Incidence and Prognostic Factors of Painful Vertebral Compression Fracture Caused by Spine Stereotactic Body Radiotherapy

Ito, Kei; Taguchi, Kentaro; Nakajima, Yujiro; Ogawa, Hiroomi; Sugita, Shurei; Murofushi, Keiko

doi:10.3390/jcm12113853

Cited by 3 publications

(5 citation statements)

References 35 publications

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“…In the SC.24 phase III trial, which compared the palliative effect between conventional EBRT and SBRT for painful spinal metastases, SBRT caused grade 3 VCF in 1% of the patients (1/110 patients) [ 7 ]. A retrospective case series at our institution found grade 3 VCFs in 1.9% of all the irradiated spinal segments (15/779 segments) [ 33 ]. On the other hand, several retrospective studies have reported a high grade 3 VCF occurrence rate of 15% (15/100 segments) and 21% (15/72 segments) [ 34 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

“…Third, VCF was not included in the DLT. We did not consider it relevant to the decision-making process because most SBRT-induced VCFs are painless [ 7 , 33 ]. However, the rare occurrence of a severe VCF (e.g., grade 3: intensely painful, requiring hospitalization or invasive interventions such as percutaneous cement injection or surgery) had a strong impact on the patient’s quality of life and influenced the treatment decision-making process.…”

Section: Discussionmentioning

confidence: 99%

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Phase II Clinical Trial of Second Course of Stereotactic Body Radiotherapy for Spinal Metastases

Ito,

Nakajima,

Taguchi

et al. 2024

Cancers

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Purpose: The optimal method for the second course of stereotactic body radiotherapy (SBRT) for spinal metastases remains poorly established. This single-center, single-arm, phase II trial was conducted to propose a safe and effective salvage spine SBRT. Methods: The patients initially treated with SBRT for spine-targeted protocol treatment, or for areas adjacent to the spine, were enrolled. The second SBRT dose was 30 Gy delivered in five fractions; the spinal cord dose constraint was 15.5 Gy at the maximum point dose. The brachial or lumbosacral plexuses were dose-constrained to <30 Gy if the boundary between the nerves and tumors was detected. The primary endpoint was dose-limiting toxicity (DLT) (grade ≥ 3 severe radiation-related toxicity) within a year after the second SBRT. Results: The second SBRT was administered to the same spinal level in 12 patients and to an adjacent spinal level in 8 patients. SBRT2 was performed for 14 painful lesions, 10 MESCC, and 6 oligometastases, with some lesions having multiple indications. The median interval between SBRT sessions was 21 months (range: 6–51 months). The median follow-up duration was 14 months. No radiation myelopathy or local failure was reported during the follow-up period. DLT was confirmed in two patients (10%) within a year, both of whom developed grade 3 lumbosacral plexopathy. These two patients received SBRT twice to the S1–2 and S1–5 vertebrae, respectively, and both experienced paralysis of the tibialis anterior muscle (L5 level). Grade 3 late adverse effects (including lumbosacral plexopathy and vertebral compression fracture) were observed in 25% of the patients throughout the entire follow-up period. Conclusions: The second spine SBRT achieved good local control without causing myelopathy. However, one-quarter of the patients experienced grade 3 late adverse effects, suggesting that the treatment protocol carries a risk of toxicity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Phase II Clinical Trial of Second Course of Stereotactic Body Radiotherapy for Spinal Metastases

Ito,

Nakajima,

Taguchi

et al. 2024

Cancers

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“…Given that the VRMDS only captures information on radiation therapy, there was also a lack of data on the combination of SBRT with systemic therapies such as immunotherapy [ 39 ]. There was also a lack of important spine SBRT outcomes data in the dataset, including local control and symptom control outcomes, as well as toxicity outcomes such as vertebral fracture [ 40 , 41 ] and radiation myelopathy [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Stereotactic Body Radiation Therapy for Spine Metastases—Findings from an Australian Population-Based Study

Ong,

Milne,

Foroudi

et al. 2023

Current Oncology

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Background: To evaluate the use of stereotactic body radiation therapy (SBRT) for spine metastases and the associated factors in Australia. Methods: The Victorian Radiotherapy Minimum Dataset, which captures all episodes of radiotherapy delivered in the state of Victoria, was accessed to evaluate the patterns and trends of SBRT for spine metastases. The primary outcome was SBRT use and associated factors. Results: There were 6244 patients who received 8861 courses of radiotherapy for spine metastases between 2012 and 2017. Of these, 277 (3%) courses were SBRT, which increased from 0.4% in 2012 to 5% in 2017 (P-trend < 0.001). There was a higher proportion of SBRT use in patients with prostate cancer (6%) and melanoma (4%) compared to other cancers (2–3%) (p < 0.001). Patients from the highest socioeconomic quintiles (5%) were more likely to be treated with SBRT compared to patients from the lowest socioeconomic quintiles (3%) (p < 0.001). There was a higher proportion of SBRT use in private radiotherapy centres (6%) compared to public radiotherapy centres (1%) (p < 0.001). No spine SBRT was delivered in regional centres. In multivariate analyses, the year of treatment, age, primary cancers and radiotherapy centres were independently associated with SBRT use. Conclusion: This is the first Australian population-based study quantifying the increasing use of spine SBRT; however, the overall use of spine SBRT remains low. We anticipate an ongoing increase in spine SBRT, as spine SBRT gradually becomes the standard-of-care treatment for painful spine metastases.

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“…The phase III SC.24 clinical trial demonstrated that spinal SBRT was superior to cEBRT in terms of pain relief and has therefore been established as one of the standard treatments [24,25].…”

Section: Introductionmentioning

confidence: 99%

“…However, it is true that the limitations of spinal SBRT, as well as its possible complications, are known to a greater extent [20]. Possible complications include vertebral body fractures (VBF) (11-39%) and myelopathy (0.4%) [19,24]. Another possibility is the appearance of the "Pain Flare" effect (14-68%), a transient increase in pain that can be controlled with corticosteroids as a preventive measure.…”

Section: Introductionmentioning

confidence: 99%

Robotic Stereotactic Body Radiotherapy for Spine Metastasis Pain Relief

Rivas,

de la Torre-Luque,

Suárez

et al. 2024

Applied Sciences

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Spinal metastasis may occur in 40–70% of patients with cancer. Symptoms can vary from pain to spinal cord compression (SCC) and can affect their quality of life (QoL). Stereotactic body radiotherapy (SBRT) allows dose escalation of spinal tumor metastases, minimizing doses to organs at risk and improving pain control. The aim of this study is to retrospectively describe our institution’s experience with robotic SBRT (CyberKnife®, Accuray Incorporated, Sunnyvale, CA, USA) for spinal metastases, in terms of feasibility, oncological results, toxicities, and pain relief observed. In total, 25 patients with 43 lesions were assessed, most of them with dorsal metastases (48.8%). The median total dose was 27 Gy (16–35 Gy), the median number of fractions administered was 3 (1–5), and the median dose per fraction was 9 Gy. Pain was evaluated using the visual analogue scale at baseline and at the end of treatment. The statistically significant reduction in pain (p < 0.01) was associated with the total dose of radiotherapy delivered (p < 0.01). Only one patient developed grade 3 dermatitis. Female gender, adenocarcinoma tumors, and lack of previous surgery were associated with better response to SBRT (p < 0.05). Robotic spine SBRT is feasible, well-tolerated, and improves patients’ QoL through a statistically significant reduction in pain, so it should be offered to patients at an early stage in their process.

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Incidence and Prognostic Factors of Painful Vertebral Compression Fracture Caused by Spine Stereotactic Body Radiotherapy

Cited by 3 publications

References 35 publications

Phase II Clinical Trial of Second Course of Stereotactic Body Radiotherapy for Spinal Metastases

Phase II Clinical Trial of Second Course of Stereotactic Body Radiotherapy for Spinal Metastases

Stereotactic Body Radiation Therapy for Spine Metastases—Findings from an Australian Population-Based Study

Robotic Stereotactic Body Radiotherapy for Spine Metastasis Pain Relief

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