Ache flare after stereotactic radiosurgery for backbone metastases.
J Radiosurg SBRT. 2018;5(2):99-105
Authors: Balagamwala EH, Naik M, Reddy CA, Angelov L, Suh JH, Djemil T, Magnelli A, Chao ST
Goal: Understanding of ache flare (PF) following backbone stereotactic radiosurgery (sSRS) is missing. This research sought to find out the incidence and threat components related to PF following single fraction sSRS.
Supplies/strategies: An IRB-approved database was compiled to incorporate sufferers who underwent sSRS. Affected person and illness traits in addition to therapy and dosimetric particulars have been collected retrospectively. Ache reduction post-sSRS was prospectively collected utilizing the Transient Ache Stock (BPI). These components have been correlated to the event of PF (outlined as a rise in ache inside 7 days of therapy which resolved with steroids). Survival was calculated utilizing Kaplan-Meier evaluation and logistic regression was utilized to guage the affiliation between the medical and therapy components and prevalence of PF.
Outcomes: A complete of 348 sufferers with 507 therapies have been included. Median age and prescription dose have been 59 years and 15 Gy (vary: 7-18), respectively, and 62% of sufferers have been male. Renal cell carcinoma (24%), lung most cancers (14%), and breast most cancers (11%) have been the most typical histologies, and 74% had epidural illness and 43% had thecal sac compression. The most typical location of metastases was within the cervical/thoracic backbone (59%), adopted by lumbar backbone (32%), and sacral backbone (9%). Commonest purpose for therapy was ache (73%), adopted by ache and neurological deficit (13%), asymptomatic illness (10%), and neurologic deficit solely (three%). Median time to ache reduction was 1.eight months. Median total survival, time to radiographic failure, and time to ache development have been 13.6 months, 26.5 months, and 56.6 months, respectively. Solely 14.four% of therapies resulted within the improvement of PF. Univariate evaluation confirmed that larger Karnofsky efficiency rating (KPS) (OR=1.03, p=zero.03), feminine gender (OR=1.80, p=zero.02), larger prescription dose (OR=1.30, p=zero.008), and tumor location of cervical/thoracic backbone vs lumbar backbone (OR=1.81, p=zero.047) have been predictors for the event of PF. On multivariate evaluation, larger seek the advice of KPS (OR=1.03, p=zero.04), feminine gender (OR=1.93, p=zero.01), larger prescription dose (OR=1.27, p=zero.02), and tumor location of cervical/thoracic backbone vs lumbar backbone (OR=1.81, p=zero.05) remained predictors of PF. No different dosimetric parameters have been related to the event of PF.
Conclusion: PF is an rare complication of sSRS. Predictors for the event of PF embrace larger seek the advice of KPS, feminine gender, larger prescription dose, and cervical/thoracic tumor location. Dose to the spinal wire was not a predictor of PF. Since a minority (14.four%) of therapies lead to PF, we don’t routinely make the most of prophylactic steroid therapy; nevertheless, prophylactic steroids could also be thought-about in feminine sufferers with cervical/thoracic metastases receiving larger dose sSRS.
PMID: 29657890 [PubMed]