Assessing the utility of the Spinal Instability in Neoplasia (SINS) score to predict fracture after conventional radiation therapy (RT) for spinal metastases

Publication date: Available online 13 February 2018
Source:Practical Radiation Oncology
Author(s): Diana D. Shi, Lauren M. Hertan, Tai Chung Lam, Sonia Skamene, John H. Chi, Michael Groff, Charles H. Cho, Marco L. Ferrone, Mitchel Harris, Yu-Hui Chen, Tracy Anne Balboni
PurposeAssessing the stability of spinal metastases is critical for making treatment decisions. The SINS score was developed by the Spine Oncology Study Group to categorize tumor-related lesions. However, data describing its utility in predicting fractures in patients with spinal metastases is limited. The purpose of this study is to assess the validity of the SINS score in predicting new or worsening fracture after radiation therapy (RT) to spine metastases.Materials/MethodsThis is a retrospective analysis of patients treated with conventional RT alone (median total dose: 30 Gy, range: 8 – 47 Gy; median number of fractions: 10 , range: 1 – 25) for spinal metastasis at XXXX from 2006 to 2013. A SINS score was calculated for each lesion (range: 0-18). The primary endpoint was time from RT start to radiographically documented new or worsening fracture or last disease assessment.ResultsA total of 203 patients and 250 lesions were included in analysis. The percentages of lesions with SINS scores of 0-6, 7-12, and 13-18 were 38.8%, 54.8%, and 6.4%, respectively. Of 250 lesions, 20.4% developed new or worsening fractures; 14.4% for SINS 0-6, 21.2% for SINS 7-12, and 50.0% for SINS 13-18. Multivariate analysis adjusted for gender, age, ECOG, histology, and total dose, indicated that compared to stable lesions (SINS: 0-6), potentially unstable lesions (SINS 7-12) demonstrated a greater likelihood of new or worsening fracture that was not statistically significant ([HR] 1.66; 95% CI 0.85, 3.22; p = 0.14), and unstable lesions (SINS 13-18) were significantly more likely to develop to new or worsening fracture ([HR] 4.37, 95% CI 1.80, 10.61; p = 0.001)ConclusionsIn this study of patients undergoing RT for spinal metastases, 20.4% developed new or worsening vertebral fractures. The SINS score is demonstrated to be a useful tool to assess fracture risk after RT.



http://ift.tt/2sw6KgJ