{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T09:06:43Z","timestamp":1780564003577,"version":"3.54.1"},"reference-count":48,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,16]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Vertebral augmentation (VA), including vertebroplasty and kyphoplasty, has become pivotal in alleviating pain and disability associated with pathological compression fractures of the spine. However, there is no existing guidance informing the ideal timing of radiotherapy (RT) and VA, with a theoretical concern of tumoral seeding if adjuvant. This study compared locoregional cancer recurrence in patients who underwent neoadjuvant versus adjuvant RT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The authors conducted a retrospective review of all adult cancer patients treated with VA and RT within 3 months between 2009 and 2023 at the University Health Network in Toronto, Ontario, Canada. They investigated locoregional recurrence (LRR), defined as recurrence within the RT field as well as 1 vertebral body above and below. Time to recurrence was estimated using cumulative incidence analysis and compared using Gray\u2019s test. Competing risk regression was used to compare the recurrence risk in the full cohort and in a matched cohort using propensity scores informed by biologically effective dose, radiosensitivity, and vertebral levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The authors included 180 patients\u201445 received adjuvant RT and 135 received neoadjuvant RT. The mean \u00b1 SD age of patients was 63.8 \u00b1 12.7 years and about half were female (52%). The mean time between VA and adjuvant RT was 30 \u00b1 26 days and 41 \u00b1 23 days between neoadjuvant RT and VA (p &lt; 0.001). Forty patients (22%) had LRR, with a median (range) time from RT to recurrence of 2.4 (0.1\u201396) months. Patients who underwent neoadjuvant RT had a reduced risk of LRR (subdistribution hazard ratio [sHR] [95% CI] 0.30 [0.16\u20130.56], p &lt; 0.001). This observation did not change after propensity score matching (sHR [95% CI] 0.41 [0.19\u20130.88], p = 0.02).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The authors observed a higher risk of LRR in patients who underwent adjuvant versus neoadjuvant RT in relation to VA. In the setting of painful spine metastases, RT should be considered before VA for improved tumor control.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.8.spine25764","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T12:00:13Z","timestamp":1769083213000},"page":"662-667","source":"Crossref","is-referenced-by-count":1,"title":["Does timing matter? A single-institution analysis of vertebral augmentation before or after radiotherapy in the treatment of painful spine metastases"],"prefix":"10.3171","volume":"44","author":[{"given":"Jane","family":"Jomy","sequence":"first","affiliation":[{"name":"Temerty Faculty of Medicine, University of Toronto;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehran","family":"Nasralla","sequence":"additional","affiliation":[{"name":"Joint Department of Medical Imaging, Toronto Western Hospital, Toronto;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna T.","family":"Santiago","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University Health Network, Toronto;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger","family":"Smith","sequence":"additional","affiliation":[{"name":"Joint Department of Medical Imaging, Toronto Western Hospital, Toronto;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Massicotte","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Toronto Western Hospital, Toronto;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Yan","sequence":"additional","affiliation":[{"name":"Radiation Medicine Program, University Health Network, Toronto; and"},{"name":"Department of Radiation Oncology, University of Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"CA Cancer J Clin","first-page":"7","article-title":"Cancer statistics, 2022","volume":"72","author":"Siegel RL","year":"2022","unstructured":"Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022;72(1):7\u201333."},{"key":"b2","series-title":"StatPearls","article-title":"Spinal metastasis","author":"Ziu E","year":"2025","unstructured":"Ziu E, Viswanathan VK, Mesfin FB. Spinal metastasis. In: StatPearls.StatPearls Publishing;2025.Accessed September 25, 2025.https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK441950\/"},{"key":"b3","series-title":"StatPearls","article-title":"Spinal cord compression","author":"Singleton JM","year":"2025","unstructured":"Singleton JM, Hefner M. Spinal cord compression. 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J Clin Med. 2024;13(12):3590."},{"issue":"2","key":"b5","series-title":"AJNR Am J Neuroradiol","first-page":"373","article-title":"Percutaneous vertebroplasty: a developing standard of care for vertebral compression fractures","volume":"22","author":"Mathis JM","year":"2001","unstructured":"Mathis JM, Barr JD, Belkoff SM, Barr MS, Jensen ME, Deramond H. Percutaneous vertebroplasty: a developing standard of care for vertebral compression fractures. AJNR Am J Neuroradiol. 2001;22(2):373\u2013381."},{"issue":"2 Pt 1","key":"b6","series-title":"J Vasc Interv Radiol","first-page":"139","article-title":"Percutaneous vertebroplasty for osteoporotic compression fractures: quantitative prospective evaluation of long-term outcomes","volume":"13","author":"Zoarski GH","year":"2002","unstructured":"Zoarski GH, Snow P, Olan WJ,  Percutaneous vertebroplasty for osteoporotic compression fractures: quantitative prospective evaluation of long-term outcomes. 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Radiat Oncol. 2020;15(1):263."},{"issue":"5","key":"b19","series-title":"Pain Physician","first-page":"447","article-title":"The use of vertebral augmentation and external beam radiation therapy in the multimodal management of malignant vertebral compression fractures","volume":"14","author":"Hirsch AE","year":"2011","unstructured":"Hirsch AE, Jha RM, Yoo AJ,  The use of vertebral augmentation and external beam radiation therapy in the multimodal management of malignant vertebral compression fractures. Pain Physician. 2011;14(5):447\u2013458."},{"issue":"2","key":"b20","series-title":"J Spine Surg","first-page":"368","article-title":"Timing of surgery and radiotherapy in the management of metastatic spine disease: expert opinion","volume":"4","author":"Lee RS","year":"2018","unstructured":"Lee RS, Batke J, Weir L, Dea N, Fisher CG. Timing of surgery and radiotherapy in the management of metastatic spine disease: expert opinion. 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Tumor extravasation following a cement augmentation procedure for vertebral compression fracture in metastatic spinal disease. J Neurosurg Spine. 2014;21(3):372\u2013377."},{"issue":"1","key":"b1","series-title":"CA Cancer J Clin","first-page":"7","article-title":"Cancer statistics, 2022","volume":"72","author":"Siegel RL","year":"2022","unstructured":"Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022;72(1):7\u201333."},{"key":"b2","series-title":"StatPearls","article-title":"Spinal metastasis","author":"Ziu E","year":"2025","unstructured":"Ziu E, Viswanathan VK, Mesfin FB. Spinal metastasis. In: StatPearls.StatPearls Publishing;2025.Accessed September 25, 2025.https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK441950\/"},{"key":"b3","series-title":"StatPearls","article-title":"Spinal cord compression","author":"Singleton JM","year":"2025","unstructured":"Singleton JM, Hefner M. Spinal cord compression. 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J Vasc Interv Radiol. 2002;13(2 Pt 1):139\u2013148."},{"issue":"7","key":"b7","series-title":"AJNR Am J Neuroradiol","first-page":"1357","article-title":"Percutaneous cement augmentations of malignant lesions of the sacrum and pelvis","volume":"30","author":"Georgy BA","year":"2009","unstructured":"Georgy BA. Percutaneous cement augmentations of malignant lesions of the sacrum and pelvis. AJNR Am J Neuroradiol. 2009;30(7):1357\u20131359."},{"issue":"1","key":"b8","series-title":"AJNR Am J Neuroradiol","first-page":"38","article-title":"Sacroplasty by CT and fluoroscopic guidance: is the procedure right for your patient?","volume":"28","author":"Strub WM","year":"2007","unstructured":"Strub WM, Hoffmann M, Ernst RJ, Bulas RV. Sacroplasty by CT and fluoroscopic guidance: is the procedure right for your patient?. 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Semin Radiat Oncol. 2023;33(2):159\u2013171."},{"issue":"4","key":"b11","series-title":"J Int Med Res","first-page":"300060519888107","article-title":"Treatment of spine metastases in cancer: a review","volume":"48","author":"Chen Y","year":"2020","unstructured":"Chen Y, He Y, Zhao C, Li X, Zhou C, Hirsch FR. Treatment of spine metastases in cancer: a review. J Int Med Res. 2020;48(4):300060519888107."},{"issue":"1","key":"b12","series-title":"Sci Rep","first-page":"7196","article-title":"Circulating tumour cell release after cement augmentation of vertebral metastases","volume":"7","author":"Mohme M","year":"2017","unstructured":"Mohme M, Riethdorf S, Dreimann M,  Circulating tumour cell release after cement augmentation of vertebral metastases. Sci Rep. 2017;7(1):7196."},{"issue":"4","key":"b13","series-title":"J Clin Epidemiol","first-page":"344","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"61","author":"von Elm E","year":"2008","unstructured":"von Elm E, Altman DG, Egger M, Pocock SJ, G\u00f8tzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344\u2013349."},{"issue":"22 Suppl","key":"b14","series-title":"Spine (Phila Pa 1976).","first-page":"S78","article-title":"Radiotherapy and radiosurgery for metastatic spine disease: what are the options, indications, and outcomes?","volume":"34","author":"Gerszten PC","year":"2009","unstructured":"Gerszten PC, Mendel E, Yamada Y. 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Radiat Oncol. 2020;15(1):263."},{"issue":"5","key":"b19","series-title":"Pain Physician","first-page":"447","article-title":"The use of vertebral augmentation and external beam radiation therapy in the multimodal management of malignant vertebral compression fractures","volume":"14","author":"Hirsch AE","year":"2011","unstructured":"Hirsch AE, Jha RM, Yoo AJ,  The use of vertebral augmentation and external beam radiation therapy in the multimodal management of malignant vertebral compression fractures. Pain Physician. 2011;14(5):447\u2013458."},{"issue":"2","key":"b20","series-title":"J Spine Surg","first-page":"368","article-title":"Timing of surgery and radiotherapy in the management of metastatic spine disease: expert opinion","volume":"4","author":"Lee RS","year":"2018","unstructured":"Lee RS, Batke J, Weir L, Dea N, Fisher CG. Timing of surgery and radiotherapy in the management of metastatic spine disease: expert opinion. J Spine Surg. 2018;4(2):368\u2013373."},{"issue":"2","key":"b21","series-title":"Radiat Oncol J","first-page":"95","article-title":"The effects of high-dose radiation therapy on bone: a scoping review","volume":"42","author":"Berk L","year":"2024","unstructured":"Berk L. The effects of high-dose radiation therapy on bone: a scoping review. Radiat Oncol J. 2024;42(2):95\u2013103."},{"issue":"8","key":"b22","series-title":"Support Care Cancer","first-page":"891","article-title":"Percutaneous cementoplasty in multiple myeloma: a valuable adjunct for pain control and ambulation maintenance","volume":"16","author":"Tran Thang NN","year":"2008","unstructured":"Tran Thang NN, Abdo G, Martin JB,  Percutaneous cementoplasty in multiple myeloma: a valuable adjunct for pain control and ambulation maintenance. Support Care Cancer. 2008;16(8):891\u2013896."},{"issue":"1","key":"b23","series-title":"J Neurosurg Spine","first-page":"72","article-title":"Safety and utility of kyphoplasty prior to spine stereotactic radiosurgery for metastatic tumors: a clinical and dosimetric analysis","volume":"28","author":"Barzilai O","year":"2018","unstructured":"Barzilai O, DiStefano N, Lis E,  Safety and utility of kyphoplasty prior to spine stereotactic radiosurgery for metastatic tumors: a clinical and dosimetric analysis. J Neurosurg Spine. 2018;28(1):72\u201378."},{"issue":"3","key":"b24","series-title":"J Neurosurg Spine","first-page":"372","article-title":"Tumor extravasation following a cement augmentation procedure for vertebral compression fracture in metastatic spinal disease","volume":"21","author":"Cruz JP","year":"2014","unstructured":"Cruz JP, Sahgal A, Whyne C, Fehlings MG, Smith R. 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