Can the spinal instability neoplastic score prior to spinal radiosurgery predict compression fractures following stereotactic spinal radiosurgery for metastatic spinal tumor?: a post hoc analysis of prospective phase II single-institution trials

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• 作者：Sun-Ho Lee ; Claudio E. Tatsui ; Amol J. Ghia ; Behrang Amini…
• 关键词：Compression fracture ; Instability ; Predictability ; Radiosurgery ; Spinal metastasis
• 刊名：Journal of Neuro-Oncology
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：126
• 期：3
• 页码：509-517
• 全文大小：790 KB
• 参考文献：1.Klimo P Jr, Schmidt MH (2004) Surgical management of spinal metastases. Oncologist 9:188–196PubMed CrossRef
  2.Lo SS, Chang EL, Yamada Y, Sloan AE, Suh JH, Mendel E (2007) Stereotactic radiosurgery and radiation therapy for spinal tumors. Expert Rev Neurother 7(1):85–93PubMed CrossRef
  3.Pan H, Simpson DR, Mell LK, Mundt AJ, Lawson JD (2011) A survey of stereotactic body radiotherapy use in the United States. Cancer 117(19):4566–4572PubMed PubMedCentral CrossRef
  4.Sahgal A, Whyne CM, Ma L, Larson DA, Fehlings MG (2013) Vertebral compression fracture after stereotactic body radiotherapy for spinal metastases. Lancet Oncol 14(8):e310–e320PubMed CrossRef
  5.Garg AK, Shiu AS, Yang J, Wang XS, Allen P, Brown BW, Grossman P, Frija EK, McAleer MF, Azeem S, Brown PD, Rhines LD, Chang EL (2012) Phase 1/2 trial of single-session stereotactic body radiotherapy for previously unirradiated spinal metastases. Cancer 118(20):5069–5077PubMed PubMedCentral CrossRef
  6.Garg AK, Wang XS, Shiu AS, Allen P, Yang J, McAleer MF, Azeem S, Rhines LD, Chang EL (2011) Prospective evaluation of spinal reirradiation by using stereotactic body radiation therapy: the University of Texas MD Anderson Cancer Center experience. Cancer 117(15):3509–3516PubMed CrossRef
  7.Sahgal A, Bilsky M, Chang EL, Ma L, Yamada Y, Rhines LD, Létourneau D, Foote M, Yu E, Larson DA, Fehlings MG (2011) Stereotactic body radiotherapy for spinal metastases: current status, with a focus on its application in the postoperative patient. A review. J Neurosurg Spine 14(2):151–166PubMed CrossRef
  8.Boehling NS, Grosshans DR, Allen PK, McAleer MF, Burton AW, Azeem S, Rhines LD, Chang EL (2012) Vertebral compression fracture risk after stereotactic body radiotherapy for spinal metastases. Clinical article. J Neurosurg Spine 16(4):379–386PubMed CrossRef
  9.Cunha MV, Al-Omair A, Atenafu EG, Masucci GL, Letourneau D, Korol R, Yu E, Howard P, Lochray F, da Costa LB, Fehlings MG, Sahgal A (2012) Vertebral compression fracture (VCF) after spine stereotactic body radiation therapy (SBRT): analysis of predictive factors. Int J Radiat Oncol Biol Phys 84(3):e343–e349PubMed CrossRef
  10.Rose PS, Laufer I, Boland PJ, Hanover A, Bilsky MH, Yamada J, Lis E (2009) Risk of fracture after single fraction image-guided intensity-modulated radiation therapy to spinal metastases. J Clin Oncol 27(30):5075–5079PubMed PubMedCentral CrossRef
  11.Sahgal A, Atenafu EG, Chao S, Al-Omair A, Boehling N, Balagamwala EH, Cunha M, Thibault I, Angelov L, Brown P, Suh J, Rhines LD, Fehlings MG, Chang E (2013) Vertebral compression fracture after spine stereotactic body radiotherapy: a multi-institutional analysis with a focus on radiation dose and the spinal instability neoplastic score. J Clin Oncol 31(27):3426–3431PubMed CrossRef
  12.Fisher CG, DiPaola CP, Ryken TC, Bilsky MH, Shaffrey CI, Berven SH, Harrop JS, Fehlings MG, Boriani S, Chou D, Schmidt MH, Polly DW, Biagini R, Burch S, Dekutoski MB, Ganju A, Gerszten PC, Gokaslan ZL, Groff MW, Liebsch NJ, Mendel E, Okuno SH, Patel S, Rhines LD, Rose PS, Sciubba DM, Sundaresan N, Tomita K, Varga PP, Vialle LR, Vrionis FD, Yamada Y, Fourney DR (2010) A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine (Phila Pa 1976) 35(22):e1221–e1229CrossRef
  13.Fourney DR, Frangou EM, Ryken TC, Dipaola CP, Shaffrey CI, Berven SH, Bilsky MH, Harrop JS, Fehlings MG, Boriani S, Chou D, Schmidt MH, Polly DW, Biagini R, Burch S, Dekutoski MB, Ganju A, Gerszten PC, Gokaslan ZL, Groff MW, Liebsch NJ, Mendel E, Okuno SH, Patel S, Rhines LD, Rose PS, Sciubba DM, Sundaresan N, Tomita K, Varga PP, Vialle LR, Vrionis FD, Yamada Y, Fisher CG (2011) Spinal instability neoplastic score: an analysis of reliability and validity from the spine oncology study group. J Clin Oncol 29(22):3072–3077PubMed CrossRef
  14.Bilsky MH, Laufer I, Fourney DR, Groff M, Schmidt MH, Varga PP, Vrionis FD, Yamada Y, Gerszten PC, Kuklo TR (2010) Reliability analysis of the epidural spinal cord compression scale. J Neurosurg Spine 13(3):324–328PubMed CrossRef
  15.Wang JC, Boland P, Mitra N, Yamada Y, Lis E, Stubblefield M, Bilsky MH (2004) Single-stage posterolateral transpedicular approach for resection of epidural metastatic spine tumors involving the vertebral body with circumferential reconstruction: results in 140 patients. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine 1(3):287–298PubMed CrossRef
  16.Aghayev K, Papanastassiou ID, Vrionis F (2011) Role of vertebral augmentation procedures in the management of vertebral compression fractures in cancer patients. Curr Opin Support Palliat Care 5(3):222–226PubMed CrossRef
  17.Berenson J, Pflugmacher R, Jarzem P, Zonder J, Schechtman K, Tillman JB, Bastian L, Ashraf T, Vrionis F, Cancer Patient Fracture Evaluation (CAFE) Investigators (2011) Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: a multicentre, randomised controlled trial. Lancet Oncol 12(3):225–235PubMed CrossRef
  18.Gerszten PC, Germanwala A, Burton SA, Welch WC, Ozhasoglu C, Vogel WJ (2005) Combination kyphoplasty and spinal radiosurgery: a new treatment paradigm for pathological fractures. J Neurosurg Spine 3(4):296–301PubMed CrossRef
  19.Tokuhashi Y, Matsuzaki H, Oda H, Oshima M, Ryu J (2005) A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine (Phila Pa 1976) 30(19):2186–2191CrossRef
  20.Tomita K, Kawahara N, Kobayashi T, Yoshida A, Murakami H, Akamaru T (2001) Surgical strategy for spinal metastases. Spine (Phila Pa 1976) 26(3):298–306CrossRef
  21.Campos M, Urrutia J, Zamora T, Román J, Canessa V, Borghero Y, Palma A, Molina M (2014) The spine instability neoplastic score: an independent reliability and reproducibility analysis. Spine J 14(8):1466–1469PubMed CrossRef
  22.Fisher CG, Schouten R, Versteeg AL, Boriani S, Varga PP, Rhines LD, Kawahara N, Fourney D, Weir L, Reynolds JJ, Sahgal A, Fehlings MG, Gokaslan ZL (2014) Reliability of the spinal instability neoplastic score (SINS) among radiation oncologists: an assessment of instability secondary to spinal metastases. Radiat Oncol 9:69PubMed PubMedCentral CrossRef
  23.Fisher CG, Versteeg AL, Schouten R, Boriani S, Varga PP, Rhines LD, Heran MK, Kawahara N, Fourney D, Reynolds JJ, Fehlings MG, Gokaslan ZL (2014) Reliability of the spinal instability neoplastic scale among radiologists: an assessment of instability secondary to spinal metastases. Am J Roentgenol 203(4):869–874CrossRef
  24.Versteeg AL, Fisher CG, Oner C, Verlaan JJ (2015) Validation of the spinal instability neoplastic score: a retrospective analysis. Global Spine J 5(Suppl 1):A225. doi:10.​1055/​s-0035-1554329
  
• 作者单位：Sun-Ho Lee (1) (2)
  Claudio E. Tatsui (1)
  Amol J. Ghia (3)
  Behrang Amini (4)
  Jing Li (3)
  Salvatore M. Zavarella (1)
  Nizar M. Tannir (5)
  Paul D. Brown (3)
  Laurence D. Rhines (1)
  
  1. Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 442, Houston, TX, 77030, USA
  2. Department of Neurosurgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
  3. Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 442, Houston, TX, 77030, USA
  4. Diagnostic Radiology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 442, Houston, TX, 77030, USA
  5. Department of Genitourinary Medical Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 442, Houston, TX, 77030, USA
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Oncology
  
• 出版者：Springer Netherlands
• ISSN：1573-7373

文摘

The aim of this study was to determine the predictability of vertebral compression fracture (VCF) development applying the spinal instability neoplastic score (SINS) prior to delivery of stereotactic spinal radiosurgery (SSRS) for spinal metastases. From two prospective cohorts of SSRS for spinal metastases, we selected patients with a low degree of cord compression or cauda equine from C3 to S1 and analyzed 79 patients enrolled according to binary SINS criteria. The primary endpoint was the development of a de novo VCF or progression of an existing fracture after SSRS. We identified 32 fractures (40.5 %): 19 de novo and 13 progressive. The mean time to fracture after SSRT was 3.3 months (range, 0.4–34.1 months). In 41 patients with low SINS (0–6), 7 patients (17.1 %) developed a fracture after SSRS. In 38 patients with high SINS (7–12), 25 (65.8 %) developed a fracture. Among the 32 fractures, 15 were symptomatic. Patients with high SINS were more likely to experience symptomatic fractures (31.6 %) than were patients with lower SINS (7.4 %). On univariate and multivariate analysis, 24-month fracture-free rates were 78.7 and 33.7 % in low and high SINS group, respectively and high SINS was found to be a significant risk factor for VCFs and symptomatic fractures (respectively, HR 5.6, p = 0.04; HR 5.3, p = 0.01). SINS is a useful tool for predicting the development of VCF after SSRS for spinal metastases. Prophylactic cement augmentation should not be considered for patients with lower SINS, since the risk of fracture is low. Keywords Compression fracture Instability Predictability Radiosurgery Spinal metastasis