Spine Stereotactic Body Radiation Therapy in Geriatric Patients: Implications of Age and Dose on Iatrogenic Vertebral Compression Fracture Risk

Adrian Wai Chan; Kang Liang Zeng; Daniel Moore-Palhares; Eshetu G Atenafu; Hanbo Chen; Sten Myrehaug; Mark Ruschin; Hany Soliman; Chia-Lin Tseng; Bei-Bei Zhang; Cari Whyne; Pejman Maralani; Arjun Sahgal; Jay Detsky

doi:10.1016/j.ijrobp.2024.11.082

Spine Stereotactic Body Radiation Therapy in Geriatric Patients: Implications of Age and Dose on Iatrogenic Vertebral Compression Fracture Risk

Int J Radiat Oncol Biol Phys. 2024 Nov 22:S0360-3016(24)03657-5. doi: 10.1016/j.ijrobp.2024.11.082. Online ahead of print.

Authors

Affiliations

¹ Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
² Department of Radiation Oncology, Royal Victoria Regional Health Centre, Barrie, Ontario, Canada.
³ Department of Biostatistics, University Health Network, Toronto, Ontario, Canada. Electronic address: [email protected].
⁴ Orthopaedic Biomechanics Lab, Sunnybrook Research Institute, Toronto, Ontario, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
⁵ Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
⁶ Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. Electronic address: [email protected].

PMID: 39580002
DOI: 10.1016/j.ijrobp.2024.11.082

Abstract

Purpose: Stereotactic body radiation therapy (SBRT) is an effective treatment for spinal metastases; however, outcomes specific to a geriatric population have not been described. This study aims to investigate the efficacy and safety of spine SBRT, in particular the rate of iatrogenic vertebral compression fracture (VCF), in patients aged 70 and older.

Patients and methods: From a prospectively maintained single-institutional database of 976 patients and 2407 spinal segments treated with SBRT for vertebral metastases between 2008 and 2021, all patients aged 70 or above were retrospectively reviewed. The primary outcome is the risk of VCF. Secondary outcomes included magnetic resonance imaging-based local failure and overall survival.

Results: A total of 252 consecutive patients with 580 spinal segments treated with spine SBRT were reviewed. The median age was 75.8 (range: 70-90.3) years and the median (interquartile range) follow-up duration was 16.9 (6.4-41.3) months. The median overall survival of the entire cohort was 20.3 months and the 2-year local failure rate was 14.3%. The cumulative risk of VCF at 12 and 24 months were 8.4% and 12.3%, respectively. Significant predictors of VCF on multivariable analyses included greater biologically equivalent dose, baseline fracture, and increasing age. In particular, the 2-year VCF rate and median time to VCF were 30.3% and 3.4 months for those 86 and older, compared with 11.2% and 12.8 months for those younger than 86, respectively (P = .0011).

Conclusion and relevance: Spine SBRT should be considered in a geriatric population; however, for those 86 and older, we suggest caution due to the significant risk of VCF.