Article Figures & Data
Figures
- Fig 1.
Index case of osseous pseudoprogression (not part of the analysis). A 55-year-old man with metastatic renal cell carcinoma. A–C, Axial, coronal, and sagittal images from the SSRS treatment plan. Twenty-four Gy (blue open area) will be delivered to the gross tumor volume corresponding to the metastasis seen on MR imaging (D), and 16 Gy (red open area), to the remainder of the at-risk vertebral body (clinical tumor volume) in a single fraction. The spinal cord (red shaded area) is spared from high-dose radiation. Other colors correspond to isodose lines as indicated. D, MR image obtained 6 weeks before therapy shows the lesion in the central vertebral body. E, The lesion enlarges on follow-up 1, 6 weeks after SSRS. There is extensive signal abnormality surrounding the lesion. The entire extent of the signal abnormality, including the lesion, is measured in this study (indicated by vertical white lines). F, Surrounding signal abnormality decreases on follow-up 2, 16 weeks following SSRS.
- Fig 2.
Osseous pseudoprogression-free survival by SSRS fraction status. OPP-free survival is defined as the length of time following SSRS that a patient lives with the disease without development of OPP. Kaplan-Meier analysis shows that there was a significant difference in OPP-free survival between single- and multifraction regimens. The 5 cases of OPP were all treated with single-fraction SSRS and occurred between approximately 3 and 6 months following SSRS (shaded area).
- Fig 3.
Time course of lesions demonstrating osseous pseudoprogression. Lesions 1, 29, 36, 37, and 45 (see Table 1) demonstrate an initial increase in size followed by a decrease (OPP). The shaded areas correspond to a ±2-mm change from baseline, representing measurement error on MR imaging. Similarly, the apparent late increase in lesion size on T2WI in patients 1, 37, and 45 falls within a ±2-mm range of the preceding time points and may represent measurement error.
Tables
No. Age (yr) Sex Histology Level Dose (Gy) Fractions Response 1 57 F Renal cell carcinoma L1 24 1 OPP 3 55 M Renal cell carcinoma L4 24 1 SD 4 54 F Renal cell carcinoma T12 24 1 PD 5 52 M Renal cell carcinoma L1 27 3 PR 8 52 M Renal cell carcinoma L4 30 5 PD 9 42 M Renal cell carcinoma T11 30 5 SD 11 53 F Renal cell carcinoma T12 30 5 PR 12 60 F Breast carcinoma T8 30 5 SD 13 63 F Melanoma L1 27 3 SD 15 58 M Basal cell carcinoma T4 30 5 PD 16 32 F Thyroid carcinoma L3 30 5 SD 17 46 F Thyroid carcinoma L1 27 3 PR L2 27 3 SD 18 50 F Thyroid carcinoma T11 27 3 SD 19 49 M Thyroid carcinoma T6 27 3 PD 20 44 F Sarcoma C3 27 3 PR 22 50 F Sarcoma T8 27 3 SD 23 70 F Sarcoma L2 27 3 PR 24 49 M Thyroid carcinoma T1 27 3 SD 25 48 F Breast carcinoma T2 18 1 PR 26 51 F Breast carcinoma T5 18 1 SD 27 38 F Lung carcinoma L1 18 1 SD 29 74 M Lung carcinoma L1 18 1 OPP 30 35 M Sarcoma T8 16 1 PR 31 50 F Sarcoma T5 18 1 PD 32 59 M Sarcoma T5 18 1 SD 35 44 M Renal cell carcinoma L4 24 1 PD 36 63 M Renal cell carcinoma L6 24 1 OPP 37 70 M Renal cell carcinoma T12 24 1 OPP 38 65 M Renal cell carcinoma C3 24 1 PR 39 61 M Renal cell carcinoma T6 27 3 PD 40 33 F Breast carcinoma L4 27 3 PD 41 67 M Colon carcinoma L3 27 3 PR 42 48 F Adenoid cystic carcinoma C2 27 3 PD 43 58 F Thyroid carcinoma L2 27 3 PR 44 34 F Breast carcinoma T9 16 1 PR 45 65 M Prostate carcinoma T6 16 1 OPP Note:—SD indicates stable disease.
Variable HR P Value 95% CI Comment Age 1.16 .01 1.03–1.30 Continuous Radiation dose 0.86 .1 0.72–1.03 Continuous Tumor radiosensitivity 0.70 .7 0.12–4.17 Radiosensitive vs -resistant Location 0.75 .8 0.13–4.48 T-spine vs C/L-spine Fraction – – – Collinearity (all OPP occurred in single-fraction regimens) Note:—HR indicates hazard ratio; C/L, cervical/lumbar; –, not applicable.
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