Abstract Date: 4/8/2014
Isabelle M. Germano, MD (New York, NY)
Andrea Carai, MD, PhD (Rome, Italy)
Sheryl Green, MD
Puneet Pawha, MD
Seth Blacksburg, MD
Isabelle Germano, MD (New York, NY)
Single fraction radiosurgery (SRS) is successfully used to manage traditionally radioresistant cancer while sparing the cord. High rates of local control and effectiveness on pain compared to conventional radiotherapy make this treatment increasingly more frequently used. The risk of vertebral compression fracture (VCF) is reported. The aim of this study is to determine the risk of VCF and identify predictive factors.
We evaluated 84 consecutive spine metastases treated with single fraction SRS on the Novalis as outpatients. MRI were evaluated for the 6 Spine Instability Neoplastic (SINS) criteria and changes in vertebral body height (VBH )at baseline, 3, and 6-9 months after SRS. Pain was evaluated with Visual Analog Scale (VAS); improvement/worsening considered a 2point change on VAS for score >3. VCF was considered a loss of VBH >10%; radiographic progression was considered loss of VBH >25%.
Pain was present in 82% of patients prior to SRS. After SRS, pain was improved in 85% of patients at 7days and persisted at 30 days. Radiographic control occurred in 98% of cases at 3 months and 88% at 6-9 months. VCF was present in 33% of cases prior to SRS. Overall rate of VCF after SRS was 20%. Rate of de novo VCF and progression was identical, more frequently occurring at 3 than 6-9months 3 after SRS. Worsening pain was present in only 20% of patients with VCF after SRS, yet 66% underwent a procedure: vertebroplasty (62%) and surgery (38%). SINS score, histology, and age did not correlate with VCF risk and/or intervention rate.
Spine SRS provide excellent radiographic and pain control. We report 80% probability of VCF-free outcome up to 9 months after SRS. Additional studies are needed to determine if in the presence of an asymptomatic VCF interventions to prevent radiographic progression are necessary.
Article ID: AA-28767