Vertebral compression fractures after spine irradiation using conventional fractionation in patients with metastatic colorectal cancer.
10.3857/roj.2014.32.4.221
- Author:
Woo Joong RHEE
;
Kyung Hwan KIM
;
Jee Suk CHANG
;
Hyun Ju KIM
;
Seohee CHOI
;
Woong Sub KOOM
- Publication Type:Original Article
- Keywords:
Spinal neoplasm;
Compression fractures;
Spinal fractures;
Radiotherapy;
Colorectal cancer;
Risk factors
- MeSH:
Colorectal Neoplasms*;
Follow-Up Studies;
Fractures, Compression*;
Humans;
Incidence;
Multivariate Analysis;
Neoplasm Metastasis;
Radiotherapy;
Retrospective Studies;
Risk Factors;
Spinal Fractures;
Spinal Neoplasms;
Spine*
- From:Radiation Oncology Journal
2014;32(4):221-230
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: To evaluate the risk of vertebral compression fracture (VCF) after conventional radiotherapy (RT) for colorectal cancer (CRC) with spine metastasis and to identify risk factors for VCF in metastatic and non-metastatic irradiated spines. MATERIALS AND METHODS: We retrospectively reviewed 68 spinal segments in 16 patients who received conventional RT between 2009 and 2012. Fracture was defined as a newly developed VCF or progression of an existing fracture. The target volume included all metastatic spinal segments and one additional non-metastatic vertebra adjacent to the tumor-involved spines. RESULTS: The median follow-up was 7.8 months. Among all 68 spinal segments, there were six fracture events (8.8%) including three new VCFs and three fracture progressions. Observed VCF rates in vertebral segments with prior irradiation or pre-existing compression fracture were 30.0% and 75.0% respectively, compared with 5.2% and 4.7% for segments without prior irradiation or pre-existing compression fracture, respectively (both p < 0.05). The 1-year fracture-free probability was 87.8% (95% CI, 78.2-97.4). On multivariate analysis, prior irradiation (HR, 7.30; 95% CI, 1.31-40.86) and pre-existing compression fracture (HR, 18.45; 95% CI, 3.42-99.52) were independent risk factors for VCF. CONCLUSION: The incidence of VCF following conventional RT to the spine is not particularly high, regardless of metastatic tumor involvement. Spines that received irradiation and/or have pre-existing compression fracture before RT have an increased risk of VCF and require close observation.