1
|
Chanbour H, Chen JW, Bendfeldt GA, Gangavarapu LS, Ahmed M, Chotai S, Luo LY, Berkman RA, Abtahi AM, Stephens BF, Zuckerman SL. Earlier Radiation Is Associated with Improved 1-Year Survival After Metastatic Spine Tumor Surgery. World Neurosurg 2024; 187:e509-e516. [PMID: 38677650 DOI: 10.1016/j.wneu.2024.04.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/18/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVE In patients undergoing metastatic spine surgery, we sought to 1) report time to postoperative radiation therapy (RT), 2) describe the predictive factors of time to postoperative RT, and 3) determine if earlier postoperative RT is associated with improved local recurrence (LR) and overall survival (OS). METHODS A single-center retrospective cohort study was undertaken of all patients undergoing spine surgery for extradural metastatic disease and receiving RT within 3 months postoperatively between January 2010 and January 2021. Time to postoperative RT was dichotomized at <1 month versus 1-3 months. The primary outcomes were LR, OS, and 1-year survival. Secondary outcomes were wound complication, Karnofsky Performance Status, and modified McCormick Scale (MMS) score. Regression analyses controlled for age, body mass index, tumor size, preoperative RT, preoperative/postoperative chemotherapy, and type of RT. RESULTS Of 76 patients undergoing spinal metastasis surgery and receiving postoperative RT within 3 months, 34 (44.7%) received RT within 1 month and 42 (55.2%) within 1-3 months. Patients with larger tumor size (β = -3.58; 95% confidence interval [CI], -6.59 to -0.57; P = 0.021) or new neurologic deficits (β = -16.21; 95% CI, -32.21 to -0.210; P = 0.047) had a shorter time to RT. No significant association was found between time to RT and LR or OS on multivariable logistic/Cox regression. However, patients who received RT between 1 and 3 months had a lower odds of 1-year survival compared with those receiving RT within 1 month (odds ratio, 0.18; 95% CI, 0.04-0.74; P = 0.022). Receiving RT within 1 month versus 1-3 months was not associated with wound complications (7.1% vs. 2.9%; P = 0.556) (odds ratio, 4.40; 95% CI, 0.40-118.0; P = 0.266) or Karnofsky Performance Status/modified McCormick Scale score. CONCLUSIONS Spine surgeons, oncologists, and radiation oncologists should make every effort to start RT within 1 month to improve 1-year survival after metastatic spine tumor surgery.
Collapse
Affiliation(s)
- Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeffrey W Chen
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | | | | | - Mahmoud Ahmed
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Silky Chotai
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Leo Y Luo
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Richard A Berkman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amir M Abtahi
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Byron F Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| |
Collapse
|
2
|
Krauss P, Wolfert CL, Sommer B, Stemmer B, Stueben G, Kahl KH, Shiban E. Intraoperative radiotherapy combined with spinal stabilization surgery-a novel treatment strategy for spinal metastases based on a first single-center experiences. J Neurooncol 2024; 168:445-455. [PMID: 38652400 PMCID: PMC11186943 DOI: 10.1007/s11060-024-04688-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/17/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Current treatment of spinal metastases (SM) aims on preserving spinal stability, neurological status, and functional status as well as achieving local control. It consists of spinal surgery followed by radiotherapy and/or systemic treatment. Adjuvant therapy usually starts with a delay of a few weeks to prevent wound healing issues. Intraoperative radiotherapy (IORT) has previously been successfully applied during brain tumor, breast and colorectal carcinoma surgery but not in SM, including unstable one, to date. In our case series, we describe the feasibility, morbidity and mortality of a novel treatment protocol for SM combining stabilization surgery with IORT. METHODS Single center case series on patients with SM. Single session stabilization by navigated open or percutaneous procedure using a carbon screw-rod system followed by concurrent 50 kV photon-IORT (ZEISS Intrabeam). The IORT probe is placed via a guide canula using navigation, positioning is controlled by IOCT or 3D-fluroscopy enabling RT isodose planning in the OR. RESULTS 15 (8 female) patients (71 ± 10y) received this treatment between 07/22 and 09/23. Median Spinal Neoplastic Instability Score was 8 [7-10] IQR. Most metastasis were located in the thoracic (n = 11, 73.3%) and the rest in the lumbar (n = 4, 26.7%) spine. 9 (60%) patients received open, 5 (33%) percutaneous stabilization and 1 (7%) decompression only. Mean length of surgery was 157 ± 45 min. Eleven patients had 8 and 3 had 4 screws placed. In 2 patients radiotherapy was not completed due to bending of the guide canula with consecutive abortion of IORT. All other patients received 8 Gy isodoses at mdn. 1.5 cm [1.1-1.9, IQR] depth during 2-6 min. The patients had Epidural Spinal Cord Compression score 1a-3. Seven patients (46.7%) experienced adverse events including 2 surgical site infection (one 65 days after surgery). CONCLUSION 50 kV photon IORT for SM and consecutive unstable spine needing surgical intervention is safe and feasible and can be a promising technique in selected cases.
Collapse
Affiliation(s)
- P Krauss
- Department of Neurosurgery, University Hospital Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany.
| | - C L Wolfert
- Department of Neurosurgery, University Hospital Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - B Sommer
- Department of Neurosurgery, University Hospital Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - B Stemmer
- Department of Neurosurgery, University Hospital Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - G Stueben
- Department of Radio Oncology, University Hospital Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - K H Kahl
- Department of Radio Oncology, University Hospital Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - E Shiban
- Department of Neurosurgery, University Hospital Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| |
Collapse
|
3
|
González-Kusjanovic N, Delgado Ochoa B, Vidal C, Campos M. Post-operative complications affect survival in surgically treated metastatic spinal cord compression. INTERNATIONAL ORTHOPAEDICS 2024; 48:1341-1350. [PMID: 38472466 DOI: 10.1007/s00264-024-06120-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 01/13/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE The prevalence of metastatic epidural spinal cord compression (MESCC) is increasing globally due to advancements in cancer diagnosis and treatment. Whilst surgery can benefit specific patients, the complication rate can reach up to 34%, with limited reporting on their impact in the literature. This study aims to analyse the influence of major complications on the survival of surgically treated MESCC patients. METHODS Consecutive MESCC patients undergoing surgery and meeting inclusion criteria were selected. Survival duration from decompressive surgery to death was recorded. Perioperative factors influencing survival were documented and analysed. Kaplan-Meier survival analysis at one year compared these factors. Univariate and multivariate Cox proportional hazard regression analyses were performed. Additionally, univariate analysis compared complicated and uncomplicated groups. RESULTS Seventy-five patients were analysed. Median survival for this cohort was 229 days (95% CI 174-365). Surgical complications, low patient performance, and rapid primary tumour growth were significant perioperative variables for survival in multivariate analyses (p < 0.001, p = 0.003, and p = 0.02, respectively) with a hazard ratio of 3.2, 3.6, and 2.1, respectively. Univariate analysis showed no variables associated with complication occurrence. CONCLUSION In this cohort, major surgical complications, patient performance, and primary tumour growth rate were found to be independent factors affecting one year survival. Thus, prioritizing complication prevention and appropriate patient selection is crucial for optimizing survival in this population.
Collapse
Affiliation(s)
- Nicolás González-Kusjanovic
- Orthopaedic Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, Santiago, Chile
| | - Byron Delgado Ochoa
- Orthopaedic Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, Santiago, Chile
| | - Catalina Vidal
- Orthopaedic Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, Santiago, Chile
| | - Mauricio Campos
- Orthopaedic Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, Santiago, Chile.
| |
Collapse
|
4
|
Patel PP, Cao Y, Chen X, LeCompte MC, Kleinberg L, Khan M, McNutt T, Bydon A, Kebaish K, Theodore N, Larry Lo SF, Lee SH, Lubelski D, Redmond KJ. Oncologic and Functional Outcomes After Stereotactic Body Radiation Therapy for High-Grade Malignant Spinal Cord Compression. Adv Radiat Oncol 2024; 9:101327. [PMID: 38260225 PMCID: PMC10801652 DOI: 10.1016/j.adro.2023.101327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 07/21/2023] [Indexed: 01/24/2024] Open
Abstract
Purpose Although surgical decompression is the gold standard for metastatic epidural spinal cord compression (MESCC) from solid tumors, not all patients are candidates or undergo successful surgical Bilsky downgrading. We report oncologic and functional outcomes for patients treated with stereotactic body radiation therapy (SBRT) to high-grade MESCC. Methods and Materials Patients with Bilsky grade 2 to 3 MESCC from solid tumor metastases treated with SBRT at a single institution from 2009 to 2020 were retrospectively reviewed. Patients who received upfront surgery before SBRT were included only if postsurgical Bilsky grade remained ≥2. Neurologic examinations, magnetic resonance imaging, pain assessments, and analgesic usage were assessed every 3 to 4 months post-SBRT. Cumulative incidence of local recurrence was calculated with death as a competing risk, and overall survival was estimated by Kaplan-Meier. Results One hundred forty-three patients were included. The cumulative incidence of local recurrence was 5.1%, 7.5%, and 14.1% at 6, 12, and 24 months, respectively. At first post-SBRT imaging, 16.2% of patients with initial Bilsky grade 2 improved to grade 1, and 53.8% of patients were stable. Five of 13 patients (38.4%) with initial Bilsky grade 3 improved to grade 1 to 2. Pain response at 3 and 6 months post-SBRT was complete in 45.4% and 55.7%, partial in 26.9% and 13.1%, stable in 24.1% and 27.9%, and worse in 3.7% and 3.3% of patients, respectively. At 3 and 6 months after SBRT, 17.8% and 25.0% of patients had improved ambulatory status and 79.7% and 72.4% had stable status. Conclusions We report the largest series to date of patients with high-grade MESCC treated with SBRT. The excellent local control and functional outcomes suggest SBRT is a reasonable approach in inoperable patients or cases unable to be successfully surgically downgraded.
Collapse
Affiliation(s)
- Palak P. Patel
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Yilin Cao
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Xuguang Chen
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Michael C. LeCompte
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lawrence Kleinberg
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Majid Khan
- Department of Radiology, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania
| | - Todd McNutt
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Khaled Kebaish
- Orthopedic Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Sheng-fu Larry Lo
- Department of Neurosurgery, Zucker School of Medicine at Hoftstra, Manhasset, New York
| | - Sang H. Lee
- Orthopedic Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Kristin J. Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| |
Collapse
|
5
|
Joerger AK, Laho X, Kehl V, Meyer B, Krieg SM, Ille S. The impact of intraoperative MRI on cranial surgical site infections-a single-center analysis. Acta Neurochir (Wien) 2023; 165:3593-3599. [PMID: 37971620 PMCID: PMC10739228 DOI: 10.1007/s00701-023-05870-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/14/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE The use of intraoperative MRI (ioMRI) contributes to an improved extent of resection. Hybrid operating room MRI suites have been established, with the patient being transferred to the MRI scanner. In the present descriptive analysis, we compared the rate of surgical site infections (SSI) after intracranial tumor surgery with and without the use of ioMRI. METHODS In this retrospective study, we included 446 patients with open craniotomy performed for brain tumor surgery. One hundred fourteen patients were operated on with the use of ioMRI between June 1, 2018, and June 30, 2019 (group 1). During the same period, 126 patients were operated on without ioMRI (group 2). As an additional control group, we analyzed 206 patients operated on from February 1, 2017, to February 28, 2018 when ioMRI had not yet been implemented (group 3). RESULTS The rate of SSI in group 1 (11.4%), group 2 (9.5%), and group 3 (6.8%) did not differ significantly (p = 0.352). Additional resection after ioMRI did not result in a significantly elevated number of SSI. No significant influence of re-resection, prior radio-/chemotherapy, blood loss or duration of surgery was found on the incidence of SSI. CONCLUSION Despite the transfer to a non-sterile MRI scanner, leading to a prolonged operation time, SSI rates with and without the use of ioMRI did not differ significantly. Hence, advantages of ioMRI outweigh potential disadvantages as confirmed by this real-life single-center study.
Collapse
Affiliation(s)
- Ann-Kathrin Joerger
- Department of Neurosurgery, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany
| | - Xhimi Laho
- Department of Neurosurgery, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany
| | - Victoria Kehl
- Institute for AI and Informatics in Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany
| | - Sandro M Krieg
- Department of Neurosurgery, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Sebastian Ille
- Department of Neurosurgery, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany
| |
Collapse
|
6
|
Lee HD, Jang HD, Park JS, Chung NS, Chung HW, Jun JY, Han K, Hong JY. Incidence and Risk Factors for Wound Revision after Surgical Treatment of Spinal Metastasis: A National Population-Based Study in South Korea. Healthcare (Basel) 2023; 11:2962. [PMID: 37998455 PMCID: PMC10671392 DOI: 10.3390/healthcare11222962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023] Open
Abstract
Wound complications are commonly seen after surgeries for metastatic spine tumors. While numerous studies have pinpointed various risk factors, there is ongoing debate. Therefore, this study aimed to verify various factors that are still under debate utilizing the comprehensive Korean National Health Insurance Service database. We identified and retrospectively reviewed a cohort of 3001 patients who underwent one of five surgical treatments (corpectomy, decompression and instrumentation, instrumentation only, decompression only, and vertebroplasty) for newly diagnosed spinal metastasis between 2009 and 2017. A Cox regression analysis was performed to determine the risk factors. A total of 197 cases (6.6%) of wound revision were found. Only the surgical method and Charlson comorbidity index were significantly different between the group that underwent wound revision and the group that did not. Regarding surgical methods, the adjusted hazard ratios for decompression only, corpectomy, instrumentation and decompression, and instrumentation only were 1.3, 2.2, 2.2, and 2.4, with these ratios being compared to the vertebroplasty group (p for trend = 0.02). In this regard, based on a sizable South Korean cohort, both surgical methods and medical comorbidity were found to be associated with the wound revision rate among spinal surgery patients for spinal metastasis.
Collapse
Affiliation(s)
- Han-Dong Lee
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon 16499, Republic of Korea; (H.-D.L.); (N.-S.C.); (H.-W.C.); (J.-Y.J.)
| | - Hae-Dong Jang
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Republic of Korea;
| | - Jin-Sung Park
- Department of Orthopedic Surgery, Spine Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea;
| | - Nam-Su Chung
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon 16499, Republic of Korea; (H.-D.L.); (N.-S.C.); (H.-W.C.); (J.-Y.J.)
| | - Hee-Woong Chung
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon 16499, Republic of Korea; (H.-D.L.); (N.-S.C.); (H.-W.C.); (J.-Y.J.)
| | - Jin-Young Jun
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon 16499, Republic of Korea; (H.-D.L.); (N.-S.C.); (H.-W.C.); (J.-Y.J.)
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, Republic of Korea;
| | - Jae-Young Hong
- Department of Orthopedics, Korea University Hospital, Ansan 15355, Republic of Korea
| |
Collapse
|
7
|
Huele EH, van der Velden JM, Kasperts N, Eppinga WSC, Grutters JPC, Suelmann BBM, Weening AA, Delawi D, Teunissen SCCM, Verkooijen HM, Verlaan JJ, Gal R. Stereotactic Body radiotherapy and pedicLE screw fixatioN During one hospital visit for patients with symptomatic unstable spinal metastases: a randomized trial (BLEND RCT) using the Trials within Cohorts (TwiCs) design. Trials 2023; 24:307. [PMID: 37143158 PMCID: PMC10157966 DOI: 10.1186/s13063-023-07315-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/17/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Spinal metastases can lead to unremitting pain and neurological deficits, which substantially impair daily functioning and quality of life. Patients with unstable spinal metastases receive surgical stabilization followed by palliative radiotherapy as soon as wound healing allows. The time between surgery and radiotherapy delays improvement of mobility, radiotherapy-induced pain relief, local tumor control, and restart of systemic oncological therapy. Stereotactic body radiotherapy (SBRT) enables delivery of preoperative high-dose radiotherapy while dose-sparing the surgical field, allowing stabilizing surgery within only hours. Patients may experience earlier recovery of mobility, regression of pain, and return to systemic oncological therapy. The BLEND RCT evaluates the effectiveness of SBRT followed by surgery within 24 h for the treatment of symptomatic, unstable spinal metastases. METHODS This phase III randomized controlled trial is embedded within the PRospective Evaluation of interventional StudiEs on boNe meTastases (PRESENT) cohort. Patients with symptomatic, unstable spinal metastases requiring stabilizing surgery and radiotherapy will be randomized (1:1). The intervention group (n = 50) will be offered same-day SBRT and surgery, which they can accept or refuse. According to the Trial within Cohorts (TwiCs) design, the control group (n = 50) will not be informed and receive standard treatment (surgery followed by conventional radiotherapy after 1-2 weeks when wound healing allows). Baseline characteristics and outcome measures will be captured within PRESENT. The primary outcome is physical functioning (EORTC-QLQ-C15-PAL) 4 weeks after start of treatment. Secondary endpoints include pain response, time until return to systemic oncological therapy, quality of life, local tumor control, and adverse events up to 3 months post-treatment. DISCUSSION The BLEND RCT evaluates the effect of same-day SBRT and stabilizing surgery for the treatment of symptomatic, unstable spinal metastases compared with standard of care. We expect better functional outcomes, faster pain relief, and continuation of systemic oncological therapy. The TwiCs design enables efficient recruitment within an ongoing cohort, as well as prevention of disappointment bias and drop-out as control patients will not be informed about the trial. TRIAL REGISTRATION ClinicalTrials.gov NCT05575323. Registered on October 11, 2022.
Collapse
Affiliation(s)
- E H Huele
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - J M van der Velden
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - N Kasperts
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - W S C Eppinga
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J P C Grutters
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - B B M Suelmann
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - A A Weening
- Department of Orthopedic Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - D Delawi
- Department of Orthopedic Surgery, St. Antoniusziekenhuis, Nieuwegein, The Netherlands
| | - S C C M Teunissen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - H M Verkooijen
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - J J Verlaan
- Department of Orthopedic Surgery, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - R Gal
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| |
Collapse
|
8
|
Lee CC, Tey J, Cheo T, Lee CH, Wong A, Kumar N, Vellayappan B. Outcomes of Patients With Spinal Metastases From Prostate Cancer Treated With Conventionally-Fractionated External Beam Radiation Therapy. Global Spine J 2023; 13:284-294. [PMID: 33648366 PMCID: PMC9972278 DOI: 10.1177/2192568221994798] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To evaluate the outcomes of conventionally-fractionated external beam radiation therapy (cEBRT) in the treatment of prostate cancer spinal metastases (PCSM). METHODS Patients who received palliative cEBRT for PCSM in our institution between 2008 and 2018 were included. Our outcomes were local progression-free survival (LPFS), overall survival (OS), pain response and toxicities graded using CTCAE version 4.03. Univariable and multivariable Cox proportional hazard regressions were performed to identify predictors for LPFS and OS. RESULTS A total of 100 patients with 132 sites of PCSM were identified, with a median follow-up of 54 months. Fourteen-percent of patients underwent surgical intervention before receiving cEBRT. Eighteen spinal segments (13.6%) had local progression, with a median time to local progression of 8 months. The median LPFS and OS were 7.8 and 9.0 months, respectively. The complete and partial pain response rates were 57% and 39% respectively. The incidence of grade ≥3 acute toxicities was 11%. Better ECOG performance status (0 to 1), castration-sensitive disease, spinal surgery and use of novel antiandrogen agent were identified as significant predictors for improved OS on multivariable analysis. CONCLUSIONS In our prostate cancer cohort, cEBRT is an effective treatment modality for local palliation of spinal metastases. More aggressive treatment approach should be considered for patients with excellent performance status and castration-sensitive disease in light of their expected longer survival. Further studies are warranted to identify the predictors for radiotherapy response in this population.
Collapse
Affiliation(s)
- Chia Ching Lee
- Department of Radiation Oncology,
National University Cancer Institute, National University Hospital, National
University Health System, National University of Singapore, Singapore,
Singapore
| | - Jeremy Tey
- Department of Radiation Oncology,
National University Cancer Institute, National University Hospital, National
University Health System, National University of Singapore, Singapore,
Singapore
| | - Timothy Cheo
- Department of Radiation Oncology,
National University Cancer Institute, National University Hospital, National
University Health System, National University of Singapore, Singapore,
Singapore
| | - Chau Hung Lee
- Department of Radiology, Tan Tock Seng
Hospital, Singapore, Singapore
| | - Alvin Wong
- Department of Haematology-Oncology,
National University Cancer Institute, National University Hospital, Singapore
| | - Naresh Kumar
- Department of Orthopaedic Surgery,
National University Hospital, National University Health System, National University
of Singapore, Singapore
| | - Balamurugan Vellayappan
- Department of Radiation Oncology,
National University Cancer Institute, National University Hospital, National
University Health System, National University of Singapore, Singapore,
Singapore
- Balamurugan Vellayappan, Department of
Radiation Oncology, National University Cancer Institute, National University
Hospital, National University Health System, National University of Singapore,
1E Kent Ridge Road, NUHS Tower Block, Level 7, 119228 Singapore, Singapore.
| |
Collapse
|
9
|
Maciejczak A, Gasik R, Kotrych D, Rutkowski P, Antoniak K, Derenda M, Dobiecki K, Górski R, Grzelak L, Guzik G, Harat M, Janusz W, Jarmużek P, Łątka D, Maciejczyk A, Mandat T, Potaczek T, Rocławski M, Trembecki Ł, Załuski R. Spinal tumours: recommendations of the Polish Society of Spine Surgery, the Polish Society of Oncology, the Polish Society of Neurosurgeons, the Polish Society of Oncologic Surgery, the Polish Society of Oncologic Radiotherapy, and the Polish Society of Orthopaedics and Traumatology. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:1300-1325. [PMID: 36854861 DOI: 10.1007/s00586-023-07546-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/31/2022] [Accepted: 01/13/2023] [Indexed: 03/02/2023]
Abstract
PURPOSE The purpose of these recommendations is to spread the available evidence for evaluating and managing spinal tumours among clinicians who encounter such entities. METHODS The recommendations were developed by members of the Development Recommendations Group representing seven stakeholder scientific societies and organizations of specialists involved in various forms of care for patients with spinal tumours in Poland. The recommendations are based on data yielded from systematic reviews of the literature identified through electronic database searches. The strength of the recommendations was graded according to the North American Spine Society's grades of recommendation for summaries or reviews of studies. RESULTS The recommendation group developed 89 level A-C recommendations and a supplementary list of institutions able to manage primary malignant spinal tumours, namely, spinal sarcomas, at the expert level. This list, further called an appendix, helps clinicians who encounter spinal tumours refer patients with suspected spinal sarcoma or chordoma for pathological diagnosis, surgery and radiosurgery. The list constitutes a basis of the network of expertise for the management of primary malignant spinal tumours and should be understood as a communication network of specialists involved in the care of primary spinal malignancies. CONCLUSION The developed recommendations together with the national network of expertise should optimize the management of patients with spinal tumours, especially rare malignancies, and optimize their referral and allocation within the Polish national health service system.
Collapse
Affiliation(s)
- A Maciejczak
- Department of Neurosurgery, Szpital Wojewódzki Tarnów, University of Rzeszów, Rzeszów, Poland.
| | - R Gasik
- Department of Neuroorthopedics and Neurology, National Geriatrics, Rheumatology and Rehabilitation Institute, Warsaw, Poland
| | - D Kotrych
- Department of Orthopedics, Traumatology and Musculoskeletal Oncology, Pomeranian Medical University, Szczecin, Poland
| | - P Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - K Antoniak
- Department of Orthopedics, Traumatology and Musculoskeletal Oncology, Pomeranian Medical University, Szczecin, Poland
| | - M Derenda
- Department of Neurosurgery, University of Warmia and Mazury, Olsztyn, Poland
| | - K Dobiecki
- Department of Orthopedics, Traumatology and Musculoskeletal Oncology, Pomeranian Medical University, Szczecin, Poland
| | - R Górski
- Department of Neurosurgery and Spine Surgery, John Paul II Western Hospital, Grodzisk Mazowiecki, Poland
| | - L Grzelak
- Department of Neurosurgery, City Hospital, Toruń, Poland
| | - G Guzik
- Department of Oncologic Orthopedics, Sub-Carpathian Oncology Center, Brzozów, Poland
| | - M Harat
- Department of Oncology and Brachytherapy, Oncology Center Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - W Janusz
- Department of Orthopedics and Traumatology, Medical University of Lublin, Lublin, Poland
| | - P Jarmużek
- Department of Neurosurgery, University of Zielona Góra, Zielona Góra, Poland
| | - D Łątka
- Department of Neurosurgery, University of Opole, Opole, Poland
| | - A Maciejczyk
- Department of Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - T Mandat
- Department of Nervous System Neoplasms, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - T Potaczek
- Department of Orthopedics and Rehabilitation, University Hospital Zakopane, Jagiellonian University, Kraków, Poland
| | - M Rocławski
- Department of Orthopaedics, Medical University of Gdansk, Gdańsk, Poland
| | - Ł Trembecki
- Department of Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - R Załuski
- Department of Neurosurgery, Wroclaw Medical University, Wroclaw, Poland
| |
Collapse
|
10
|
Ferini *G, Palmisciano P, Scalia G, Haider AS, Bin-Alamer O, Sagoo NS, Bozkurt I, Deora H, Priola SM, Aoun SG, Umana GE. The role of radiation therapy in the treatment of spine metastases from hepatocellular carcinoma: a systematic review and meta-analysis. Neurosurg Focus 2022; 53:E12. [DOI: 10.3171/2022.8.focus2255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE
Spine hepatocellular carcinoma (HCC) metastases severely worsen quality of life and prognosis, with the role of radiotherapy being controversial. The authors systematically reviewed the literature on radiotherapy for spine metastatic HCCs.
METHODS
The PubMed, Scopus, Web of Science, and Cochrane databases were searched according to the PRISMA guidelines to include studies of radiotherapy for spine metastatic HCCs. Outcomes, complications, and local control were analyzed with indirect random-effect meta-analyses.
RESULTS
The authors included 12 studies comprising 713 patients. The median time interval from diagnosis of HCC to spine metastases was 12 months (range 0–105 months). Most lesions were thoracic (35.9%) or lumbar (24.7%). Radiotherapy was delivered with conventional external-beam (67.3%) or stereotactic (31.7%) techniques. The median dose was 30.3 Gy (range 12.5–52 Gy) in a median of 5 fractions (range 1–20 fractions). The median biologically effective dose was 44.8 Gy10 (range 14.4–112.5 Gy10). Actuarial rates of postradiotherapy pain relief and radiological response were 87% (95% CI 84%–90%) and 70% (95% CI 65%–75%), respectively. Radiation-related adverse events and vertebral fractures had actuarial rates of 8% (95% CI 5%–11%) and 16% (95% CI 10%–23%), respectively, with fracture rates significantly higher after stereotactic radiotherapy (p = 0.033). Fifty-eight patients (27.6%) had local recurrences after a median of 6.8 months (range 0.1–59 months), with pooled local control rates of 61.6% at 6 months and 40.8% at 12 months, and there were no significant differences based on radiotherapy type (p = 0.068). The median survival was 6 months (range 0.1–62 months), with pooled rates of 52.5% at 6 months and 23.4% at 12 months.
CONCLUSIONS
Radiotherapy in spine metastatic HCCs shows favorable rates of pain relief, radiological responses, and local control. Rates of postradiotherapy vertebral fractures are higher after high-dose stereotactic radiotherapy.
Collapse
Affiliation(s)
- *Gianluca Ferini
- Department of Radiation Oncology, REM Radioterapia srl, Viagrande, Catania, Italy
| | | | - Gianluca Scalia
- Department of Neurosurgery, Highly Specialized Hospital of National Importance "Garibaldi," Catania, Italy
| | - Ali S Haider
- Texas A&M University College of Medicine, Houston, Texas
| | - Othman Bin-Alamer
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Navraj S Sagoo
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ismail Bozkurt
- Department of Neurosurgery, Cankiri State Hospital, Cankiri, Turkey
| | - Harsh Deora
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Stefano M Priola
- Division of Neurosurgery, Health Sciences North, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Salah G Aoun
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas; and
| | - Giuseppe E Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| |
Collapse
|
11
|
Diabira S, Akhaddar A, Lebhar J, Breitel D, Bacon P, Blamoutier A. Metastasi spinali degli adulti. Neurologia 2022. [DOI: 10.1016/s1634-7072(22)46431-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
12
|
Jarvers JS, Lange M, Schiemann S, Pfränger J, Heyde CE, Osterhoff G. Risk factors for wound-related complications after surgical stabilization of spinal metastases with a special focus on the effect of postoperative radiation therapy. BMC Surg 2021; 21:423. [PMID: 34920720 PMCID: PMC8684154 DOI: 10.1186/s12893-021-01431-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 12/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Advancements in the field of oncological therapies during the last decades have led to a significantly prolonged survival of cancer patients. This has led to an increase in the incidence of spinal metastases. The purpose of this study was to assess risk factors for wound-related complications after surgical stabilization of spinal metastases with a special focus on the effect of postoperative RT and its timing. METHODS Patients who had been treated for metastatic spine disease by surgical stabilization followed by radiotherapy between 01/2012 and 03/2019 were included and a retrospective chart review was performed. RESULTS Of 604 patients who underwent stabilizing surgery for spinal metastases, 237 patients (mean age 66 years, SD 11) with a mean follow-up of 11 months (SD 7) were eligible for further analysis. Forty-one patients (17.3%) had wound-related complications, 32 of them before and 9 after beginning of the RT. Revision surgery was necessary in 26 patients (11.0%). Body weight (p = 0.021), obesity (p = 0.018), ASA > 2 (p = 0.001), and start of radiation therapy within 21 days after surgery (p = 0.047) were associated with an increased risk for wound complications. Patients with chemotherapy within 3 weeks of surgery (12%) were more likely to have a wound-related surgical revision (p = 0.031). CONCLUSION Body weight, obesity and ASA > 2 were associated with an increased risk for wound complications. Patients with chemotherapy within 3 weeks of the surgery were more likely to have a wound-related revision surgery. Patients who had begun radiation therapy within 21 days after surgery were more likely to have a wound complication compared to patients who waited longer.
Collapse
Affiliation(s)
- Jan-Sven Jarvers
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Maximilian Lange
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Samuel Schiemann
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Jan Pfränger
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Christoph-Eckhard Heyde
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Georg Osterhoff
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103, Leipzig, Germany.
| |
Collapse
|
13
|
Madhu S, Thomas AC, Tang SS, Shen L, Ramakrishnan SA, Kumar N. Analysis of Short-Term versus Long-Term Readmission-Free Survival After Metastatic Spine Tumor Surgery. World Neurosurg 2021; 158:e946-e955. [PMID: 34863936 DOI: 10.1016/j.wneu.2021.11.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/25/2021] [Accepted: 11/26/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Readmission-free survival (ReAFS) is a novel clinical and quality metric after metastatic spine tumor surgery (MSTS). We believe that factors influencing ReAFS after index MSTS vary based on time. We considered 2 time frames and defined short-term ReAFS as survival without an unplanned hospital readmission up to 90 days and long-term ReAFS as survival without unplanned hospital readmission up to 1 year after MSTS. METHODS We retrospectively analyzed 266 patients who underwent MSTS between 2005 and 2016. All relevant oncologic, surgical and follow-up data were collected. Multivariate logistic regression analysis was used to analyze prognostic factors associated with higher probability of short-term ReAFS and long-term ReAFS. RESULTS Multivariate analysis showed that Eastern Cooperative Oncology Group score ≤2 (P = 0.011), preoperative hemoglobin (Hb) level >12 g/dL (P = 0.008), ≤3 comorbidities (P = 0.052), shorter index length of stay ≤10 days (P = 0.007), and absence of neurologic/hematologic complications during index stay (P = 0.015) significantly increased the probability of short-term ReAFS, whereas preoperative Hb level >12 g/dL (P = 0.003) or tumor primaries with advanced treatment modalities such as breast (P = 0.012), hematologic (P = 0.006), prostate (P = 0.004), and renal/thyroid (P = 0.038) as opposed to aggressive lung tumor primaries were associated with significantly higher probability of long-term ReAFS. CONCLUSIONS Patient and treatment factors predominantly influence ReAFS up to 90 days, whereas primary tumor-related factors alongside general health influence ReAFS beyond 90 days after index MSTS. Awareness of these factors may help oncologists and surgeons optimize treatment planning. The clinical significance of this study will continue to evolve, because we have been witnessing over the past decade that patients are becoming more involved in both their general health and understanding the natural history of the diseases that affect them.
Collapse
Affiliation(s)
- Sirisha Madhu
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | | | - Sarah Shuyun Tang
- Department of Orthopaedic Surgery, National University Health System, Singapore
| | - Liang Shen
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Singapore
| | | | - Naresh Kumar
- Department of Orthopaedic Surgery, National University Health System, Singapore.
| |
Collapse
|
14
|
Glowacki J, Epperly MW, Bellare A, Wipf P, Greenberger JS. Combined injury: irradiation with skin or bone wounds in rodent models. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2021; 41:S561-S577. [PMID: 34233299 DOI: 10.1088/1361-6498/ac125b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/07/2021] [Indexed: 06/13/2023]
Abstract
A radiation combined injury is defined as an injury that occurs in the setting of irradiation, such as those expected after a nuclear accident, radiation dispersal device release (a 'dirty bomb'), or a nuclear weapon detonation. There is much research on irradiation-associated burns and their healing, but there is less known about other injuries sustained in the context of irradiation. Animal models are limited in their correlations to clinical situations but can support research on specific questions about injuries and their healing. Mouse models of irradiation with skin or bone wounds are validated as highly reproducible and quantitative. They show dose-dependent impairment of wound healing, with later recovery. Irradiation-induced delay of bone wound healing was mitigated to different extents by single doses of gramicidin S-nitroxide JP4-039, a plasmid expressing manganese superoxide dismutase, amifostine/WR2721, or the bifunctional sulfoxide MMS-350. These models should be useful for research on mechanisms of radiation dermal and osseous damage and for further development of new radioprotectors. They also provide information of potential relevance to the effects of clinical radiation therapies.
Collapse
Affiliation(s)
- Julie Glowacki
- Department of Orthopedic Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Michael W Epperly
- Department of Radiation Oncology, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States of America
| | - Anuj Bellare
- Department of Orthopedic Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Peter Wipf
- Department of Chemistry, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Joel S Greenberger
- Department of Radiation Oncology, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States of America
| |
Collapse
|
15
|
Rapeaud E, Meynard C, Lecante F, Durdux C. [Bone metastasis: Efficacy and technical modalities of classical radiotherapy]. Cancer Radiother 2021; 25:707-712. [PMID: 34266736 DOI: 10.1016/j.canrad.2021.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/06/2021] [Accepted: 06/11/2021] [Indexed: 11/27/2022]
Abstract
Conventional radiotherapy is a pivotal treatment in the management of bone metastasis. It is indicated primarily for palliative, analgesic, or decompressive purposes and in the prevention of severe bone events such as fractures and spinal cord compressions. It should be performed as early as possible from the onset of symptoms or within 14days following a surgical procedure of decompression or bone stabilization. Except in some cases, a pattern of 8Gy single dose is currently recommended, possibly renewable, by being vigilant on associated treatments which some, like antiangiogenics, must be imperatively suspended.
Collapse
Affiliation(s)
- E Rapeaud
- Service d'oncologie-radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - C Meynard
- Service d'oncologie-radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - F Lecante
- Service d'oncologie-radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - C Durdux
- Service d'oncologie-radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
| |
Collapse
|
16
|
Pennington Z, Ehresman J, Elsamadicy AA, Shin JH, Goodwin CR, Schwab JH, Sciubba DM. Systematic review of charged-particle therapy for chordomas and sarcomas of the mobile spine and sacrum. Neurosurg Focus 2021; 50:E17. [PMID: 33932924 DOI: 10.3171/2021.2.focus201059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/23/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Long-term local control in patients with primary chordoma and sarcoma of the spine and sacrum is increasingly reliant upon en bloc resection with negative margins. At many institutions, adjuvant radiation is recommended; definitive radiation is also recommended for the treatment of unresectable tumors. Because of the high off-target radiation toxicities associated with conventional radiotherapy, there has been growing interest in the use of proton and heavy-ion therapies. The aim of this study was to systematically review the literature regarding these therapies. METHODS The PubMed, OVID, Embase, and Web of Science databases were queried for articles describing the use of proton, combined proton/photon, or heavy-ion therapies for adjuvant or definitive radiotherapy in patients with primary sarcoma or chordoma of the mobile spine and sacrum. A qualitative synthesis of the results was performed, focusing on overall survival (OS), progression-free survival (PFS), disease-free survival (DFS), and disease-specific survival (DSS); local control; and postradiation toxicities. RESULTS Of 595 unique articles, 64 underwent full-text screening and 38 were included in the final synthesis. All studies were level III or IV evidence with a high risk of bias; there was also significant overlap in the reported populations, with six centers accounting for roughly three-fourths of all reports. Five-year therapy outcomes were as follows: proton-only therapies, OS 67%-82%, PFS 31%-57%, and DFS 52%-62%; metastases occurred in 17%-18% and acute toxicities in 3%-100% of cases; combined proton/photon therapy, local control 62%-85%, OS 78%-87%, PFS 90%, and DFS 61%-72%; metastases occurred in 12%-14% and acute toxicities in 84%-100% of cases; and carbon ion therapy, local control 53%-100%, OS 52%-86%, PFS (only reported for 3 years) 48%-76%, and DFS 50%-53%; metastases occurred in 2%-39% and acute toxicities in 26%-48%. There were no studies directly comparing outcomes between photon and charged-particle therapies or comparing outcomes between radiation and surgical groups. CONCLUSIONS The current evidence for charged-particle therapies in the management of sarcomas of the spine and sacrum is limited. Preliminary evidence suggests that with these therapies local control and OS at 5 years are comparable among various charged-particle options and may be similar between those treated with definitive charged-particle therapy and historical surgical cohorts. Further research directly comparing charged-particle and photon-based therapies is necessary.
Collapse
Affiliation(s)
- Zach Pennington
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jeff Ehresman
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aladine A Elsamadicy
- 2Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - John H Shin
- 3Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - C Rory Goodwin
- 4Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina; and
| | - Joseph H Schwab
- 5Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel M Sciubba
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
17
|
An Overview of Decision Making in the Management of Metastatic Spinal Tumors. Indian J Orthop 2021; 55:799-814. [PMID: 34194637 PMCID: PMC8192670 DOI: 10.1007/s43465-021-00368-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 01/29/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Spinal metastases are the most commonly encountered spinal tumors. With increasing life expectancy and better systemic treatment options, the incidence of patients seeking treatment for spinal metastasis is rising. Radical resections and conventional low-dose radiotherapy have given way to modern 'separation' surgeries and stereotactic body radiotherapy which entails lesser morbidity and improved local control. This article provides an overview of the decision making and currently available treatment options for metastatic spinal tumors. METHODS A MEDLINE literature search was made for studies in English language reporting on human subjects, describing results of various treatment options that are a part of multidisciplinary management of metastatic spinal tumors. The highest-quality evidence available in the literature was reviewed. DISCUSSION Treatment of patients with metastatic spinal tumors is largely palliative, with radiotherapy and selective surgery being the mainstays of management. Multidisciplinary management that incorporates factors like patient performance status, expected survival and systemic burden of disease and employs well-validated decision-making frameworks for guiding treatment holds the key to an effective palliative treatment strategy. Effective pain management, achieving local control, adequate neurological decompression in the setting of epidural cord compression and surgical stabilization for mechanical stabilization are the main goals of treatment. CONCLUSION The management of metastatic spinal tumors has been rapidly evolving; currently, limited decompression and stabilization followed by postoperative SBRT for local tumor control are associated with less morbidity and may be referred to as the current standard of care in these patients.
Collapse
|
18
|
Kumar N, Thomas AC, Ramos MRD, Tan JYH, Shen L, Madhu S, Lopez KG, Villanueva A, Tan JH, Vellayappan BA. Readmission-Free Survival Analysis in Metastatic Spine Tumour Surgical Patients: A Novel Concept. Ann Surg Oncol 2021; 28:2474-2482. [PMID: 33393052 DOI: 10.1245/s10434-020-09404-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/04/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Outcomes commonly used to ascertain success of metastatic spine tumour surgery (MSTS) are 30-day complications/mortality and overall/disease-free survival. We believe a new, effective outcome indicator after MSTS would be the absence of unplanned hospital readmission (UHR) after index discharge. We introduce the concept of readmission-free survival (ReAFS), defined as 'the time duration between hospital discharge after index operation and first UHR or death'. The aim of this study is to identify factors influencing ReAFS in MSTS patients. PATIENTS AND METHODS We retrospectively analysed 266 consecutive patients who underwent MSTS between 2005 and 2016. Demographics, oncological characteristics, procedural, preoperative and postoperative details were collected. ReAFS of patients within 2 years or until death was reviewed. Perioperative factors predictive of reduced ReAFS were evaluated using multivariate regression analysis. RESULTS Of 266 patients, 230 met criteria for analysis. A total of 201 had UHR, whilst 1 in 8 (29/230) had no UHR. Multivariate analysis revealed that haemoglobin ≥ 12 g/dL, ECOG score of ≤ 2, primary prostate, breast and haematological cancers, comorbidities ≤ 3, absence of preoperative radiotherapy and shorter postoperative length of stay significantly prolonged the time to first UHR. CONCLUSIONS Readmission-free survival is a novel concept in MSTS, which relies on patients' general condition, appropriateness of interventional procedures and underlying disease burden. Additionally, it may indicate the successful combination of a multi-disciplinary treatment approach. This information will allow oncologists and surgeons to identify patients who may benefit from increased surveillance following discharge to increase ReAFS. We envisage that ReAFS is a concept that can be extended to other surgical oncological fields.
Collapse
Affiliation(s)
- Naresh Kumar
- Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore.
| | - Andrew Cherian Thomas
- Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
| | | | - Joel Yong Hao Tan
- Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
| | - Liang Shen
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sirisha Madhu
- Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
| | - Keith Gerard Lopez
- Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
| | - Andre Villanueva
- Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
| | - Jiong Hao Tan
- Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
| | | |
Collapse
|
19
|
Chang SY, Mok S, Park SC, Kim H, Chang BS. Treatment Strategy for Metastatic Spinal Tumors: A Narrative Review. Asian Spine J 2020; 14:513-525. [PMID: 32791769 PMCID: PMC7435309 DOI: 10.31616/asj.2020.0379] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 12/29/2022] Open
Abstract
Metastatic spinal tumors are common, and their rising incidence can be attributed to the expanding aging population and increased survival rates among cancer patients. The decision-making process in the treatment of spinal metastasis requires a multidisciplinary approach that includes medical and radiation oncology, surgery, and rehabilitation. Various decision-making systems have been proposed in the literature in order to estimate survival and suggest appropriate treatment options for patients experiencing spinal metastasis. However, recent advances in treatment modalities for spinal metastasis, such as stereotactic radiosurgery and minimally invasive surgical techniques, have reshaped clinical practices concerning patients with spinal metastasis, making a demand for further improvements on current decision-making systems. In this review, recent improvements in treatment modalities and the evolution of decision-making systems for metastatic spinal tumors are discussed.
Collapse
Affiliation(s)
- Sam Yeol Chang
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sujung Mok
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sung Cheol Park
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hyoungmin Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Bong-Soon Chang
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|