title: Clinical outcome of vertebral compression fracture after single fraction spine radiosurgery for spinal metastases.
abstract: Vertebral compression fracture (VCF) occurs after stereotactic body radiation therapy (SBRT) for spine metastasis. Recently, single fraction radiosurgery (sfSRS) is used more frequently. The aim of this study is to determine the clinical outcome of VCF after sfSRS. Spinal instability neoplastic score (SINS) criteria were used to retrospectively score 143 consecutive vertebral segments in 79 patients treated with SRS. Follow-up MRI, pain, and neurologic assessments obtained every 3-6 months. Pain also scored at 7, 14, and 30 days after sfSRS. Follow up was 16 ± 18 months ±SD, range 3-78. Long-term radiographic control occurred in 94 % of cases. Pain improvement resulted within 7 days in 100 % of cases with severe pain and sustained long-term in 95 %. VCF occurred in 21 % of segments: 30 % were de novo VCF. The overall 1 year fracture free probability (1yFFP) was 76 %. Pre-existing VCF resulted in higher probability to progress: 1yFFP 90 versus 60 %. Symptoms presented in 6 % of cases with de novo VCF and 39 % with progressive. The former were treated with vertebral augmentation (VA), the latter with open surgery. Surgery/VA prior to SRS did not change risk of progressive VCF. Univariate but not multivariate analysis identified histology (colorectal), pre-existing VCF, and pain (severe) as significant predictors of VCF. In conclusion, sfSRS compares favourably to SBRT for radiographic and pain control with similar VCF risk. Patients with pre-existing VCF have a higher probability to progress, become symptomatic, and require surgery. These results may help discussing risk and benefits with patients undergoing sfSRS for spinal metastasis and developing new treatment algorithms.
authors.affiliation: Departments of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA. isabelle.germano@mountsinai.org.|Department of Neurosurgery, The Mount Sinai Medical Center, 5 East 98th Street 7th Floor, New York, NY, 10029, USA. isabelle.germano@mountsinai.org.
authors.forename: Isabelle M
authors.identifier: http://orcid.org/0000-0002-3992-373X
authors.initials: IM
authors.lastname: Germano
authors.affiliation: Departments of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Carai
authors.affiliation: Departments of Radiology (Neuro-radiology), Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Puneet
authors.initials: P
authors.lastname: Pawha
authors.affiliation: Departments of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Seth
authors.initials: S
authors.lastname: Blacksburg
authors.affiliation: Departments of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Yeh-Chi
authors.initials: YC
authors.lastname: Lo
authors.affiliation: Departments of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Sheryl
authors.initials: S
authors.lastname: Green
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019583:Dose Fractionation, Radiation; D005260:Female; D050815:Fractures, Compression / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery / Q000009:adverse effects* / Q000379:methods*; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000453:epidemiology / Q000209:etiology*; D013125:Spinal Neoplasms / Q000556:secondary / Q000601:surgery*
keywords: Oncology; Outcome; Spine metastases; Spine radiosurgery; Vertebral compression fracture