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- Title
Radiation-induced vertebral compression fracture following spine stereotactic radiosurgery: clinical-pathological correlation.
- Authors
Al-Omair, A. S.; Smith, R.; Kiehl, T.; L. Lao; E. Yu; Massicotte, E.; Keith, J.; Fehlings, M.; Sahgal, A.
- Abstract
Purpose: Spine radiosurgery (SRS) is increasingly being applied to treat metastatic spinal tumors. As the experience matures, we are observing high rates of vertebral compression fracture (VCF) and it is of a great challenge to distinguish disease progression from radiation induced VCF. The aim of this case report is to present the clinical, radiological and pathological findings of two patients with radiographic evidence of late progression after spine SBRT. Method: We report a case of radiation necrosis and a case of radiation fibrosis. The first case is a 51 year old female who develop an isolated L2 metastases two years after completing a radical treatment for a stage IIIA NSCLC. She was treated with spine SRS with a dose of 20 Gy in a single fraction. Follow-up MRI at two years indicated significant progression of the VCF. Biopsy and simultaneous Kyphoplasty was performed. Histopathologic analysis described abundant avital bone and necrotic debris with numerous minute fragments of metastatic adenocarcinoma interspersed between fragments of bone and necrotic tissue with no evidence of disease progression. A second case is a 53-year-old male was diagnosed with metastatic neuroendocrine cancer with disease Isolated to multiple segments of the spine. He was treated with spine SRS to L3 and L4 with a total dose of 24 Gy in 2 fractions. A follow-up MRI three years following spine SRS showed VCF isolated to L3 and not L4. A biopsy and Kyphoplasty of the L3 vertebrae was done. Histopathologic analysis showed markedly thinned bone trabeculae, and the bone marrow was completely replaced by either dense fibrous tissue with focal lymphocytic inflammation or loose paucicellular fibrous tissue. There was no evidence of residual carcinoma or necrosis. Conclusion: We recommend biopsy when it is unclear based on imaging alone if true Progression has occurred as marrow signal change within SRS-treated bone by itself may not be an objective finding, and alternatively be a consequence of radiation-induced necrosis and fibrosis. Disclosure: No significant relationships.
- Subjects
SPINE radiography; RADIOSURGERY; COMPRESSION fractures; RADIOTHERAPY; NEUROENDOCRINE tumors; FIBROSIS; THERAPEUTICS
- Publication
Journal of Radiosurgery & SBRT, 2013, Vol 2, p21
- ISSN
2156-4639
- Publication type
Article