{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T17:56:18Z","timestamp":1794333378197,"version":"4.9.0"},"reference-count":20,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"27","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCO"],"published-print":{"date-parts":[[2013,9,20]]},"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p> Vertebral compression fracture (VCF) is increasingly recognized as an adverse event after spine stereotactic body radiotherapy (SBRT). We report a multi-institutional study aimed at clarifying the risk and predictive factors associated with VCF. <\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and Methods<\/jats:title><jats:p> A total of 252 patients with 410 spinal segments treated with SBRT were included. The primary outcome was the development of VCF (a new VCF or progression of a baseline VCF). In addition to various patient-, treatment-, and tumor-specific factors, the Spinal Instability Neoplastic Scoring (SINS) system was applied to determine predictive value. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> The median follow-up was 11.5 months (range, 0.03 to 113 months). The median and mean overall survival rates were 16 and 26 months, respectively. We observed 57 fractures (57 of 410, 14%), with 47% (27 of 57) new fractures and 53% (30 of 57) fracture progression. The median time to VCF was 2.46 months (range, 0.03 to 43.01 months), and 65% occurred within the first 4 months. The 1- and 2-year cumulative incidences of fracture were 12.35% and 13.49%, respectively. Multivariable analysis identified dose per fraction (greatest risk for \u2265 24 Gy v 20 to 23 Gy v \u2264 19 Gy), in addition to three of the six original SINS criteria: baseline VCF, lytic tumor, and spinal deformity, as significant predictors of VCF. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p> Caution must be observed when treating with \u2265 20 Gy\/fraction, in particular, for patients with lytic tumor, spinal misalignment, and a baseline VCF. Frequent short-term follow-up is required, as nearly two thirds of all VCF occurred within the first 4 months. We also conclude that SINS may have utility in predicting patients at high risk of SBRT-induced VCF. <\/jats:p><\/jats:sec>","DOI":"10.1200\/jco.2013.50.1411","type":"journal-article","created":{"date-parts":[[2013,8,20]],"date-time":"2013-08-20T05:02:59Z","timestamp":1376974979000},"page":"3426-3431","source":"Crossref","is-referenced-by-count":362,"title":["Vertebral Compression Fracture After Spine Stereotactic Body Radiotherapy: A Multi-Institutional Analysis With a Focus on Radiation Dose and the Spinal Instability Neoplastic Score"],"prefix":"10.1200","volume":"31","author":[{"given":"Arjun","family":"Sahgal","sequence":"first","affiliation":[{"name":"Arjun Sahgal and Ameen Al-Omair, Princess Margaret Cancer Centre; Arjun Sahgal, Ameen Al-Omair, Marcelo Cunha, and Isabelle Thibault, Sunnybrook Health Sciences Centre; Eshetu G. Atenafu, University Health Network; Michael G. Fehlings, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Sam Chao, Ehsan H. Balagamwala, Lilyana Angelov, and John Suh, Cleveland Clinic, Cleveland, OH; Nicholas Boehling, Paul Brown, Laurence D. Rhines, and Eric Chang, MD Anderson Cancer Center,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eshetu G.","family":"Atenafu","sequence":"additional","affiliation":[{"name":"Arjun Sahgal and Ameen Al-Omair, Princess Margaret Cancer Centre; Arjun Sahgal, Ameen Al-Omair, Marcelo Cunha, and Isabelle Thibault, Sunnybrook Health Sciences Centre; Eshetu G. Atenafu, University Health Network; Michael G. Fehlings, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Sam Chao, Ehsan H. Balagamwala, Lilyana Angelov, and John Suh, Cleveland Clinic, Cleveland, OH; Nicholas Boehling, Paul Brown, Laurence D. Rhines, and Eric Chang, MD Anderson Cancer Center,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam","family":"Chao","sequence":"additional","affiliation":[{"name":"Arjun Sahgal and Ameen Al-Omair, Princess Margaret Cancer Centre; Arjun Sahgal, Ameen Al-Omair, Marcelo Cunha, and Isabelle Thibault, Sunnybrook Health Sciences Centre; Eshetu G. Atenafu, University Health Network; Michael G. Fehlings, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Sam Chao, Ehsan H. Balagamwala, Lilyana Angelov, and John Suh, Cleveland Clinic, Cleveland, OH; Nicholas Boehling, Paul Brown, Laurence D. Rhines, and Eric Chang, MD Anderson Cancer Center,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ameen","family":"Al-Omair","sequence":"additional","affiliation":[{"name":"Arjun Sahgal and Ameen Al-Omair, Princess Margaret Cancer Centre; Arjun Sahgal, Ameen Al-Omair, Marcelo Cunha, and Isabelle Thibault, Sunnybrook Health Sciences Centre; Eshetu G. Atenafu, University Health Network; Michael G. Fehlings, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Sam Chao, Ehsan H. Balagamwala, Lilyana Angelov, and John Suh, Cleveland Clinic, Cleveland, OH; Nicholas Boehling, Paul Brown, Laurence D. Rhines, and Eric Chang, MD Anderson Cancer Center,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Boehling","sequence":"additional","affiliation":[{"name":"Arjun Sahgal and Ameen Al-Omair, Princess Margaret Cancer Centre; Arjun Sahgal, Ameen Al-Omair, Marcelo Cunha, and Isabelle Thibault, Sunnybrook Health Sciences Centre; Eshetu G. Atenafu, University Health Network; Michael G. Fehlings, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Sam Chao, Ehsan H. Balagamwala, Lilyana Angelov, and John Suh, Cleveland Clinic, Cleveland, OH; Nicholas Boehling, Paul Brown, Laurence D. Rhines, and Eric Chang, MD Anderson Cancer Center,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ehsan H.","family":"Balagamwala","sequence":"additional","affiliation":[{"name":"Arjun Sahgal and Ameen Al-Omair, Princess Margaret Cancer Centre; Arjun Sahgal, Ameen Al-Omair, Marcelo Cunha, and Isabelle Thibault, Sunnybrook Health Sciences Centre; Eshetu G. Atenafu, University Health Network; Michael G. Fehlings, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Sam Chao, Ehsan H. Balagamwala, Lilyana Angelov, and John Suh, Cleveland Clinic, Cleveland, OH; Nicholas Boehling, Paul Brown, Laurence D. Rhines, and Eric Chang, MD Anderson Cancer Center,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcelo","family":"Cunha","sequence":"additional","affiliation":[{"name":"Arjun Sahgal and Ameen Al-Omair, Princess Margaret Cancer Centre; Arjun Sahgal, Ameen Al-Omair, Marcelo Cunha, and Isabelle Thibault, Sunnybrook Health Sciences Centre; Eshetu G. Atenafu, University Health Network; Michael G. Fehlings, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Sam Chao, Ehsan H. Balagamwala, Lilyana Angelov, and John Suh, Cleveland Clinic, Cleveland, OH; Nicholas Boehling, Paul Brown, Laurence D. Rhines, and Eric Chang, MD Anderson Cancer Center,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"Thibault","sequence":"additional","affiliation":[{"name":"Arjun Sahgal and Ameen Al-Omair, Princess Margaret Cancer Centre; Arjun Sahgal, Ameen Al-Omair, Marcelo Cunha, and Isabelle Thibault, Sunnybrook Health Sciences Centre; Eshetu G. Atenafu, University Health Network; Michael G. Fehlings, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Sam Chao, Ehsan H. Balagamwala, Lilyana Angelov, and John Suh, Cleveland Clinic, Cleveland, OH; Nicholas Boehling, Paul Brown, Laurence D. 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