Lockney Dennis T, Hopkins Benjamin, Lockney Natalie A, Coleman Christian Z, Rubin Elena, Lis Eric, Yamada Yoshiya, Schmitt Adam, Higginson Daniel, Bilsky Mark H, Laufer Ilya
Department of Neurosurgery, University of Florida, Gainesville, FL, USA.
Department of Surgery, Neurological Divisiony, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Ann Transl Med. 2019 May;7(10):211. doi: 10.21037/atm.2019.04.68.
Vertebral body compression fracture (VCF) is a complication following spinal stereotactic radiosurgery (SRS). However, the incidence of VCF in vertebrae adjacent to the level of SRS is unknown. This study aimed to determine the incidence of adjacent level VCF (adjVCF) following spinal SRS.
A retrospective review of 239 lesions treated with single-fraction SRS from 2011-2014 was performed. Clinical and pathologic factors were collected including evaluation of VCFs in adjacent levels to SRS site. In patients with adjVCFs, dose-volume histograms for adjacent-level endplates were calculated. Cox regression analysis was performed to determine any association among clinical factors and adjVCF occurrence.
Median follow-up was 14.7 months. Twenty-six adjVCFs occurred (10.8%). Of the adjVCFs, 19 had metastases following SRS, and seven did not (2.9% of total treatments). Median time to fracture post-SRS was 13.5 months. In adjVCFs, median of the mean dose to adjacent level fractured endplate was 23.3 Gy, and median of the mean dose of sixteen non-fractured endplates immediately adjacent to the SRS site was 19.1 Gy. Age, gender, and histology were not associated with adjVCF.
AdjVCF after spinal SRS occurs at a rate of 2.9%, when excluding metastatic sites of disease. Adjacent level endplates should be investigated as an organ at risk during SRS planning.
椎体压缩性骨折（VCF）是脊柱立体定向放射外科手术（SRS）后的一种并发症。然而，SRS治疗水平相邻椎体中VCF的发生率尚不清楚。本研究旨在确定脊柱SRS后相邻节段VCF（adjVCF）的发生率。
对2011年至2014年接受单次分割SRS治疗的239个病灶进行回顾性研究。收集临床和病理因素，包括评估SRS部位相邻节段的VCF。对于发生adjVCF的患者，计算相邻节段终板的剂量体积直方图。进行Cox回归分析以确定临床因素与adjVCF发生之间的任何关联。
中位随访时间为14.7个月。发生了26例adjVCF（10.8%）。在adjVCF中，19例在SRS后发生转移，7例未发生转移（占总治疗病例的2.9%）。SRS后骨折的中位时间为13.5个月。在adjVCF中，相邻节段骨折终板的平均剂量中位数为23.3 Gy，紧邻SRS部位的16个未骨折终板的平均剂量中位数为19.1 Gy。年龄、性别和组织学与adjVCF无关。
排除疾病转移部位后，脊柱SRS后adjVCF的发生率为2.9%。在SRS计划期间，应将相邻节段终板作为危险器官进行研究。
