Diabetes increases the risk of serious adverse events after re-irradiation of the spine

TY - JOUR

T1 - Diabetes increases the risk of serious adverse events after re-irradiation of the spine

AU - Suppli, Morten Hiul

AU - Munck Af Rosenschöld, Per

AU - Pappot, Helle

AU - Engelholm, Svend Aage

N1 - Copyright © 2019 Elsevier B.V. All rights reserved.

PY - 2019/7

Y1 - 2019/7

N2 - INTRODUCTION: In this study we investigate the risk of radiation-induced serious adverse event of the spine in a large cohort of consecutive retreated patients with palliative radiotherapy (RT) for metastatic cancer in the spine.METHODS AND MATERIALS: From 2010 to 2014, 2387 patients received spinal irradiation with a palliative intent for metastatic spinal cord compression at our institution. The patients were reviewed for prior RT and 220 patients had received re-irradiation of the spine. Clinical and treatment data were obtained from the patients' records and the RT planning system.RESULTS: Patients had metastatic disease from breast, prostate, lung, hematological or other cancers (22.7%, 21.8%, 21.4%, 3.2% and 30.9%, respectively). Median follow-up was 99 days. Median cumulative EQD2 was 57.6 Gy2; range: 20.0-90.0 Gy. Spinal events related to re-irradiation were observed in fourteen patients; six patients were diagnosed with radiation-induced myelopathy (RIM) and nine patients with radiation-induced vertebral fracture (RIF). In a multivariate analysis, diabetes was related to increased risk of toxicity (HR = 7.9; P = 0.003).CONCLUSION: The incidence of RIM and RIF (6 and 9 out of 220 patients, respectively) was low in our cohort of re-irradiated patients. Patients with diabetes had a higher risk of adverse events which should be considered before re-irradiation of the spine.

AB - INTRODUCTION: In this study we investigate the risk of radiation-induced serious adverse event of the spine in a large cohort of consecutive retreated patients with palliative radiotherapy (RT) for metastatic cancer in the spine.METHODS AND MATERIALS: From 2010 to 2014, 2387 patients received spinal irradiation with a palliative intent for metastatic spinal cord compression at our institution. The patients were reviewed for prior RT and 220 patients had received re-irradiation of the spine. Clinical and treatment data were obtained from the patients' records and the RT planning system.RESULTS: Patients had metastatic disease from breast, prostate, lung, hematological or other cancers (22.7%, 21.8%, 21.4%, 3.2% and 30.9%, respectively). Median follow-up was 99 days. Median cumulative EQD2 was 57.6 Gy2; range: 20.0-90.0 Gy. Spinal events related to re-irradiation were observed in fourteen patients; six patients were diagnosed with radiation-induced myelopathy (RIM) and nine patients with radiation-induced vertebral fracture (RIF). In a multivariate analysis, diabetes was related to increased risk of toxicity (HR = 7.9; P = 0.003).CONCLUSION: The incidence of RIM and RIF (6 and 9 out of 220 patients, respectively) was low in our cohort of re-irradiated patients. Patients with diabetes had a higher risk of adverse events which should be considered before re-irradiation of the spine.

U2 - 10.1016/j.radonc.2019.04.002

DO - 10.1016/j.radonc.2019.04.002

M3 - Journal article

C2 - 31015114

SN - 0167-8140

VL - 136

SP - 130

EP - 135

JO - Radiotherapy & Oncology

JF - Radiotherapy & Oncology

ER -