1
|
Pielkenrood BJ, Visser TF, van Tol FR, Foppen W, Eppinga WSC, Verhoeff JJC, Bol GH, Van der Velden JM, Verlaan JJ. Remineralization of lytic spinal metastases after radiotherapy. Spine J 2023; 23:571-578. [PMID: 36623735 DOI: 10.1016/j.spinee.2022.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 11/07/2022] [Accepted: 12/28/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND CONTEXT Palliative radiotherapy (RT) can lead to remineralization of osteolytic lesions thereby potentially restoring some of the weight-bearing capacity and preventing vertebral collapse. It is not clear, however, under which circumstances remineralization of osteolytic lesions occurs. PURPOSE The aim of this study was to investigate the change in bone mineral density in spinal metastases after RT compared to a reference region, and find associated factors. STUDY DESIGN Retrospective analysis within prospective observational cohort OUTCOME MEASURES: change in bone mineral density measured in Hounsfield Units (HU). PATIENT SAMPLE patients treated with RT for (painful) bone metastases. METHODS Patients with spinal metastases were included if computed tomography scans both pre- and post-RT were available. Bone density was measured in HU. A region of interest (ROI) was drawn manually in the metastatic lesion. As a reference, a measurement of bone density in adjacent, unaffected, and non-irradiated vertebrae was used. Factors tested for association were origin of the primary tumor, RT dose and fractionation scheme, and concomitant use of bisphosphonates. RESULTS A total of 31 patients with 49 spinal metastases, originating from various primary tumors, were included. The median age on baseline was 58 years (IQR: 53-63) and median time between baseline and follow-up scan was 8.2 months (IQR: 3.0-18.4). Difference in HU in the lesion before and after treatment was 146.9 HU (95% CI 68.4-225.4; p<.01). Difference in HU in the reference vertebra between baseline and first follow-up was 19.1 HU (95% CI -47.9 to 86.0; p=.58). Difference between reference vertebrae and metastatic lesions on baseline was -194.1 HU (95% CI -276.2 to -112.0; p<.01). After RT, this difference was reduced to -50.3 HU (95% CI -199.6 to 99.0; p=.52). Patients using bisphosphonates showed a greater increase in HU, 194.1 HU versus 60.6 HU, p=.01. CONCLUSIONS Palliative radiation of osteolytic lytic spinal metastases is positively associated with an increased bone mineral density at follow-up. The use of bisphosphonates was linked to an increased bone mineral density when used during or after RT.
Collapse
Affiliation(s)
- Bart J Pielkenrood
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Thomas F Visser
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Floris R van Tol
- Department of Orthopedic Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Wouter Foppen
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Wietse S C Eppinga
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Joost J C Verhoeff
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Gijs H Bol
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Joanne M Van der Velden
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Jorrit-Jan Verlaan
- Department of Orthopedic Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| |
Collapse
|
2
|
Wang Q, Sun B, Meng X, Liu C, Cong Y, Wu S. Density of bone metastatic lesions increases after radiotherapy in patients with breast cancer. JOURNAL OF RADIATION RESEARCH 2019; 60:394-400. [PMID: 30785994 PMCID: PMC6530615 DOI: 10.1093/jrr/rry098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 04/17/2018] [Indexed: 06/09/2023]
Abstract
The aim of this study was to assess local response to radiotherapy (RT) in a quantitative manner by evaluating the bone density of metastases. Spinal and pelvic bone metastases in 44 patients with breast cancer who were treated between May 2010 and December 2016 were retrospectively assessed. Bone density values of irradiated and unirradiated bone metastases before, 1-3 months after, 4-6 months after, and 7-9 months after RT were compared. At each time point, mean bone density ± standard deviation values were measured in Hounsfield units (HU) from computed tomography (CT) scans. Student's t-test was used for statistical analyses of the differences in bone density and for univariate analysis of the prognostic factors for differences in bone density at various time points after RT. Mean bone densities in irradiated and unirradiated bone metastases before RT were 297.31 ± 211.93 HU and 326.29 ± 228.61 HU, respectively. At the subsequent three time points examined, the mean bone density values in the irradiated and unirradiated bone metastases were: 61.97 ± 78.58 HU (P = 0.000) and 36.93 ± 52.49 HU (P = 0.001); 149.07 ± 133.27 HU (P = 0.000) and 68.40 ± 101.10 HU (P = 0.000); and 183.94 ± 168.30 HU (P = 0.000) and 88.21 ± 159.49 HU (P = 0.004), respectively, in each case. Patients receiving bisphosphonates exhibited greater increases in bone density in their metastases 1-3 months after RT (83.04 ± 82.18 HU vs 26.86 ± 60.55 HU, respectively; P = 0.044), whereas chemotherapy before RT was associated with significantly lower increases in bone density at the subsequent three time points [(37.53 ± 67.66 HU vs 93.63 ± 80.36 HU, P = 0.027), (99.30 ± 107.92 HU vs 180.24 ± 127.85 HU, P = 0.030), and (126.07 ± 141.77 HU vs 236.28 ± 158.22 HU, P = 0.024), respectively, in each case]. Comparing bone density values determined from CT scans appears to be a practicable and reproducible method for assessing local response to RT for bone metastasis of breast cancer. Increased bone density was also observed in the irradiated bone metastases.
Collapse
Affiliation(s)
- Qian Wang
- Department of Radiation Oncology, 307 Hospital of People’s Liberation Army, Beijing, China
| | - Bing Sun
- Department of Radiation Oncology, 307 Hospital of People’s Liberation Army, Beijing, China
| | - Xiangying Meng
- Department of Radiation Oncology, 307 Hospital of People’s Liberation Army, Beijing, China
| | - Chao Liu
- Department of Radiation Oncology, 307 Hospital of People’s Liberation Army, Beijing, China
| | - Yang Cong
- Department of Radiation Oncology, 307 Hospital of People’s Liberation Army, Beijing, China
| | - Shikai Wu
- Department of Radiation Oncology, 307 Hospital of People’s Liberation Army, Beijing, China
| |
Collapse
|
3
|
Finkelstein S, Raman S, Van Der Velden J, Zhang L, Tan C, Dhillon A, Tonolete F, Chiu N, Probyn L, McDonald R, Sahgal A, Chow E, Chin L. Changes in Volume and Density Parameters Measured on Computed Tomography Images Following Stereotactic Body Radiation Therapy of Nonspine Bone Metastases. Technol Cancer Res Treat 2019; 18:1533033819853532. [PMID: 31319776 PMCID: PMC6640058 DOI: 10.1177/1533033819853532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Volumetric and density parameters measured from computed tomography scans were investigated for evaluating treatment response of nonspine bone lesions following stereotactic body radiation therapy. Methods: Twenty-three patients treated with stereotactic body radiation therapy to nonspine bone metastases with pre- and post-treatment radiological follow-up with computed tomography imaging were identified in a retrospective review. An expert radiologist classified 26 lesions by type (lytic, sclerotic) and by response. Two independent radiation oncologists created separate contours of the bone and soft tissue lesion volumes. Density and volume were assessed relative to baseline values. Results: For bone-only lesions, all lesions designated as local control decreased in volume or remained within 20% of baseline volumes. Lytic lesions classified as progressive disease exhibited much larger volume increases. Lytic bone lesions showed indications of remineralization with some exhibiting immediate increases in density (1-6 months) and others decreasing initially then increasing back toward baseline between 7 and 12 months. The majority of sclerotic lesions, all classified as local control, decreased slightly in both volume and density. Lesions with both soft tissue and boney involvement resulted in contradictory results when employing both radiological and size parameters for assessing treatment response. Classification was dominated by changes in soft tissue volume, despite associated volume or density changes in the corresponding boney lesion. In contrast, when soft tissue volume changes were minimal (<20% increase), classification appeared to be related primarily to density changes and not bone volume. Conclusions: Volume and density changes show promise as quantitative parameters for classifying treatment responses of nonspine osseous lesions. Further work is required for clarifying how these metrics can be applied to lesions with both boney and soft tissue components.
Collapse
Affiliation(s)
- Samuel Finkelstein
- 1 Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Srinivas Raman
- 1 Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Joanne Van Der Velden
- 1 Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,2 Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Liying Zhang
- 3 Department of Medical Physics, Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Carolyn Tan
- 1 Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Amanpreet Dhillon
- 4 Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Frances Tonolete
- 4 Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas Chiu
- 1 Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Linda Probyn
- 4 Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Rachel McDonald
- 1 Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Arjun Sahgal
- 1 Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Edward Chow
- 1 Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Lee Chin
- 3 Department of Medical Physics, Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|