Oncology Medical News about spinal metastases;risk of fracture;single fraction image-guided intensity-modulated radiation therapy

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Risk of fracture after single fraction image-guided intensity-modulated radiation therapy to spinal metastases
Journal of Clinical Oncology, 09/14/09

Rose PS et al. – Vertebral fracture is common after single fraction IG-IMRT for metastatic spine lesions. Lytic disease involving more than 40% of the vertebral body and location at or below T10 confer a high risk of fracture, the presence of which yields significantly poorer clinical outcomes. These results may help identify high-risk patients who would benefit from prophylactic vertebro- or kypho-plasty.

Methods

62 consecutive patients
Single fraction IG-IMRT
71 sites for solid organ metastases
Prospectively obtained magnetic resonance/ CT imaging studies evaluated for post-treatment fracture development and tumor recurrence

Results

Fracture progression noted in 27 vertebrae
Multivariate logistic regression analysis showed CT appearance, lesion location, and percent vertebral body involvement independently predicted fracture progression
Lesions located between T10 and sacrum 4.6 times more likely to fracture than lesions above T10
Lytic lesions 6.8 times more likely to fracture than sclerotic and mixed lesions
As percent vertebral body involvement increased, fracture risk increased
Patients with fracture progression had higher narcotic use, change in Karnofsky performance score, and trend toward higher pain scores
Local tumor progression in seven patients
Local tumor progression contributed to one fracture
Obesity, posterior element involvement, bisphosphonate use, and local kyphosis did not increase risk

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