Table 1.
Summarized risk factors for vertebral compression fracture after stereotactic spinal radiation surgery
| Study (Year; hospital) | Total patients, N | Total VBs | Dose/fx (median) | VB fractures, n (%) | Risk factors (UVA) | Risk factors (MVA) |
|---|---|---|---|---|---|---|
| Rose et al9 (2009; MSKCC) | 62 | 71 | 24/1 | 27 (39) | Not reported | CT appearance (lytic = 6.8x); lesion location (T10 and below = 4.6x); % VB involvement (>40%) |
| Boehling et al10 (2012; MDACC) | 93 | 123 | 18/1 27/3 30/5 |
25 (20) | Age >55 y; preexisting fracture; baseline pain; narcotic use before and after SBRT | Age >55 y; preexisting fracture; baseline pain |
| Cunha et al11 (2012; PMH) | 90 | 167 | 24/2 | 19 (11) | Spinal misalignment; lesion type (lytic); degree of preexisting VCF | Spinal misalignment; lesion type (lytic); dose per fraction (≥20 Gy); lung primary; hepatocellular primary |
| Sahgal et al12 (2013; PMH) | 252 | 410 | 24/1 | 57 (14) | Dose per fraction; preexisting VCF; lesion type (lytic); spinal deformity; spinal misalignment; paraspinal/epidural extension | Dose per fraction; preexisting VCF; lesion type (lytic); spinal deformity; spinal misalignment; paraspinal/ epidural extension |
| Sung et al13 (2014; KCCH) | 72 | 72 | 21/1∗ | 26 (36) | SINS; spinal deformity (<40% vs ≥40%); whole VB involvement (<40% vs ≥40%); VB osteolysis rate (<61% vs ≥61%) | VB osteolysis rate (<61% vs ≥61%) |
| Thibault et al14 (2014; Sunnybrook) | 37 | 71 | 24/2 | 10 (16) | Not reported | Single-fraction SBRT; preexisting VCF |
| Guckenburger et al15 (2014; Wurzburg) | 301 | 387 | 24/3 | 30 (8) | Not reported | Not reported |
| Germano et al16 (2016; Mt. Sinai) | 79 | 143 | 18/1 | 30 (21) | Colorectal primary; preexisting VCF; severe pain | Not reported |
| Jawad et al17 2016; Beaumont |
541 | 594 | 20/1 | 34 (5.7) | SBRT <36.8 d after diagnosis; no additional bone metastasis; no prior chemotherapy; preexisting VCF; tumor volume >37.3 cm3; EQD2 tumor >41.8 Gy; EQD2 spinal cord Dmax >46.1 Gy | Preexisting VCF; no additional bone metastasis; target volume >38.4 Gy |
| Lee et al18 (2016; MDACC) | 79 | 100 | 24-27/3 | 32 (41) | ESCC grade 1a and 1b; high SINS score (7-12) | High SINS score (7-12) |
| Thibault et al19 (2017; Sunnybrook) | 55 | 100 | 24/2 | 17 (17) | Dmax; D90; D80; D50 | Osteolytic percentage (≥11.6%); preexisting VCF; SBRT dose ≥20 Gy/fx |
| Boyce-Fappiano et al2 (2017; Henry Ford) | 448 | 1070 | 18/1 | 127 (12) | Preexisting VCF; hematologic primary; thoracic spine tumors; lesion type (lytic); female patients | Preexisting VCF; lesion type (lytic) |
| Virk et al20 (2017; MSKCC) | 323 | 552 | 24/1 | 40 (7.2) | Not reported | Not reported |
| Totals | 2432 | 3860 | 24/1 | 474 (12.3) |
Abbreviations: CT = computed tomography; Dmax = maximum dose; EQD2 = equivalent 2-Gy tumor dose; ESCC = epidural spinal cord compression classification; Fx = fraction; KCCH = Korean Cancer Center Hospital; MDACC = MD Anderson Cancer Center; MSKCC = Memorial Sloan Kettering Cancer Center; MVA = multivariate analysis; PMH. Princess Margaret Hospital; SBRT = stereotactic body radiation therapy; SINS = spinal instability neoplastic score; UVA = univariate analysis; VB = vertebral body; VCF = vertebral compression fracture.
∗
Mean Dose/Fractionation.