Treatment planning and fracture prediction in patients with skeletal metastasis with CT-Based rigidity analysis

Ara Nazarian, Vahid Entezari, David Zurakowski, Nathan Calderon, John A. Hipp, Juan C. Villa-Camacho, Patrick P. Lin, Felix H. Cheung, Albert J. Aboulafia, Robert Turcotte, Megan E. Anderson, Mark C. Gebhardt, Edward Y. Cheng, Richard M. Terek, Michael J Yaszemski, Timothy A. Damron, Brian D. Snyder

Research output: Contribution to journalArticle

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Abstract

Purpose: Pathologic fractures could be prevented if reliable methods of fracture risk assessment were available. A multicenter prospective study was conducted to identify significant predictors of physicians' treatment plan for skeletal metastasis based on clinical fracture risk assessments and the proposed CT-based Rigidity Analysis (CTRA). Experimental Design: Orthopedic oncologists selected a treatment plan for 124 patients with 149 metastatic lesions based on the Mirels method. Then, CTRA was performed, and the results were provided to the physicians, who were asked to reassess their treatment plan. The pre-and post-CTRA treatment plans were compared to identify cases in which the treatment plan was changed based on the CTRA report. Patients were followed for a 4-month period to establish the incidence of pathologic fractures. Results: Pain, lesion type, and lesion size were significant predictors of the pre-CTRA plan. After providing the CTRA results, physicians changed their plan for 36 patients. CTRA results, pain, and primary source of metastasis were significant predictors of the post-CTRA plan. Follow-up of patients who did not undergo fixation resulted in 7 fractures; CTRA predicted these fractures with 100% sensitivity and 90% specificity, whereas the Mirels method was 71% sensitive and 50% specific. Conclusions: Lesion type and size and pain level influenced the physicians' plans for the management of metastatic lesions. Physicians' treatment plans and fracture risk predictions were significantly influenced by the availability of CTRA results. Due to its high sensitivity and specificity, CTRA could potentially be used as a screening method for pathologic fractures.

Original languageEnglish (US)
Pages (from-to)2514-2519
Number of pages6
JournalClinical Cancer Research
Volume21
Issue number11
DOIs
StatePublished - Jun 1 2015

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Neoplasm Metastasis
Spontaneous Fractures
Physicians
Pain
Therapeutics
Sensitivity and Specificity
Multicenter Studies
Orthopedics
Research Design
Prospective Studies
Incidence

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Nazarian, A., Entezari, V., Zurakowski, D., Calderon, N., Hipp, J. A., Villa-Camacho, J. C., ... Snyder, B. D. (2015). Treatment planning and fracture prediction in patients with skeletal metastasis with CT-Based rigidity analysis. Clinical Cancer Research, 21(11), 2514-2519. https://doi.org/10.1158/1078-0432.CCR-14-2668

Treatment planning and fracture prediction in patients with skeletal metastasis with CT-Based rigidity analysis. / Nazarian, Ara; Entezari, Vahid; Zurakowski, David; Calderon, Nathan; Hipp, John A.; Villa-Camacho, Juan C.; Lin, Patrick P.; Cheung, Felix H.; Aboulafia, Albert J.; Turcotte, Robert; Anderson, Megan E.; Gebhardt, Mark C.; Cheng, Edward Y.; Terek, Richard M.; Yaszemski, Michael J; Damron, Timothy A.; Snyder, Brian D.

In: Clinical Cancer Research, Vol. 21, No. 11, 01.06.2015, p. 2514-2519.

Research output: Contribution to journalArticle

Nazarian, A, Entezari, V, Zurakowski, D, Calderon, N, Hipp, JA, Villa-Camacho, JC, Lin, PP, Cheung, FH, Aboulafia, AJ, Turcotte, R, Anderson, ME, Gebhardt, MC, Cheng, EY, Terek, RM, Yaszemski, MJ, Damron, TA & Snyder, BD 2015, 'Treatment planning and fracture prediction in patients with skeletal metastasis with CT-Based rigidity analysis', Clinical Cancer Research, vol. 21, no. 11, pp. 2514-2519. https://doi.org/10.1158/1078-0432.CCR-14-2668
Nazarian, Ara ; Entezari, Vahid ; Zurakowski, David ; Calderon, Nathan ; Hipp, John A. ; Villa-Camacho, Juan C. ; Lin, Patrick P. ; Cheung, Felix H. ; Aboulafia, Albert J. ; Turcotte, Robert ; Anderson, Megan E. ; Gebhardt, Mark C. ; Cheng, Edward Y. ; Terek, Richard M. ; Yaszemski, Michael J ; Damron, Timothy A. ; Snyder, Brian D. / Treatment planning and fracture prediction in patients with skeletal metastasis with CT-Based rigidity analysis. In: Clinical Cancer Research. 2015 ; Vol. 21, No. 11. pp. 2514-2519.
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abstract = "Purpose: Pathologic fractures could be prevented if reliable methods of fracture risk assessment were available. A multicenter prospective study was conducted to identify significant predictors of physicians' treatment plan for skeletal metastasis based on clinical fracture risk assessments and the proposed CT-based Rigidity Analysis (CTRA). Experimental Design: Orthopedic oncologists selected a treatment plan for 124 patients with 149 metastatic lesions based on the Mirels method. Then, CTRA was performed, and the results were provided to the physicians, who were asked to reassess their treatment plan. The pre-and post-CTRA treatment plans were compared to identify cases in which the treatment plan was changed based on the CTRA report. Patients were followed for a 4-month period to establish the incidence of pathologic fractures. Results: Pain, lesion type, and lesion size were significant predictors of the pre-CTRA plan. After providing the CTRA results, physicians changed their plan for 36 patients. CTRA results, pain, and primary source of metastasis were significant predictors of the post-CTRA plan. Follow-up of patients who did not undergo fixation resulted in 7 fractures; CTRA predicted these fractures with 100{\%} sensitivity and 90{\%} specificity, whereas the Mirels method was 71{\%} sensitive and 50{\%} specific. Conclusions: Lesion type and size and pain level influenced the physicians' plans for the management of metastatic lesions. Physicians' treatment plans and fracture risk predictions were significantly influenced by the availability of CTRA results. Due to its high sensitivity and specificity, CTRA could potentially be used as a screening method for pathologic fractures.",
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T1 - Treatment planning and fracture prediction in patients with skeletal metastasis with CT-Based rigidity analysis

AU - Nazarian, Ara

AU - Entezari, Vahid

AU - Zurakowski, David

AU - Calderon, Nathan

AU - Hipp, John A.

AU - Villa-Camacho, Juan C.

AU - Lin, Patrick P.

AU - Cheung, Felix H.

AU - Aboulafia, Albert J.

AU - Turcotte, Robert

AU - Anderson, Megan E.

AU - Gebhardt, Mark C.

AU - Cheng, Edward Y.

AU - Terek, Richard M.

AU - Yaszemski, Michael J

AU - Damron, Timothy A.

AU - Snyder, Brian D.

PY - 2015/6/1

Y1 - 2015/6/1

N2 - Purpose: Pathologic fractures could be prevented if reliable methods of fracture risk assessment were available. A multicenter prospective study was conducted to identify significant predictors of physicians' treatment plan for skeletal metastasis based on clinical fracture risk assessments and the proposed CT-based Rigidity Analysis (CTRA). Experimental Design: Orthopedic oncologists selected a treatment plan for 124 patients with 149 metastatic lesions based on the Mirels method. Then, CTRA was performed, and the results were provided to the physicians, who were asked to reassess their treatment plan. The pre-and post-CTRA treatment plans were compared to identify cases in which the treatment plan was changed based on the CTRA report. Patients were followed for a 4-month period to establish the incidence of pathologic fractures. Results: Pain, lesion type, and lesion size were significant predictors of the pre-CTRA plan. After providing the CTRA results, physicians changed their plan for 36 patients. CTRA results, pain, and primary source of metastasis were significant predictors of the post-CTRA plan. Follow-up of patients who did not undergo fixation resulted in 7 fractures; CTRA predicted these fractures with 100% sensitivity and 90% specificity, whereas the Mirels method was 71% sensitive and 50% specific. Conclusions: Lesion type and size and pain level influenced the physicians' plans for the management of metastatic lesions. Physicians' treatment plans and fracture risk predictions were significantly influenced by the availability of CTRA results. Due to its high sensitivity and specificity, CTRA could potentially be used as a screening method for pathologic fractures.

AB - Purpose: Pathologic fractures could be prevented if reliable methods of fracture risk assessment were available. A multicenter prospective study was conducted to identify significant predictors of physicians' treatment plan for skeletal metastasis based on clinical fracture risk assessments and the proposed CT-based Rigidity Analysis (CTRA). Experimental Design: Orthopedic oncologists selected a treatment plan for 124 patients with 149 metastatic lesions based on the Mirels method. Then, CTRA was performed, and the results were provided to the physicians, who were asked to reassess their treatment plan. The pre-and post-CTRA treatment plans were compared to identify cases in which the treatment plan was changed based on the CTRA report. Patients were followed for a 4-month period to establish the incidence of pathologic fractures. Results: Pain, lesion type, and lesion size were significant predictors of the pre-CTRA plan. After providing the CTRA results, physicians changed their plan for 36 patients. CTRA results, pain, and primary source of metastasis were significant predictors of the post-CTRA plan. Follow-up of patients who did not undergo fixation resulted in 7 fractures; CTRA predicted these fractures with 100% sensitivity and 90% specificity, whereas the Mirels method was 71% sensitive and 50% specific. Conclusions: Lesion type and size and pain level influenced the physicians' plans for the management of metastatic lesions. Physicians' treatment plans and fracture risk predictions were significantly influenced by the availability of CTRA results. Due to its high sensitivity and specificity, CTRA could potentially be used as a screening method for pathologic fractures.

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