PMID- 28041324
OWN - NLM
STAT- MEDLINE
DCOM- 20170302
LR  - 20220408
IS  - 1092-0684 (Electronic)
IS  - 1092-0684 (Linking)
VI  - 42
IP  - 1
DP  - 2017 Jan
TI  - Frequency of symptomatic vertebral body compression fractures requiring 
      intervention following single-fraction stereotactic radiosurgery for spinal 
      metastases.
PG  - E8
LID - 2016.10.FOCUS16359 [pii]
LID - 10.3171/2016.10.FOCUS16359 [doi]
AB  - OBJECTIVE The purpose of this study was to determine the rate of symptomatic 
      vertebral body compression fractures (VCFs) requiring kyphoplasty or surgery in 
      patients treated with 24-Gy single-fraction stereotactic radiosurgery (SRS). 
      METHODS This retrospective analysis included all patients who had been treated 
      with 24-Gy, single-fraction, image-guided intensity-modulated radiation therapy 
      for histologically confirmed solid tumor metastases over an 8-year period 
      (2005-2013) at Memorial Sloan Kettering Cancer Center. Charts and imaging studies 
      were reviewed for post-SRS kyphoplasty or surgery for mechanical instability. A 
      Spinal Instability Neoplastic Score (SINS) was calculated for each patient both 
      at the time of SRS and at the time of intervention for VCF. RESULTS Three hundred 
      twenty-three patients who had undergone single-fraction SRS between C-1 and L-5 
      were included in this analysis. The cumulative incidence of VCF 5 years after SRS 
      was 7.2% (95% CI 4.1-10.2), whereas that of death following SRS at the same time 
      point was 82.5% (95% CI 77.5-87.4). Twenty-six patients with 36 SRS-treated 
      levels progressed to symptomatic VCF requiring treatment with kyphoplasty (6 
      patients), surgery (10 patients), or both (10 patients). The median time to 
      symptomatic VCF was 13 months. Seven patients developed VCF at 11 levels adjacent 
      to the SRS-treated level. Fractured levels had no evidence of tumor progression. 
      The median SINS changed from 6.5 at SRS (interquartile range [IQR] 4.3-8.8) to 
      11.5 at stabilization (IQR 9-13). In patients without prior stabilization at the 
      level of SRS, there was an association between the SINS and the time to fracture. 
      CONCLUSIONS Five years after ablative single-fraction SRS to spinal lesions, the 
      cumulative incidence of symptomatic VCF at the treated level without tumor 
      recurrence was 7.2%. Higher SINSs at the time of SRS correlated with earlier 
      fractures.
FAU - Virk, Michael S
AU  - Virk MS
AD  - Departments of1Neurological Surgery.
AD  - 2Department of Neurological Surgery, Weill Cornell Medical College, 
      NewYork-Presbyterian Hospital, New York, New York; and.
FAU - Han, James E
AU  - Han JE
AD  - 3Radiation Oncology.
FAU - Reiner, Anne S
AU  - Reiner AS
AD  - 4Epidemiology and Biostatistics, and.
FAU - McLaughlin, Lily A
AU  - McLaughlin LA
AD  - Departments of1Neurological Surgery.
FAU - Sciubba, Daniel M
AU  - Sciubba DM
AD  - 5Department of Neurosurgery, Johns Hopkins University School of Medicine, 
      Baltimore, Maryland.
FAU - Lis, Eric
AU  - Lis E
AD  - 6Radiology, Memorial Sloan Kettering Cancer Center.
FAU - Yamada, Yoshiya
AU  - Yamada Y
AD  - 3Radiation Oncology.
FAU - Bilsky, Mark
AU  - Bilsky M
AD  - Departments of1Neurological Surgery.
AD  - 2Department of Neurological Surgery, Weill Cornell Medical College, 
      NewYork-Presbyterian Hospital, New York, New York; and.
FAU - Laufer, Ilya
AU  - Laufer I
AD  - Departments of1Neurological Surgery.
AD  - 2Department of Neurological Surgery, Weill Cornell Medical College, 
      NewYork-Presbyterian Hospital, New York, New York; and.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Neurosurg Focus
JT  - Neurosurgical focus
JID - 100896471
SB  - IM
MH  - Aged
MH  - Female
MH  - Fractures, Compression/*etiology/*surgery
MH  - Humans
MH  - Karnofsky Performance Status
MH  - Kyphoplasty/*methods
MH  - Magnetic Resonance Imaging
MH  - Male
MH  - Middle Aged
MH  - Neoplasm Recurrence, Local/diagnostic imaging/surgery
MH  - Postoperative Complications/diagnostic imaging/*surgery
MH  - Radiosurgery/*adverse effects
MH  - Spinal Neoplasms/diagnostic imaging/secondary/surgery
MH  - Tomography Scanners, X-Ray Computed
OTO - NOTNLM
OT  - IG-IMRT = image-guided IMRT
OT  - IMRT = intensity-modulated radiation therapy
OT  - IQR = interquartile range
OT  - KPS = Karnofsky Performance Scale
OT  - SINS = Spinal Instability Neoplastic Score
OT  - SRS = stereotactic radiosurgery
OT  - VCF = vertebral body compression fracture
OT  - complications
OT  - kyphoplasty
OT  - stereotactic radiosurgery
OT  - vertebral body fracture
EDAT- 2017/01/04 06:00
MHDA- 2017/03/03 06:00
CRDT- 2017/01/03 06:00
PHST- 2017/01/03 06:00 [entrez]
PHST- 2017/01/04 06:00 [pubmed]
PHST- 2017/03/03 06:00 [medline]
AID - 2016.10.FOCUS16359 [pii]
AID - 10.3171/2016.10.FOCUS16359 [doi]
PST - ppublish
SO  - Neurosurg Focus. 2017 Jan;42(1):E8. doi: 10.3171/2016.10.FOCUS16359.