Capp Juliana C, Pennington Zach, Hamouda Abdelrahman, Mikula Anthony L, Lakomkin Nikita, Sebastian Arjun S, Freedman Brett A, Rose Peter S, Karim S Mohammed, Nassr Ahmad, Bydon Mohamad, Krauss William E, Fogelson Jeremy L, Kowalchuk Roman O, Merrell Kenneth W, Clarke Michelle J, Elder Benjamin D
1Departments of Neurosurgery.
2Orthopedic Surgery, and.
Neurosurg Focus. 2025 May 1;58(5):E13. doi: 10.3171/2025.2.FOCUS24905.
The aim of this study was to determine independent risk factors for vertebral compression fracture (VCF) following stereotactic body radiation therapy (SBRT) in metastatic spine disease.
Patients treated with SBRT for spinal metastasis at a single tertiary care center between 2008 and 2019 were retrospectively identified. Patients with CT scans obtained within 1 year of SBRT completion were included. Variables collected included demographics, Spine Instability Neoplastic Score (SINS), primary tumor pathology, Weinstein-Boriani-Biagini (WBB) classification, chemoradiation treatment details, and bone quality as assessed by Hounsfield units (HUs) on CT. HUs were measured for the medullary bone of the metastatic level, the tumor, and the vertebral bodies cephalad and caudal to the metastasis. Multivariable logistic regression was used to identify predictors of post-SBRT pathological fracture.
A total of 292 patients (mean age 66 years) with 392 unique lesions were included. The most common pathologies were prostate (n = 193), kidney/renal cell (n = 46), and lung (n = 33). The most common tumor levels were thoracic (n = 206 lesions) and lumbar (n = 128 lesions). SBRT was generally delivered in 1-3 fractions with doses ranging from 16 to 24 Gy in 1 fraction and 24-36 Gy in 3 fractions. Of the 392 lesions, 73 suffered VCF: 21 (29%) with < 25% height loss, 15 (21%) with 25%-40% height loss, and 37 (51%) with > 40% height loss. On univariate analysis, patients with VCF had lower average HUs (156 ± 52 vs 202 ± 89, p < 0.001), more WBB sectors involved (3 ± 2 vs 3 ± 1, p < 0.001), higher SINSs (8 ± 3 vs 6 ± 2, p < 0.001), were more commonly female (33% vs 22%, p = 0.05), and more commonly had nonprostate pathology (67% vs 47%, p = 0.003). VCF rates were similar between moderate (< 20 Gy in 1 fraction, < 30 Gy in 3 or 5 fractions) and high-dose (> 20 Gy in 1 fraction, > 30 Gy in 3 or 5 fractions) radiation schema (15% VCF vs 16% no VCF, respectively; p = 0.99). On multivariable logistic regression, independently significant predictors of VCF were HUs ≤ 229 (OR 6, p < 0.001), affected levels ≥ 3 WBB segments (OR 3, p < 0.001), and an SINS ≥ 8 (OR 2, p = 0.02).
Low pre-radiation HUs, involvement of more WBB sectors, and a higher SINS were independent predictors of VCF following SBRT for metastatic spine disease.
本研究旨在确定立体定向体部放疗（SBRT）治疗转移性脊柱疾病后椎体压缩骨折（VCF）的独立危险因素。
回顾性纳入2008年至2019年在单一三级医疗中心接受SBRT治疗脊柱转移瘤的患者。纳入在SBRT完成后1年内进行CT扫描的患者。收集的变量包括人口统计学资料、脊柱不稳定肿瘤评分（SINS）、原发肿瘤病理、Weinstein-Boriani-Biagini（WBB）分类、放化疗治疗细节以及通过CT上的Hounsfield单位（HUs）评估的骨质。测量转移灶所在节段的髓质骨、肿瘤以及转移灶上下椎体的HUs。采用多变量逻辑回归分析确定SBRT后病理性骨折的预测因素。
共纳入292例患者（平均年龄66岁），有392个独立病灶。最常见的病理类型为前列腺癌（n = 193）、肾/肾细胞癌（n = 46）和肺癌（n = 33）。最常见 的肿瘤节段为胸椎（n = 206个病灶）和腰椎（n = 128个病灶）。SBRT一般分1 - 3次进行，单次剂量范围为16至24 Gy，3次剂量范围为24至36 Gy。在392个病灶中，73个发生了VCF：2 % 高度丢失< 25%的有21个（29%），高度丢失25% - 40%的有15个（21%）以及高度丢失> 40%的有37个（51%）。单因素分析显示，发生VCF的患者平均HUs较低（156 ± 52 vs 202 ± 89，p < 0.001），累及的WBB节段更多（3 ± 2 vs 3 ± 1，p < 0.001），SINS更高（8 ± 3 vs 6 ± 2，p < 0.001），女性更常见（33% vs 22%，p = 0.05），且非前列腺病理类型更常见（67% vs 47%，p = 0.003）。中等剂量（单次< 20 Gy，3次或5次< 30 Gy）和高剂量（单次> 20 Gy，次或5次> < span=""> 30 Gy）放疗方案的VCF发生率相似（分别为15%的VCF vs 16%无VCF；p = 0.99）。多变量逻辑回归分析显示，VCF的独立显著预测因素为HUs≤229（比值比6，p < 0.001）、受累节段≥3个WBB节段（比值比3，p < 0.001）以及SINS≥8（比值比2，p = 0.02）。
放疗前HUs低、累及更多WBB节段以及SINS更高是SBRT治疗转移性脊柱疾病后VCF的独立预测因素。
