Volume of Lytic Vertebral Body Metastatic Disease Quantified Using Computed Tomography-Based Image Segmentation Predicts Fracture Risk After Spine Stereotactic Body Radiation Therapy

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• 作者：Isabelle Thibault ; MD^&lowast ; ; ^&dagger ; ; Cari M. Whyne ; PhD^&Dagger ; ; Stephanie Zhou ; BSc^&lowast ; ; Mikki Campbell ; BSc ; MRT(T)^&lowast ; ; Eshetu G. Atenafu ; MSc ; PStat^§ ; ; Sten Myrehaug ; MD^&lowast ; ; Hany Soliman ; MD^&lowast ; ; Young K. Lee ; PhD^&lowast ; ; Hamid Ebrahimi ; BSc^&Dagger ; ; Albert J.M. Yee ; MD^‖ ; Arjun Sahgal ; MD^&lowast ; ; ^{arjun.sahgal@sunnybrook.ca}
• 刊名：International Journal of Radiation Oncology*Biology*Physics
• 出版年：2017
• 出版时间：1 January 2017
• 年：2017
• 卷：97
• 期：1
• 页码：75-81
• 全文大小：372 K
• 卷排序：97

文摘

To determine a threshold of vertebral body (VB) osteolytic or osteoblastic tumor involvement that would predict vertebral compression fracture (VCF) risk after stereotactic body radiation therapy (SBRT), using volumetric image-segmentation software.Methods and MaterialsA computational semiautomated skeletal metastasis segmentation process refined in our laboratory was applied to the pretreatment planning CT scan of 100 vertebral segments in 55 patients treated with spine SBRT. Each VB was segmented and the percentage of lytic and/or blastic disease by volume determined.ResultsThe cumulative incidence of VCF at 3 and 12 months was 14.1% and 17.3%, respectively. The median follow-up was 7.3 months (range, 0.6-67.6 months). In all, 56% of segments were determined lytic, 23% blastic, and 21% mixed, according to clinical radiologic determination. Within these 3 clinical cohorts, the segmentation-determined mean percentages of lytic and blastic tumor were 8.9% and 6.0%, 0.2% and 26.9%, and 3.4% and 15.8% by volume, respectively. On the basis of the entire cohort (n=100), a significant association was observed for the osteolytic percentage measures and the occurrence of VCF (P<.001) but not for the osteoblastic measures. The most significant lytic disease threshold was observed at ≥11.6% (odds ratio 37.4, 95% confidence interval 9.4-148.9). On multivariable analysis, ≥11.6% lytic disease (P<.001), baseline VCF (P<.001), and SBRT with ≥20 Gy per fraction (P=.014) were predictive.ConclusionsPretreatment lytic VB disease volumetric measures, independent of the blastic component, predict for SBRT-induced VCF. Larger-scale trials evaluating our software are planned to validate the results.