Frequency of symptomatic vertebral body compression fractures requiring intervention following single-fraction stereotactic radiosurgery for spinal metastases Journal Article


Authors: Virk, M. S.; Han, J. E.; Reiner, A. S.; McLaughlin, L. A.; Sciubba, D. M.; Lis, E.; Yamada, Y.; Bilsky, M.; Laufer, I.
Article Title: Frequency of symptomatic vertebral body compression fractures requiring intervention following single-fraction stereotactic radiosurgery for spinal metastases
Abstract: 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, imageguided 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. Conc lusions 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. © AANS, 2017.
Keywords: complications; stereotactic radiosurgery; kyphoplasty; vertebral body fracture
Journal Title: Neurosurgical Focus
Volume: 42
Issue: 1
ISSN: 1092-0684
Publisher: American Association of Neurological Surgeons  
Date Published: 2017-01-01
Start Page: E8
Language: English
DOI: 10.3171/2016.10.focus16359
PROVIDER: scopus
PUBMED: 28041324
DOI/URL:
Notes: Article -- Export Date: 2 February 2017 -- Source: Scopus
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
  1. Anne S Reiner
    251 Reiner
  2. Eric Lis
    138 Lis
  3. Yoshiya Yamada
    479 Yamada
  4. Mark H Bilsky
    320 Bilsky
  5. Ilya Laufer
    146 Laufer
  6. James Edward Han
    17 Han
  7. Michael Virk
    2 Virk