Evaluation of Risk Factors for Vertebral Compression Fracture after Carbon-Ion Radiotherapy for Primary Spinal and Paraspinal Sarcoma.

Yoshihiro Matsumoto,Seiji Okada,Reiko Imai,Keiichiro Iida,Makoto Endo,Jun-Ichi Fukushi,Hirofumi Bekki,Nokitaka Setsu,Kenichi Kawaguchi,Yoshiyuki Shioyama,Tadashi Kamada,Makoto Shinoto,Yasuharu Nakashima

doi:10.1155/2017/9467402

Abstract

Background and Purpose Carbon-ion radiotherapy (C-ion RT) was effective therapy for inoperable spinal and paraspinal sarcomas. However, a significant adverse event following radiotherapies is vertebral compression fractures (VCFs). In this study, we investigated the incidence of and risk factors for post-C-ion RT VCFs in patients with spinal or paraspinal sarcomas. Material and Methods Thirty consecutive patients with spinal or paraspinal sarcomas treated with C-ion RT were retrospectively reviewed. Various clinical parameters and the Spinal Instability Neoplastic Score (SINS) were used to evaluate the risk factors for post-C-ion RT VCFs. Results The overall incidence of VCFs was 23% (median time: 7 months). Patients with VCFs showed a markedly higher SINS score (median value, 9 points) than those without VCF (5 points). The area under the receiver operating characteristic curve for the SINS score was 0.88, and the optimum SINS cut-off score was 8 points. The cumulative incidence of VCFs at 1 year was 9% for patients with a SINS score under 8 points, versus 80% for those with a SINS score of 8 points or higher (p < 0.0001). Conclusions In patients with a SINS score of 8 points or higher, referral to a spine surgeon for stabilization and multidisciplinary discussion is appropriate.

Highlights

Spinal and paraspinal sarcomas are rare tumors that are comprised 4% and 13% of bone and soft tissue sarcomas, respectively [1]
Thirty consecutive patients with spinal or paraspinal sarcomas who met all of the following eligibility criteria were retrospectively reviewed: histologically proven primary sarcoma; tumors judged to be medically inoperable by a multidisciplinary tumor board comprised of spine surgeons, radiation oncologists, neuroradiologists, pathologists, and oncologists; grossly measurable tumors
We retrospectively reviewed 30 patients with spinal (26 cases) or paraspinal (4 cases) sarcomas treated with C-ion RT

Summary

Introduction

Spinal and paraspinal sarcomas are rare tumors that are comprised 4% and 13% of bone and soft tissue sarcomas, respectively [1]. Radiotherapy is an alternative option for patients with inoperable spinal or paraspinal sarcomas. Carbon-ion radiotherapy (C-ion RT) was effective therapy for inoperable spinal and paraspinal sarcomas. We investigated the incidence of and risk factors for post-C-ion RT VCFs in patients with spinal or paraspinal sarcomas. Various clinical parameters and the Spinal Instability Neoplastic Score (SINS) were used to evaluate the risk factors for post-C-ion RT VCFs. Results. Patients with VCFs showed a markedly higher SINS score (median value, 9 points) than those without VCF (5 points). The cumulative incidence of VCFs at 1 year was 9% for patients with a SINS score under 8 points, versus 80% for those with a SINS score of 8 points or higher (p < 0.0001). In patients with a SINS score of 8 points or higher, referral to a spine surgeon for stabilization and multidisciplinary discussion is appropriate

Objectives

Methods

Conclusion