PMID- 37414253 OWN - NLM STAT- MEDLINE DCOM- 20230821 LR - 20230821 IS - 1879-0887 (Electronic) IS - 0167-8140 (Linking) VI - 186 DP - 2023 Sep TI - Predictors of pathologic fracture and local recurrence following stereotactic body radiation therapy to 505 non-spine bone metastases. PG - 109792 LID - S0167-8140(23)00330-4 [pii] LID - 10.1016/j.radonc.2023.109792 [doi] AB - PURPOSE: Stereotactic Body Radiation Therapy (SBRT) is increasingly applied to treat non-spine bone metastases (NSBM) though data remains limited on this approach. In this retrospective study, we report outcomes and predictors of local failure (LF) and pathological fracture (PF) post-SBRT for NSBM using a mature single-institution database. METHODS: Patients with NSBM treated with SBRT between 2011 and 2021 were identified. The primary objective was to assess the rates of radiographic LF. Secondary objectives were to assess the rates of in-field PF, overall survival (OS), and late grade >/= 3 toxicity. Competing risks analysis was used to assess rates of LF and PF. Univariable regression and multivariable regression (MVR) were performed to investigate predictors of LF and PF. RESULTS: A total of 373 patients with 505 NSBM were included in this study. Median follow-up was 26.5 months. The cumulative incidence of LF at 6, 12, and 24 months were 5.7%, 7.9%, and 12.6%, respectively. The cumulative incidence of PF at 6, 12, and 24 months were 3.8%, 6.1%, and 10.9%, respectively. Lytic NSBM (HR = 2.18; p < 0.01), a lower biologically effective dose (HR = 1.11 per 5 Gy(10) decrease; p = 0.04), and a PTV >/= 54 cc (HR = 4.32; p < 0.01) predicted for a higher risk of LF on MVR. Lytic NSBM (HR = 3.43; p < 0.01), mixed (lytic/sclerotic) lesions (HR = 2.70; p = 0.04), and rib metastases (HR = 2.68; p < 0.01) predicted for a higher risk of PF on MVR. CONCLUSION: SBRT is an effective modality to treat NSBM with high rates of radiographic local control with an acceptable rate of PF. We identify predictors of both LF and PF that can serve to inform practice and trial design. CI - Copyright (c) 2023 Elsevier B.V. All rights reserved. FAU - Nguyen, Eric K AU - Nguyen EK AD - Department of Radiation Oncology, Walker Family Cancer Center, Niagara Health, St. Catharines, Ontario L2S 0A9, Canada. FAU - Korol, Renee AU - Korol R AD - Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario M4N 3M5, Canada. FAU - Ali, Saher AU - Ali S AD - Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario M4N 3M5, Canada. FAU - Cumal, Aaron AU - Cumal A AD - Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario M4N 3M5, Canada. FAU - Erler, Darby AU - Erler D AD - Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario M4N 3M5, Canada. FAU - Louie, Alexander V AU - Louie AV AD - Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario M4N 3M5, Canada. FAU - Nguyen, Timothy K AU - Nguyen TK AD - Department of Radiation Oncology, London Health Sciences Center, Western University, London, Ontario N6A 5W9, Canada. FAU - Poon, Ian AU - Poon I AD - Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario M4N 3M5, Canada. FAU - Cheung, Patrick AU - Cheung P AD - Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario M4N 3M5, Canada. FAU - Chu, William AU - Chu W AD - Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario M4N 3M5, Canada. FAU - Soliman, Hany AU - Soliman H AD - Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario M4N 3M5, Canada. FAU - Vesprini, Danny AU - Vesprini D AD - Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario M4N 3M5, Canada. FAU - Sahgal, Arjun AU - Sahgal A AD - Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario M4N 3M5, Canada. FAU - Chen, Hanbo AU - Chen H AD - Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario M4N 3M5, Canada. Electronic address: hanbo.chen@sunnybrook.ca. LA - eng PT - Journal Article DEP - 20230705 PL - Ireland TA - Radiother Oncol JT - Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology JID - 8407192 SB - IM MH - Humans MH - *Fractures, Spontaneous/etiology MH - *Radiosurgery/adverse effects MH - Retrospective Studies MH - *Lung Neoplasms/pathology MH - Incidence OTO - NOTNLM OT - Bone metastasis OT - Control OT - Radiotherapy OT - Stereotactic COIS- Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2023/07/07 01:05 MHDA- 2023/08/21 06:42 CRDT- 2023/07/06 19:26 PHST- 2023/02/21 00:00 [received] PHST- 2023/06/27 00:00 [revised] PHST- 2023/06/28 00:00 [accepted] PHST- 2023/08/21 06:42 [medline] PHST- 2023/07/07 01:05 [pubmed] PHST- 2023/07/06 19:26 [entrez] AID - S0167-8140(23)00330-4 [pii] AID - 10.1016/j.radonc.2023.109792 [doi] PST - ppublish SO - Radiother Oncol. 2023 Sep;186:109792. doi: 10.1016/j.radonc.2023.109792. Epub 2023 Jul 5.