,[14][15][16]. However, a major complication after SBRT is vertebral compression fracture (VCF), which may occur in up to 40% of patients, specifically in case of pre-existing sintering [17][18][19]. Albeit occurrence or progression of VCF after SBRT resulted in a low mean increase of pain, SBRT may further pose a risk of VCF in adjacent vertebrae [17,20].…”

Section: Discussionmentioning

confidence: 99%

“…However, a major complication after SBRT is vertebral compression fracture (VCF), which may occur in up to 40% of patients, specifically in case of pre-existing sintering [17][18][19]. Albeit occurrence or progression of VCF after SBRT resulted in a low mean increase of pain, SBRT may further pose a risk of VCF in adjacent vertebrae [17,20]. The inherent stabilization and restoration of the vertebral body by cement augmentation virtually eradicates the risk of VCF or further progression of VCF, especially for patients with pre-existing VCF which would have a high probability of progredient VCF after SBRT.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcome after combined kyphoplasty and intraoperative radiotherapy (Kypho-IORT) for vertebral tumors

et al. 2020

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Introduction The spine represents the site which is most frequently affected by bone metastases in patients with systemic cancer. Of all local treatment options, combined kyphoplasty and intraoperative radiotherapy (Kypho-IORT) provides both, instantaneous stabilization and immediate pain relief. We here report on the long-term outcomes of the largest cohort treated with Kypho-IORT to date. Methods Between 2009 and 2019 a total of 104 patients underwent Kypho-IORT to vertebral tumors in the thoracic, lumbar, or sacral spine with transpedicular kyphoplasty and intraoperative irradiation with a needle-shaped electronic brachytherapy source at our center. Patients were treated either on trial, within the prospective Kypho-IORT studies (NCT01280032 and NCT02773966), or, after completion of the study, off trial but compliant with the study protocol. Follow-up and imaging with computed tomography (CT) or magnetic resonance imaging was scheduled after 3 and 6 months and then bi-annually. Results A total of 143 vertebrae (89 thoracic spine, 53 lumbar spine, and 1 sacral spine) were treated in 104 patients. The median follow-up was 14.5 months (range 0.4–109). Local progression occurred in 10 patients (10 vertebrae) after a median time of 22.3 months (range 1.5–73) resulting in local control rates of 97.1, 95.9, and 94.2% at 6, 12, and 24 months, respectively. Overall survival was 74.6, 61.7, and 50.3% at 6, 12, and 24 months, respectively. A single serious adverse event was reported. Conclusion In addition to immediate pain reduction and stabilization, Kypho-IORT shows excellent long-term local control with minimal side effects.

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Risk factors for vertebral compression fracture after spine stereotactic body radiation therapy: Long-term results of a prospective phase 2 study

Cited by 20 publications

References 20 publications

Long-Term Results of Dose-Intensified Fractionated Stereotactic Body Radiation Therapy (SBRT) for Painful Spinal Metastases

Long-Term Results of Dose-Intensified Fractionated Stereotactic Body Radiation Therapy (SBRT) for Painful Spinal Metastases

Stereotactic Body Radiation Therapy With Simultaneous Integrated Boost in Patients With Spinal Metastases

Long-term outcome after combined kyphoplasty and intraoperative radiotherapy (Kypho-IORT) for vertebral tumors

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