Evaluation of Risk Factors for Vertebral Compression Fracture after Carbon-Ion Radiotherapy for Primary Spinal and Paraspinal Sarcoma

Abstract EN

Background and Purpose.

Carbon-ion radiotherapy (C-ion RT) was effective therapy for inoperable spinal and paraspinal sarcomas.

However, a significant adverse event following radiotherapies is vertebral compression fractures (VCFs).

In this study, we investigated the incidence of and risk factors for post-C-ion RT VCFs in patients with spinal or paraspinal sarcomas.

Material and Methods.

Thirty consecutive patients with spinal or paraspinal sarcomas treated with C-ion RT were retrospectively reviewed.

Various clinical parameters and the Spinal Instability Neoplastic Score (SINS) were used to evaluate the risk factors for post-C-ion RT VCFs.

Results.

The overall incidence of VCFs was 23% (median time: 7 months).

Patients with VCFs showed a markedly higher SINS score (median value, 9 points) than those without VCF (5 points).

The area under the receiver operating characteristic curve for the SINS score was 0.88, and the optimum SINS cut-off score was 8 points.

The cumulative incidence of VCFs at 1 year was 9% for patients with a SINS score under 8 points, versus 80% for those with a SINS score of 8 points or higher (p<0.0001).

Conclusions.

In patients with a SINS score of 8 points or higher, referral to a spine surgeon for stabilization and multidisciplinary discussion is appropriate.