Correlation of computed tomography imaging features with pain response in patients with spine metastases after radiation therapy.
OBJECTIVE
To correlate computed tomography (CT) imaging features of spinal metastases with pain relief after radiotherapy (RT).


METHODS
Thirty-three patients receiving computed tomography (CT)-simulated RT for spinal metastases in an outpatient palliative RT clinic from January 2007 to October 2008 were retrospectively reviewed. Forty spinal metastases were evaluated. Pain response was rated using the International Bone Metastases Consensus Working Party endpoints. Three musculoskeletal radiologists and two orthopaedic surgeons evaluated CT features, including osseous and soft tissue tumor extent, presence of a pathologic fracture, severity of vertebral height loss, and presence of kyphosis.


RESULTS
The mean patient age was 69 years; 24 were men and 9 were women. The mean worst pain score was 7/10, and the mean total daily oral morphine equivalent was 77.3 mg. Treatment doses included 8 Gy in one fraction (22/33), 20 Gy in five fractions (10/33), and 20 Gy in eight fractions (1/33). The CT imaging appearance of spinal metastases included vertebral body involvement (40/40), pedicle involvement (23/40), and lamina involvement (18/40). Soft tissue component (10/40) and nerve root compression (9/40) were less common. Pathologic fractures existed in 11/40 lesions, with resultant vertebral body height loss in 10/40 and kyphosis in 2/40 lesions. At months 1, 2, and 3 after RT, 18%, 69%, and 70% of patients experienced pain relief. Pain response was observed with various CT imaging features.


CONCLUSIONS
Pain response after RT did not differ in patients with and without pathologic fracture, kyphosis, or any other CT features related to extent of tumor involvement. All patients with painful spinal metastases may benefit from palliative RT.
Mitera
Gunita
G
Rapid Response Radiotherapy Program, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada M4N 3M5. Gunita.Mitera@Sunnybrook.ca
Probyn
Linda
L
Ford
Michael
M
Donovan
Andrea
A
Rubenstein
Joel
J
Finkelstein
Joel
J
Christakis
Monique
M
Zhang
Liying
L
Campos
Sarah
S
Culleton
Shaelyn
S
Nguyen
Janet
J
Sahgal
Arjun
A
Barnes
Elizabeth
E
Tsao
May
M
Danjoux
Cyril
C
Holden
Lori
L
Yee
Albert
A
Khan
Luluel
L
Chow
Edward
E
D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms; D005260:Female; D005598:Fractures, Spontaneous / Q000000981:diagnostic imaging; D006801:Humans; D008175:Lung Neoplasms; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000209:etiology / Q000532:radiotherapy*; D009985:Orthopedics; D010166:Palliative Care; D011471:Prostatic Neoplasms; D011871:Radiology; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy* / Q000556:secondary; D014057:Tomography, X-Ray Computed