Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut St, suite 840, 19107, Philadelphia, PA, USA.
Department of Radiology, Thomas Jefferson University Hospital, 132 South 10th St, Floor 10, 19107, Philadelphia, PA, USA.
BMC Cancer. 2023 Apr 12;23(1):337. doi: 10.1186/s12885-023-10776-8.
The utilization of stereotactic body radiation therapy (SBRT) is increasing for primary and secondary lung neoplasms. Despite encouraging results, SBRT is associated with an increased risk of osteoradionecrosis-induced rib fracture. We aimed to (1) evaluate potential clinical, demographic, and procedure-related risk factors for rib fractures and (2) describe the radiographic features of post-SBRT rib fractures.
We retrospectively identified 106 patients who received SBRT between 2015 and 2018 for a primary or metastatic lung tumor with at least 12 months of follow up. Exclusion criteria were incomplete records, previous ipsilateral thoracic radiation, or relevant prior trauma. Computed tomography (CT) images were reviewed to identify and characterize rib fractures. Multivariate logistic regression modeling was employed to determine clinical, demographic, and procedural risk factors (e.g., age, sex, race, medical comorbidities, dosage, and tumor location).
A total of 106 patients with 111 treated tumors met the inclusion criteria, 35 (32%) of whom developed at least one fractured rib (60 total fractured ribs). The highest number of fractured ribs per patient was five. Multivariate regression identified posterolateral tumor location as the only independent risk factor for rib fracture. On CT, fractures showed discontinuity between healing edges in 77% of affected patients.
Nearly one third of patients receiving SBRT for lung tumors experienced rib fractures, 34% of whom experienced pain. Many patients developed multiple fractures. Post-SBRT fractures demonstrated a unique discontinuity between the healing edges of the rib, a distinct feature of post-SBRT rib fractures. The only independent predictor of rib fracture was tumor location along the posterolateral chest wall. Given its increasing frequency of use, describing the risk profile of SBRT is vital to ensure patient safety and adequately inform patient expectations.
立体定向体放射治疗（SBRT）在原发性和继发性肺部肿瘤中的应用日益增多。尽管结果令人鼓舞，但 SBRT 与放射性骨坏死引起的肋骨骨折风险增加有关。我们旨在（1）评估发生肋骨骨折的潜在临床、人口统计学和与治疗相关的危险因素，（2）描述 SBRT 后肋骨骨折的影像学特征。
我们回顾性地确定了 106 名在 2015 年至 2018 年间接受 SBRT 治疗的患者，这些患者患有原发性或转移性肺肿瘤，至少有 12 个月的随访期。排除标准为记录不完整、同侧胸部放疗史或相关既往创伤史。对 CT 图像进行了回顾，以确定和描述肋骨骨折。采用多变量逻辑回归模型来确定临床、人口统计学和程序危险因素（例如年龄、性别、种族、医疗合并症、剂量和肿瘤位置）。
共有 106 名患者的 111 个治疗肿瘤符合纳入标准，其中 35 名（32%）患者至少发生了一根肋骨骨折（共 60 根骨折肋骨）。每位患者最多发生 5 根肋骨骨折。多变量回归分析确定肿瘤位于后外侧是肋骨骨折的唯一独立危险因素。在 CT 上，77%的受影响患者的骨折显示愈合边缘之间的连续性中断。
接受 SBRT 治疗肺部肿瘤的患者中有近三分之一发生肋骨骨折，其中 34%的患者出现疼痛。许多患者发生了多处骨折。SBRT 后骨折在肋骨愈合边缘之间显示出独特的不连续性，这是 SBRT 后肋骨骨折的一个独特特征。肋骨骨折的唯一独立预测因子是位于后外侧胸壁的肿瘤位置。鉴于 SBRT 使用频率的增加，描述 SBRT 的风险概况对于确保患者安全和充分告知患者预期至关重要。
