A Volumetric Dosimetry Analysis of Vertebral Body Fracture Risk After Single Fraction Spine Stereotactic Body Radiation Therapy
| Autor: | Maxwell Y. Lee, Salim Balik, Lilyana Angelov, Zi Ouyang, John H. Suh, Danielle LaHurd, Anthony Magnelli, Samuel T. Chao, Ehsan H. Balagamwala, Ping Xia |
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| Rok vydání: | 2021 |
| Předmět: |
Fracture risk
Spinal Neoplasms Vertebral Body business.industry Stereotactic body radiation therapy Hazard ratio Radiosurgery Spine Single fraction Vertebral body Oncology Fractures Compression Clinical endpoint Humans Spinal Fractures Medicine Dosimetry Radiology Nuclear Medicine and imaging Complication business Nuclear medicine Retrospective Studies |
| Zdroj: | Practical Radiation Oncology. 11:480-487 |
| ISSN: | 1879-8500 |
| Popis: | Vertebral compression fractures (VCF) are a common and severe complication of spine stereotactic body radiation therapy (SBRT). We sought to analyze how volumetric dosimetry and clinical factors were associated with the risk of VCF.We evaluated 173 spinal segments that underwent single fraction SBRT in 85 patients from a retrospective database. Vertebral bodies were contoured and dosimetric values were calculated. Competing risk models were used to evaluate the effect of clinical and dosimetry variables on the risk of VCF.Our primary endpoint was development of a post-SBRT VCF. New or progressive fractures were noted in 21/173 vertebrae (12.1%); the median time to fracture was 322 days. Median follow-up time was 426 days. Upon multivariable analysis, the percentages of vertebral body volume receiving20 Gy and24 Gy were significantly associated with increased risk of VCF (hazard ratio, 1.036, 1.104; P = .029, .044, respectively). No other patient or treatment factors were found to be significant on multivariable analysis. Sensitivity analysis revealed that the percentages of vertebral body volume receiving20 Gy and24 Gy required to obtain 90% sensitivity for predicting vertebral body fracture were 24% and 0%, respectively.VCF is a common complication after SBRT, with a crude incidence of 12.1%. Treatment plans that permit higher volumes receiving doses20 Gy and24 Gy to the vertebral body are associated with increased risk of VCF. To achieve 90% sensitivity for predicting VCF post-SBRT, the percentage of vertebral volume receiving20 Gy should be24% and maximum point dose should be24 Gy. These results may help guide clinicians when evaluating spine SBRT treatment plans to minimize the risk of developing posttreatment VCF. |
| Databáze: | OpenAIRE |
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