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Article: Adverse outcomes after palliative radiation therapy for uncomplicated spine metastases: Role of spinal instability and single-fraction radiation therapy Presented in abstract form as a poster presentation at the Annual Meeting of the American Society for Radiation Oncology, San Francisco, CA, Sept 14-17, 2014.

TitleAdverse outcomes after palliative radiation therapy for uncomplicated spine metastases: Role of spinal instability and single-fraction radiation therapy Presented in abstract form as a poster presentation at the Annual Meeting of the American Society for Radiation Oncology, San Francisco, CA, Sept 14-17, 2014.
Authors
Issue Date2015
Citation
International Journal of Radiation Oncology - Biology - Physics, 2015, v. 93, n. 2, p. 373-381 How to Cite?
Abstract© 2015 Elsevier Inc. All rights reserved. Purpose Level I evidence demonstrates equivalent pain response after single-fraction (SF) or multifraction (MF) radiation therapy (RT) for bone metastases. The purpose of this study is to provide additional data to inform the incidence and predictors of adverse outcomes after RT for spine metastases. Methods and Materials At a single institution, 299 uncomplicated spine metastases (without cord compression, prior RT, or surgery) treated with RT from 2008 to 2013 were retrospectively reviewed. The spinal instability neoplastic score (SINS) was used to assess spinal instability. The primary outcome was time to first spinal adverse event (SAE) at the site, including symptomatic vertebral fracture, hospitalization for site-related pain, salvage surgery, interventional procedure, new neurologic symptoms, or cord compression. Fine and Gray's multivariable model assessed associations of the primary outcome with SINS, SF RT, and other significant baseline factors. Propensity score matched analysis further assessed the relationship of SF RT to first SAEs. Results The cumulative incidence of first SAE after SF RT (n=66) was 6.8% at 30 days, 16.9% at 90 days, and 23.6% at 180 days. For MF RT (n=233), the incidence was 3.5%, 6.4%, and 9.2%, respectively. In multivariable analysis, SF RT (hazard ratio [HR] = 2.8, 95% confidence interval [CI] 1.5-5.2, P=.001) and SINS ≥11 (HR=2.5, 95% CI 1.3-4.9, P=.007) were predictors of the incidence of first SAE. In propensity score matched analysis, first SAEs had developed in 22% of patients with SF RT versus 6% of those with MF RT cases (HR=3.9, 95% CI 1.6-9.6, P=.003) at 90 days after RT. Conclusion In uncomplicated spinal metastases treated with RT alone, spinal instability with SINS ≥11 and SF RT were associated with a higher rate of SAEs.
Persistent Identifierhttp://hdl.handle.net/10722/223112
ISSN
2015 Impact Factor: 4.495
2015 SCImago Journal Rankings: 2.274

 

DC FieldValueLanguage
dc.contributor.authorLam, Tai Chung-
dc.contributor.authorUno, Hajime-
dc.contributor.authorKrishnan, Monica-
dc.contributor.authorLutz, Steven-
dc.contributor.authorGroff, Michael-
dc.contributor.authorCheney, Matthew-
dc.contributor.authorBalboni, Tracy-
dc.date.accessioned2016-02-19T02:37:46Z-
dc.date.available2016-02-19T02:37:46Z-
dc.date.issued2015-
dc.identifier.citationInternational Journal of Radiation Oncology - Biology - Physics, 2015, v. 93, n. 2, p. 373-381-
dc.identifier.issn0360-3016-
dc.identifier.urihttp://hdl.handle.net/10722/223112-
dc.description.abstract© 2015 Elsevier Inc. All rights reserved. Purpose Level I evidence demonstrates equivalent pain response after single-fraction (SF) or multifraction (MF) radiation therapy (RT) for bone metastases. The purpose of this study is to provide additional data to inform the incidence and predictors of adverse outcomes after RT for spine metastases. Methods and Materials At a single institution, 299 uncomplicated spine metastases (without cord compression, prior RT, or surgery) treated with RT from 2008 to 2013 were retrospectively reviewed. The spinal instability neoplastic score (SINS) was used to assess spinal instability. The primary outcome was time to first spinal adverse event (SAE) at the site, including symptomatic vertebral fracture, hospitalization for site-related pain, salvage surgery, interventional procedure, new neurologic symptoms, or cord compression. Fine and Gray's multivariable model assessed associations of the primary outcome with SINS, SF RT, and other significant baseline factors. Propensity score matched analysis further assessed the relationship of SF RT to first SAEs. Results The cumulative incidence of first SAE after SF RT (n=66) was 6.8% at 30 days, 16.9% at 90 days, and 23.6% at 180 days. For MF RT (n=233), the incidence was 3.5%, 6.4%, and 9.2%, respectively. In multivariable analysis, SF RT (hazard ratio [HR] = 2.8, 95% confidence interval [CI] 1.5-5.2, P=.001) and SINS ≥11 (HR=2.5, 95% CI 1.3-4.9, P=.007) were predictors of the incidence of first SAE. In propensity score matched analysis, first SAEs had developed in 22% of patients with SF RT versus 6% of those with MF RT cases (HR=3.9, 95% CI 1.6-9.6, P=.003) at 90 days after RT. Conclusion In uncomplicated spinal metastases treated with RT alone, spinal instability with SINS ≥11 and SF RT were associated with a higher rate of SAEs.-
dc.languageeng-
dc.relation.ispartofInternational Journal of Radiation Oncology - Biology - Physics-
dc.titleAdverse outcomes after palliative radiation therapy for uncomplicated spine metastases: Role of spinal instability and single-fraction radiation therapy Presented in abstract form as a poster presentation at the Annual Meeting of the American Society for Radiation Oncology, San Francisco, CA, Sept 14-17, 2014.-
dc.typeArticle-
dc.description.natureLink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.ijrobp.2015.06.006-
dc.identifier.pmid26279324-
dc.identifier.scopuseid_2-s2.0-84941316661-
dc.identifier.volume93-
dc.identifier.issue2-
dc.identifier.spage373-
dc.identifier.epage381-
dc.identifier.eissn1879-355X-

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