Vertebral Compression Fractures After Spine Irradiation Using Conventional Fractionation in Patients With Metastatic Colorectal Cancer

Rhee, Woo Joong; Kim, K.; Chang, Jee Suk; Kim, M.; Kim, H.; Choi, Seo Hee; Koom, Woong Sub

doi:10.1016/j.ijrobp.2014.05.2036

Cited by 3 publications

(4 citation statements)

References 15 publications

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“…At present, little is known about the effect of lytic defect on the propensity of adjacent vertebra to undergo failure. However, both radiotherapy and cement‐based augmentation are associated with higher fracture risk in this patient population. This study highlights the need to better understand the effect of lytic lesions on the load transfer between adjacent segments in order to establish better diagnostic and palliative treatments for keeping the risk of adjacent vertebral collapse to a minimum.…”

Section: Discussionmentioning

confidence: 95%

Mechanical assessment of the effects of metastatic lytic defect on the structural response of human thoracolumbar spine

Alkalay

Harrigan

2016

Journal Orthopaedic Research

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To investigate the effects of a clinical lytic defect on the structural response of human thoracolumbar functional spinal unit. A novel CT-compatible mechanical test system was used to image the deformation of a T12-L1 motion segment and measure the change in strain response under compressive loads ranging from 50 to 750 N. A lytic lesion (LM) with cortex involvement (33% by volume) was introduced to the upper vertebral body and the CT experiments were repeated. Finite element models, established from the CT volumes, were used to investigate the defect's effects on the structural response and the state of principal and shear stresses within the affected and adjacent vertebrae. The lytic lesion resulted in severe loss of the vertebral structural competence, resulting in significant, non-linear, and asymmetric increase in the experimentally measured strains and computed stresses within both vertebrae (p < 0.01). At the cortex, the tensile strains were significantly increased, while compressive strains significantly decreased, (p < 0.05). Both the vertebral bone and cortex regions adjacent to the defect showed significant increase in computed compressive, tensile, and shear stresses (p < 0.01). Changes in stress and strain distribution within the affected and adjacent vertebral bone and the experimentally observed bulging and buckling of the vertebral cortices suggested that initiation of catastrophic vertebral failure may occur under load magnitudes encountered in daily living. Although the effect of LM on the global deformation of the spine was well-predicted, our results show that FE predictions of local strain changes must be carefully assessed for clinical relevance. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1808-1819, 2016.

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Section: Discussionmentioning

confidence: 95%

Mechanical assessment of the effects of metastatic lytic defect on the structural response of human thoracolumbar spine

Alkalay

Harrigan

2016

Journal Orthopaedic Research

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“…5,21 In our previous study examining small cohorts, we also found that the rate of VCF was 9% after conventional radiation in metastatic spines with lytic or mixed lesions of CRC. 17 We also examined the parameters associated with patients at risk for VCF. The effect of VCF after SBRT/stereotactic radiosurgery for spinal metastases has been well established in recent studies, and the incidence of VCF is estimated to be 11%-39%.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of predictive factors of vertebral compression fracture after conventional palliative radiotherapy for spinal metastasis from colorectal cancer

Lee

Rhee

Chang

et al. 2018

Journal of Neurosurgery: Spine

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OBJECTIVEDelayed consequences of spinal radiotherapy (RT), including vertebral compression fracture (VCF), are critical complications. However, the predisposing factors that contribute to VCF after conventional RT are unclear. The aim of this study was to assess the incidence of VCF and to determine the predictors of VCF following conventional spinal RT specific to colorectal cancer (CRC).METHODSThe authors retrospectively reviewed 237 spinal segments (147 metastatic and 90 nonmetastatic) in 53 patients with CRC who underwent RT with a median total dose of 30 Gy in 10 fractions between January 2007 and December 2014. The primary end point was the development of a VCF following RT, either de novo VCF or the progression of a baseline VCF. VCFs were assessed using the spinal instability neoplastic score (SINS) criteria.RESULTSAmong all 237 spinal segments, 22 VCFs (9.3%) were observed following RT, including 13 de novo and 9 progressive fractures, and the median time to VCF was 4 months. All VCFs developed in metastatic spines. Among 147 metastatic spinal segments, 22 fractures were observed, with a 12-month cumulative incidence of VCF of 14.8%. Results of multivariable analysis indicated sex (p = 0.023) and SINS class II/III (p < 0.001) as risk factors related to development of a VCF in metastatic spinal segments. Among the SINS criteria, a lytic tumor and the presence of a baseline VCF were identified as predictors of VCF in metastatic spinal segments.CONCLUSIONSIn osteolytic or mixed lesions that were predominant in spinal metastases of CRC, the incidence of VCF was not negligible, even in patients treated with conventional spinal RT. This was especially evident in patients with spinal metastases with a SINS score ≥ 7. Presence of a baseline VCF after spinal RT is a predictor of VCF development and should be observed carefully.

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“…Eighteen clinical studies reported on fracture rate during follow up after radiotherapy [33][34][35]38,41,45,46,49,50,[53][54][55][56][57][58][59]61,62] (Supplementary File D, 7 th column). Overall, fracture rates after primary radiotherapy ranged from 0% to about 15%.…”

Section: Pathological Fracturesmentioning

confidence: 99%

“…Overall, fracture rates after primary radiotherapy ranged from 0% to about 15%. In addition, reported rates on progression of spinal fractures after radiotherapy range from about 7% to 55% [50,58]. Three controlled clinical trials compared single-fraction radiotherapy with multiple-fraction radiotherapy (1 Â 8 Gy vs. 10 Â 3 Gy [41]; 1 Â 8 Gy vs. 5 Â 4 Gy or 10 Â 3 Gy [38]; 1 Â 8 Gy vs. 6 Â 4 Gy [57]).…”

Section: Pathological Fracturesmentioning

confidence: 99%

The effect of radiotherapy, and radiotherapy combined with bisphosphonates or RANK ligand inhibitors on bone quality in bone metastases. A systematic review

Groenen¹,

Pouw

Hannink³

et al. 2016

Radiotherapy and Oncology

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Despite the clinical experience that radiotherapy is an effective treatment for bone metastases, there was no sufficient evidence for a positive effect on bone quality and fracture risk. Animal studies showed that adding bisphosphonates to radiotherapy restored bone quality and strength, whereas this was not proven in patients. There were no studies addressing the adjunct effect of RANKL inhibitors to radiotherapy. Although associated with several methodological, practical and ethical challenges, randomized controlled trials are needed.

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Vertebral Compression Fractures After Spine Irradiation Using Conventional Fractionation in Patients With Metastatic Colorectal Cancer

Cited by 3 publications

References 15 publications

Mechanical assessment of the effects of metastatic lytic defect on the structural response of human thoracolumbar spine

Mechanical assessment of the effects of metastatic lytic defect on the structural response of human thoracolumbar spine

Evaluation of predictive factors of vertebral compression fracture after conventional palliative radiotherapy for spinal metastasis from colorectal cancer

The effect of radiotherapy, and radiotherapy combined with bisphosphonates or RANK ligand inhibitors on bone quality in bone metastases. A systematic review

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