title: Correlation of computed tomography imaging features with pain response in patients with spine metastases after radiation therapy.
abstract: 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.
authors.affiliation: Rapid Response Radiotherapy Program, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada M4N 3M5. Gunita.Mitera@Sunnybrook.ca
authors.forename: Gunita
authors.initials: G
authors.lastname: Mitera
authors.forename: Linda
authors.initials: L
authors.lastname: Probyn
authors.forename: Michael
authors.initials: M
authors.lastname: Ford
authors.forename: Andrea
authors.initials: A
authors.lastname: Donovan
authors.forename: Joel
authors.initials: J
authors.lastname: Rubenstein
authors.forename: Joel
authors.initials: J
authors.lastname: Finkelstein
authors.forename: Monique
authors.initials: M
authors.lastname: Christakis
authors.forename: Liying
authors.initials: L
authors.lastname: Zhang
authors.forename: Sarah
authors.initials: S
authors.lastname: Campos
authors.forename: Shaelyn
authors.initials: S
authors.lastname: Culleton
authors.forename: Janet
authors.initials: J
authors.lastname: Nguyen
authors.forename: Arjun
authors.initials: A
authors.lastname: Sahgal
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Barnes
authors.forename: May
authors.initials: M
authors.lastname: Tsao
authors.forename: Cyril
authors.initials: C
authors.lastname: Danjoux
authors.forename: Lori
authors.initials: L
authors.lastname: Holden
authors.forename: Albert
authors.initials: A
authors.lastname: Yee
authors.forename: Luluel
authors.initials: L
authors.lastname: Khan
authors.forename: Edward
authors.initials: E
authors.lastname: Chow
mesh_terms: 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