Histopathological Findings After Reirradiation In comparison with First Irradiation of Spinal Bone Metastases With Stereotactic Physique Radiotherapy: A Cohort Examine.
Neurosurgery. 2018 Mar 14;:
Authors: Foerster R, Cho BCJ, Fahim DK, Gerszten PC, Flickinger JC, Grills IS, Jawad MS, Kersh CR, Létourneau D, Mantel F, Sahgal A, Shin JH, Winey BA, Guckenberger M
BACKGROUND: Stereotactic physique radiotherapy (SBRT) of the backbone gives superior tumor management, however vertebral compression fractures are elevated and the pathophysiological course of beneath just isn’t properly understood. Knowledge on histopathological adjustments, significantly after salvage SBRT (sSBRT) following standard irradiation, are scarce.
OBJECTIVE: To research surgical specimens after sSBRT and first SBRT (pSBRT) concerning histopathological adjustments.
METHODS: We assessed 704 sufferers handled with backbone SBRT 2006 to 2012. Thirty sufferers underwent salvage surgical procedure; 23 histopathological reviews have been accessible. Scientific and histopathological findings have been analyzed for sSBRT (69.6%) and pSBRT (30.four%).
RESULTS: Imply time to surgical procedure after sSBRT/pSBRT was eight.three/10.three mo (P = .64). Purpose for surgical procedure included ache (sSBRT/pSBRT: 12.5%/71.four%, P = .25), fractures (sSBRT/pSBRT: 37.5%/28.6%, P = .68), and neurological signs (sSBRT/pSBRT: 68.eight%/42.9%, P = .24). Radiological tumor development after sSBRT/pSBRT was seen in 71.four%/42.9% (P = .2). Most specimens displayed viable/proliferative tumor (sSBRT/pSBRT: 62.5%/71.four%, P = .68 and 56.three%/57.1%, P = .97). Few specimens confirmed delicate tissue necrosis (sSBRT/pSBRT: 20%/28.6%, P = .66), osteonecrosis (sSBRT/pSBRT: 14.three%/16.7%, P = .89), or bone marrow fibrosis (sSBRT/pSBRT: 42.9%/33.three%, P = .69). Tumor mattress necrosis was extra frequent after sSBRT (81.three%/42.9%, P = .066). Radiological tumor development correlated with viable/proliferative tumor (P = .03/P = .006) and tumor mattress necrosis (P = .03). Fractures have been elevated with bone marrow fibrosis (P = .07), however not with osteonecrosis (P = .53) or delicate tissue necrosis (P = .19). Neurological signs have been frequent with radiological tumor development (P = .07), however not with fractures (P = .18).
CONCLUSION: For each, sSBRT and pSBRT, histopathological adjustments have been related. Neurological signs have been attributable to tumor development and pathological fractures weren’t related to osteonecrosis or tumor development.
PMID: 29547929 [PubMed – as supplied by publisher]