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Patel PP, Esposito EP, Zhu J, Chen X, Khan M, Kleinberg L, Lubelski D, Theodore N, Lo SFL, Hun Lee S, Kebaish K, Bydon A, Redmond KJ. Antiresorptive Medications Prior to Stereotactic Body Radiotherapy for Spinal Metastasis are Associated with Reduced Incidence of Vertebral Body Compression Fracture. Global Spine J 2024; 14:1778-1785. [PMID: 36749660 PMCID: PMC11268289 DOI: 10.1177/21925682231156394] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
STUDY DESIGN Retrospective Cohort. OBJECTIVE Antiresorptive drugs are often given to minimize fracture risk for bone metastases, but data regarding optimal time or ability to reduce stereotactic body radiotherapy (SBRT)-induced fracture risk is limited. This study examines the association between antiresorptive use surrounding spinal SBRT and vertebral compression fracture (VCF) incidence to provide information regarding effectiveness and optimal timing of use. METHODS Patients treated with SBRT for spinal metastases at a single institution between 2009-2020 were included. Kaplan-Meier analysis was used to compare cumulative incidence of VCF for those taking antiresorptive drugs pre-SBRT, post-SBRT only, and none at all. Cox proportional hazards and Fine-Gray competing risk models were used to identify additional factors associated with VCF. RESULTS Of the 234 patients (410 vertebrae) analyzed, 49 (20.9%) were taking bisphosphonates alone, 42 (17.9%) were taking denosumab alone, and 25 (10.7%) were taking both. Kaplan-Meier analysis revealed a statistically significant lower VCF incidence for patients initiating antiresorptive drugs before SBRT compared to those taking none at all (4% vs 12% at 1 year post-SBRT, P = .045; and 4% vs 23% at 2 years, P = .008). On multivariate analysis, denosumab duration (HR: .87, P = .378) or dose (HR: 1.00, P = .644) as well as bisphosphonate duration (HR: .98, P= .739) or dose (HR: .99, P= .741) did not have statistical significance on VCF incidence. CONCLUSION Initiating antiresorptive agents before SBRT may reduce the risk of treatment-induced VCF. Antiresorptive drugs are underutilized in patients with spine metastases and may represent a useful intervention to minimize toxicity and improve long-term outcomes.
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Affiliation(s)
- Palak P. Patel
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Edward P. Esposito
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jiafeng Zhu
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Xuguang Chen
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Majid Khan
- Department of Radiology, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Lawrence Kleinberg
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sheng-fu Larry Lo
- Department of Neurosurgery, Zucker School of Medicine at Hoftstra, Manhasset, NY, USA
| | - Sang Hun Lee
- Department of Orthopedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Khaled Kebaish
- Department of Orthopedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ali Bydon
- Department of Orthopedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kristin J. Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Waltenberger M, Vogel MME, Bernhardt D, Münch S, Dobiasch S, Redmond KJ, Lo SS, Acker G, Fehlings MG, Ringel F, Vajkoczy P, Meyer B, Combs SE. Radiotherapy concepts for spinal metastases-results from an online survey among radiation oncologists of the German Society for Radiation Oncology. Strahlenther Onkol 2024; 200:159-174. [PMID: 37272996 PMCID: PMC10805849 DOI: 10.1007/s00066-023-02082-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/31/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE Spinal metastases (SM) are a common radiotherapy (RT) indication. There is limited level I data to drive decision making regarding dose regimen (DR) and target volume definition (TVD). We aim to depict the patterns of care for RT of SM among German Society for Radiation Oncology (DEGRO) members. METHODS An online survey on conventional RT and Stereotactic Body Radiation Therapy (SBRT) for SM, distributed via e‑mail to all DEGRO members, was completed by 80 radiation oncologists between February 24 and April 29, 2022. Participation was voluntary and anonymous. RESULTS A variety of DR was frequently used for conventional RT (primary: n = 15, adjuvant: n = 14). 30 Gy/10 fractions was reported most frequently. TVD in adjuvant RT was heterogenous, with a trend towards larger volumes. SBRT was offered in 65% (primary) and 21% (adjuvant) of participants' institutions. A variety of DR was reported (primary: n = 40, adjuvant: n = 27), most commonly 27 Gy/3 fractions and 30 Gy/5 fractions. 59% followed International Consensus Guidelines (ICG) for TVD. CONCLUSION We provide a representative depiction of RT practice for SM among DEGRO members. DR and TVD are heterogeneous. SBRT is not comprehensively practiced, especially in the adjuvant setting. Further research is needed to provide a solid data basis for detailed recommendations.
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Affiliation(s)
- Maria Waltenberger
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany.
- German Cancer Consortium (DKTK), partner site Munich, Munich, Germany.
- German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Marco M E Vogel
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Denise Bernhardt
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Stefan Münch
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Sophie Dobiasch
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
- German Cancer Consortium (DKTK), partner site Munich, Munich, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum, Munich, Germany
| | - Kristin J Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, USA
| | - Güliz Acker
- Department of Neurosurgery, Charité Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Michael G Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Florian Ringel
- Department of Neurosurgery, University Hospital Mainz, Mainz, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
- German Cancer Consortium (DKTK), partner site Munich, Munich, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum, Munich, Germany
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Byun HK, Koom WS, Park SJ, Kim SI, Kim JH, Kim YH, Chang BS, Ahn YC. Different decision-making in spine metastasis management among radiation oncologists and orthopedic surgeons: a Korean online survey study. Front Neurol 2024; 14:1317858. [PMID: 38274867 PMCID: PMC10808525 DOI: 10.3389/fneur.2023.1317858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/27/2023] [Indexed: 01/27/2024] Open
Abstract
Purpose To understand the current practice of radiation oncologists (ROs) and orthopedic surgeons (OSs) regarding spine metastasis. Methods In 2022, an internet-based survey was conducted for ROs and OSs who treat spinal metastasis in Korea. Respondents were asked to choose the treatment option for two clinical scenarios. Scenario 1 involved a case displaying symptoms of leg weakness due to spinal cord compression and Scenario 2 involved a case with back pain due to pathologic compression fracture. The survey also included a question that required respondents to rank the importance of 11 clinical factors that affect treatment decisions. Results Forty-nine ROs and 30 OSs responded to the survey. There were significant differences in treatment choices between two groups for both scenarios (P = 0.001). In Scenario 1, more OSs chose surgical resection than ROs (43.3% vs. 16.7%), while more ROs chose radiotherapy than OSs (83.3% vs. 53.3%). In Scenario 2, a similar proportion of OSs and ROs chose radiotherapy (OSs, 71.4% vs. ROs, 67.3%), while more OSs opted for prophylactic fixation after radiotherapy than ROs (95.0% vs. 42.4%). The top three factors influencing treatment decisions were general performance status, life expectancy, and spinal instability for both ROs and OSs. In both Scenarios 1 and 2, the treatment decisions of ROs changed significantly when clinical conditions related to these top three factors were altered. Conclusion Although ROs and OSs share the same factors influencing treatment decisions for spinal metastases, notable differences exist in their actual treatment preferences, with ROs preferring radiotherapy and OSs opting for surgical resection. Multidisciplinary discussions may be necessary to reduce the gap in decision-making.
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Affiliation(s)
- Hwa Kyung Byun
- Department of Radiation Oncology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Republic of Korea
| | - Woong Sub Koom
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Se-Jun Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang-Il Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young-Hoon Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Bong-Soon Chang
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Nakata E, Sugihara S, Nakahara R, Katayama H, Itano T, Ozaki T. Changes in Spinal Instability After Conventional Radiotherapy for Painful Vertebral Bone Metastases. Cancer Control 2024; 31:10732748241250219. [PMID: 38686892 PMCID: PMC11062211 DOI: 10.1177/10732748241250219] [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: 08/06/2023] [Revised: 03/12/2024] [Accepted: 04/10/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVE Precise assessment of spinal instability is critical before and after radiotherapy (RT) for evaluating the effectiveness of RT. Therefore, we retrospectively evaluated the efficacy of RT in spinal instability over a period of 6 months after RT, utilizing the spinal instability neoplastic score (SINS) in patients with painful spinal metastasis. We retrospectively evaluated 108 patients who received RT for painful vertebral metastasis in our institution. Mechanical pain at metastatic vertebrae, radiological responses of irradiated vertebrae, and spinal instability were assessed. Follow-up assessments were done at the start of and at intervals of 1, 2, 3, 4, and 6 months after RT, with the pain disappearing in 67%, 85%, 93%, 97%, and 100% of the patients, respectively. The median SINS were 8, 6, 6, 5, 5, and 4 at the beginning and after 1, 2, 3, 4, and 6 months of RT, respectively. Multivariate analysis revealed that posterolateral involvement of spinal elements (PLISE) was the only risk factor for continuous potentially unstable/unstable spine at 1 month. In conclusion, there was improvement of pain, and recalcification results in regaining spinal stability over time after RT although vertebral body collapse and malalignment occur in some irradiated vertebrae. Clinicians should pay attention to PLISE in predicting continuous potentially unstable/unstable spine.
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Affiliation(s)
- Eiji Nakata
- Department of Orthopedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Shinsuke Sugihara
- Department of Orthopedic Surgery, Shikoku Cancer Center, Matsuyama, Japan
| | - Ryuichi Nakahara
- Department of Orthopedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Haruyoshi Katayama
- Department of Orthopedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Takuto Itano
- Department of Orthopedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopedic Surgery, Okayama University Hospital, Okayama, Japan
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Waltenberger M, Strick C, Vogel MME, Diehl C, Combs SE. SBRT of Spinal Metastases Using a Simultaneous Integrated Boost Concept in Oligometastatic Cancer Patients Is Safe and Effective. Cancers (Basel) 2023; 15:5813. [PMID: 38136357 PMCID: PMC10741748 DOI: 10.3390/cancers15245813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/27/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Purpose: To assess the safety and effectivity of stereotactic body radiotherapy (SBRT) on spinal metastases utilizing a simultaneous integrated boost (SIB) concept in oligometastatic cancer patients. (2) Methods: 62 consecutive patients with 71 spinal metastases received SIB-SBRT between 01/2013 and 09/2022 at our institution. We retrospectively analyzed toxicity, local tumor control (LC), and progression-free (PFS) and overall survival (OS) following SIB-SBRT and assessed possible influencing factors (Kaplan-Meier estimator, log-rank test and Cox proportional-hazards model). (3) Results: SIB-SBRT was delivered in five fractions, mostly with 25/40 Gy (n = 43; 60.56%) and 25/35 Gy (n = 19, 26.76%). Estimated rates of freedom from VCF were 96.1/90.4% at one/two years. VCF development was significantly associated with osteoporosis (p < 0.001). No ≥ grade III acute and one grade III late toxicity (VCF) were observed. Estimated LC rates at one/two years were 98.6/96.4%, and histology was significantly associated with local treatment failure (p = 0.039). Median PFS/OS was 10 months (95% CI 6.01-13.99)/not reached. Development of metastases ≥ one year after initial diagnosis and Karnofsky Performance Score ≥ 90% were predictors for superior PFS (p = 0.038) and OS (p = 0.012), respectively. (4) Conclusion: Spinal SIB-SBRT yields low toxicity and excellent LC. It may be utilized in selected oligometastatic patients to improve prognosis. To the best of our knowledge, we provide the first clinical data on the toxicity and effectivity of SIB-SBRT in spinal metastases in a larger patient cohort.
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Affiliation(s)
- Maria Waltenberger
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technical University of Munich (TUM), 81675 Munich, Germany; (C.S.); (M.M.E.V.); (C.D.); (S.E.C.)
- German Cancer Consortium (DKTK), Partner Site Munich, a Partnership between DKFZ and University Hospital Klinikum Rechts der Isar, 81675 Munich, Germany
| | - Christian Strick
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technical University of Munich (TUM), 81675 Munich, Germany; (C.S.); (M.M.E.V.); (C.D.); (S.E.C.)
| | - Marco M. E. Vogel
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technical University of Munich (TUM), 81675 Munich, Germany; (C.S.); (M.M.E.V.); (C.D.); (S.E.C.)
| | - Christian Diehl
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technical University of Munich (TUM), 81675 Munich, Germany; (C.S.); (M.M.E.V.); (C.D.); (S.E.C.)
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, 85764 Neuherberg, Germany
| | - Stephanie E. Combs
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technical University of Munich (TUM), 81675 Munich, Germany; (C.S.); (M.M.E.V.); (C.D.); (S.E.C.)
- German Cancer Consortium (DKTK), Partner Site Munich, a Partnership between DKFZ and University Hospital Klinikum Rechts der Isar, 81675 Munich, Germany
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, 85764 Neuherberg, Germany
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Ryvlin J, Javed K, la Garza Ramos RD, Hamad M, Essibayi MA, Gelfand Y, Murthy S, Yassari R. Is perioperative blood transfusion associated with postoperative thromboembolism or infection after metastatic spinal tumor surgery? Clin Neurol Neurosurg 2023; 235:108052. [PMID: 37980825 DOI: 10.1016/j.clineuro.2023.108052] [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: 09/07/2023] [Revised: 10/04/2023] [Accepted: 11/10/2023] [Indexed: 11/21/2023]
Abstract
STUDY DESIGN Retrospective cohort. SUMMARY OF BACKGROUND DATA Patients with metastatic spine disease who undergo surgical intervention have a high risk of requiring red blood cell (RBC) transfusion. Perioperative transfusion has been independently associated with increased risk of venous thromboembolic (VTE) and infectious complications following orthopedic procedures and degenerative spinal intervention; however, literature within spine oncology is limited. OBJECTIVE To determine the association between perioperative RBC transfusion and postoperative VTE or infection following spinal tumor surgery. METHODS A total of 153 patients who underwent surgery for spinal metastases between April 2012 and April 2022 were included. Medical records were reviewed to identify RBC transfusion administered either intraoperatively or within 96 h following surgery. The primary endpoints were: 1) development of any VTE or 2) development of any infection within 30 days following surgery. Any VTE was defined as deep vein thrombosis or pulmonary embolism, and any infection was defined as pneumonia, meningitis, Clostridium difficile infection, urinary tract infection, surgical site infection, or sepsis. Logistic regression analyses were performed. RESULTS Of the 153 patients included in the study, 43 % received a perioperative RBC transfusion. The overall incidence of postoperative VTE and infection was 15 % and 22 %, respectively. In univariate analysis, perioperative transfusion was not associated with postoperative VTE (odds ratio [OR] 2.41; 95 % confidence interval [CI] 0.97-6.00; p = 0.058) but was associated with infection (OR 3.02; 95 % CI 1.36-6.73; p = 0.007). After adjusting for confounders such as performance status, operative time, and surgical extent, transfusion was not associated with both VTE (OR 1.25; 95 % CI 0.36-4.32; p = 0.727) or infection (OR 1.86; 95 % CI 0.70-4.92; p = 0.210). While not statistically significant, sub-analyses demonstrated a trend towards increased VTE incidence in patients requiring transfusion earlier (within 24 h) as opposed to later postoperatively. CONCLUSIONS We found that perioperative transfusion was not an independent predictor of 30-day postoperative VTE or infection in patients undergoing metastatic spinal surgery. Further exploration of time-dependent transfusion outcomes is warranted.
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Affiliation(s)
- Jessica Ryvlin
- Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Kainaat Javed
- Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rafael De la Garza Ramos
- Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA; Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mousa Hamad
- Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA; Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Muhammed Amir Essibayi
- Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yaroslav Gelfand
- Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA; Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Saikiran Murthy
- Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA; Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Reza Yassari
- Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA; Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
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Liu S, Wang Z, Wei Q, Duan X, Liu Y, Wu M, Ding J. Biomaterials-enhanced bioactive agents to efficiently block spinal metastases of cancers. J Control Release 2023; 363:721-732. [PMID: 37741462 DOI: 10.1016/j.jconrel.2023.09.039] [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: 06/15/2023] [Revised: 09/12/2023] [Accepted: 09/20/2023] [Indexed: 09/25/2023]
Abstract
The spine is the most common site of bone metastases, as 20%-40% of cancer patients suffer from spinal metastases. Treatments for spinal metastases are scarce and palliative, primarily aiming at relieving bone pain and preserving neurological function. The bioactive agents-mediated therapies are the most effective modalities for treating spinal metastases because they achieve systematic and specific tumor regression. However, the clinical applications of some bioactive agents are limited due to the lack of targeting capabilities, severe side effects, and vulnerability of drug resistance. Fortunately, advanced biomaterials have been developed as excipients to enhance these treatments, including chemotherapy, phototherapy, magnetic hyperthermia therapy, and combination therapy, by improving tumor targeting and enabling sustaining and stimuli-responsive release of various therapeutic agents. Herein, the review summarizes the development of biomaterials-mediated bioactive agents for enhanced treatments of spinal metastases and predicts future research trends.
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Affiliation(s)
- Shixian Liu
- Department of Orthopedics, The Second Hospital of Jilin University, 218 Ziqiang Street, Changchun 130041, PR China; Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, 5625 Renmin Street, Changchun 130022, PR China
| | - Zhonghan Wang
- Department of Orthopedics, The Second Hospital of Jilin University, 218 Ziqiang Street, Changchun 130041, PR China
| | - Qi Wei
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, 5625 Renmin Street, Changchun 130022, PR China; Department of Thoracic Surgery, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun 130033, PR China
| | - Xuefeng Duan
- Department of Orthopedics, The Second Hospital of Jilin University, 218 Ziqiang Street, Changchun 130041, PR China; Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, 5625 Renmin Street, Changchun 130022, PR China
| | - Yang Liu
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, 5625 Renmin Street, Changchun 130022, PR China
| | - Minfei Wu
- Department of Orthopedics, The Second Hospital of Jilin University, 218 Ziqiang Street, Changchun 130041, PR China.
| | - Jianxun Ding
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, 5625 Renmin Street, Changchun 130022, PR China; Key Laboratory of Advanced Drug Delivery Systems of Zhejiang Province, 388 Yuhangtang Road, Hangzhou 310058, PR China.
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Seol Y, Song JH, Choi KH, Lee YK, Choi BO, Kang YN. Predicting vertebral compression fracture prior to spinal SBRT using radiomics from planning CT. 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 2023:10.1007/s00586-023-07963-3. [PMID: 37814013 DOI: 10.1007/s00586-023-07963-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/22/2023] [Accepted: 09/16/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE The purpose of the study was to develop a predictive model for vertebral compression fracture (VCF) prior to spinal stereotactic body radiation therapy (SBRT) using radiomics features extracted from pre-treatment planning CT images. METHODS A retrospective analysis was conducted on 85 patients (114 spinal lesions) who underwent spinal SBRT. Radiomics features were extracted from pre-treatment planning CT images and used to develop a predictive model using a classification algorithm selected from nine different machine learning algorithms. Four different models were trained, including clinical features only, clinical and radiomics features, radiomics and dosimetric features, and all features. Model performance was evaluated using accuracy, precision, recall, F1-score, and area under the curve (AUC). RESULTS The model that used all features (radiomics, clinical, and dosimetric) showed the highest performance with an AUC of 0.871. The radiomics and dosimetric features model had the superior performance in terms of accuracy, precision, recall, and F1-score. CONCLUSION The developed predictive model based on radiomics features extracted from pre-treatment planning CT images can accurately predict the likelihood of VCF prior to spinal SBRT. This model has significant implications for treatment planning and preventive measures for patients undergoing spinal SBRT. Future research can focus on improving model performance by incorporating new data and external validation using independent data sets.
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Affiliation(s)
- Yunji Seol
- Department of Biomedicine and Health Sciences, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Korea
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Korea
| | - Jin Ho Song
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Korea
| | - Kyu Hye Choi
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Korea
| | - Young Kyu Lee
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Korea
| | - Byung-Ock Choi
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Korea
| | - Young-Nam Kang
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Korea.
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Kanda Y, Kakutani K, Sakai Y, Miyazaki K, Matsuo T, Yurube T, Takeoka Y, Ohnishi H, Ryu M, Kumagai N, Kuroshima K, Hiranaka Y, Kawamoto T, Hara H, Hoshino Y, Hayashi S, Akisue T, Kuroda R. Clinical Characteristics and Surgical Outcomes of Metastatic Spine Tumors in the Very Elderly: A Prospective Cohort Study in a Super-Aged Society. J Clin Med 2023; 12:4747. [PMID: 37510862 PMCID: PMC10380659 DOI: 10.3390/jcm12144747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/09/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
The number of advanced-age patients with spinal metastases is rising. This study was performed to clarify the characteristics and surgical outcomes of spinal metastases in advanced-age patients. We prospectively analyzed 216 patients with spinal metastases from 2015 to 2020 and divided them into three age groups: <70 years (n = 119), 70-79 years (n = 73), and ≥80 years (n = 24). Although there were no significant intergroup differences in preoperative characteristics and surgery-related factors except for age, patients aged ≥80 years tended to have a worse performance status (PS), Barthel index, and EuroQol-5 dimension (EQ-5D) before and after surgery than the other two groups. Although the median PS, mean Barthel index and mean EQ-5D greatly improved postoperatively in each group, the median PS and mean Barthel index at 6 months and the mean EQ-5D at 1 month postoperatively were significantly poorer in the ≥80-year group than the 70-79-year group. The rates of postoperative complications and re-deterioration of the EQ-5D were significantly higher in the oldest group than in the other two groups. Although surgery for spinal metastases improved the PS, Barthel index, and EQ-5D regardless of age, clinicians should be aware of the poorer outcomes and higher complication rates in advanced-age patients.
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Affiliation(s)
- Yutaro Kanda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Kenichiro Kakutani
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Yoshitada Sakai
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Kunihiko Miyazaki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Tomoya Matsuo
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Takashi Yurube
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Yoshiki Takeoka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Hiroki Ohnishi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Masao Ryu
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Naotoshi Kumagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Kohei Kuroshima
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Yoshiaki Hiranaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Teruya Kawamoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Hitomi Hara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Toshihiro Akisue
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe 654-0142, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
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Al Farii H, Aoude A, Al Shammasi A, Reynolds J, Weber M. Surgical Management of the Metastatic Spine Disease: A Review of the Literature and Proposed Algorithm. Global Spine J 2023; 13:486-498. [PMID: 36514950 PMCID: PMC9972274 DOI: 10.1177/21925682221146741] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
STUDY DESIGN Narrative Review. The spine remains the most common site for bony metastasis. It is estimated that up to 70% of cancer patients harbor secondary spinal disease. And up to 10% will develop a clinically significant lesion. The last two decades have seen a substantial leap forward in the advancements of the management of spinal metastases. What once was a death sentence is now a manageable, even potentially treatable condition. With marked advancements in the surgical treatment and post-operative radiotherapy, a standardized approach to stratify and manage these patients is both prudent and now feasible. OBJECTIVES This article looks to examine the best available evidence in the stratification and surgical management of patients with spinal metastases. So the aim of this review is to offer a standardized approach for surgical management and surgical planning of patients with spinal metastases.
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Affiliation(s)
- Humaid Al Farii
- Division of Orthopaedic Surgery, McGill University, Montreal, QC, Canada
- Humaid Al Farii, Division of Orthopaedic Surgery,
McGill University, 1070 st matheiu, 1201, Montreal, QC H3H 2S8, Canada.
| | - Ahmed Aoude
- Division of Orthopaedic Surgery, McGill University, Montreal, QC, Canada
| | - Ahmed Al Shammasi
- Division of Orthopaedic Surgery, McGill University, Montreal, QC, Canada
| | - Jeremy Reynolds
- Division of Orthopaedic Surgery, McGill University, Montreal, QC, Canada
| | - Michael Weber
- Division of Orthopaedic Surgery, McGill University, Montreal, QC, Canada
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11
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Pusceddu C, Marsico S, Derudas D, Ballicu N, Melis L, de Felice C, Calabrese A, Santucci D, Faiella E. Percutaneous CT-Guided Microwave Ablation Combined with Pedicle Screw Fixation Followed by Vertebroplasty (MASFVA): Initial Experience of a Minimally Invasive Treatment of Vertebral Metastases with Extension to the Vertebral Pedicle. Curr Oncol 2023; 30:1663-1672. [PMID: 36826088 PMCID: PMC9955473 DOI: 10.3390/curroncol30020127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
(1) Background: The aim of this study was to retrospectively evaluate the safety and efficacy of a combined CT-guided percutaneous microwave ablation (MWA) and pedicle screw fixation followed by vertebroplasty (MASFVA) for the treatment and stabilization of painful vertebral metastases with vertebral pedicle involvement. (2) Methods: from January 2013 to January 2017 11 patients with 16 vertebral metastatic lesions (7 men and 5 women; mean age, 65 ± 11 years) with vertebral metastases underwent CT-guided microwave ablation and screw fixation followed by vertebroplasty (MASFVA). Technical success, complication rate, pain evaluation using a visual analogue scale (VAS), Oswestry Disability Index (ODI) and local tumor control were examined. (3) Results: Technical success rate was 100%. No procedure-related major complications occurred. VAS score decreased from 6.8 ± 0.7 to 0.6 ± 0.6. ODI score decreased from 3.1 ± 0.7 to 1.2 ± 0.4. All patients could walk independently without neurological complication after one week from the procedure. No new bone fractures or local disease recurrence occurred during a median follow-up of 12 months. (4) Conclusions: Our results suggest that MWA and percutaneous pedicle screw fixation followed by vertebroplasty for the treatment of painful vertebral metastases is a safe and effective procedure for painful vertebral metastases with vertebral pedicle involvement, allowing pain relief and local tumor control.
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Affiliation(s)
- Claudio Pusceddu
- Department of Oncological and Interventional Radiology, Businco Hospital, Via Edward Jenner 1, 09121 Cagliari, Italy
| | - Salvatore Marsico
- Department of Radiology, Hospital del Mar, Pg. Marítim de la Barceloneta, 25, 29, 08003 Barcelona, Spain
| | - Daniele Derudas
- Department of Hematology, Businco Hospital, Via Edward Jenner 1, 09121 Cagliari, Italy
| | - Nicola Ballicu
- Department of Oncological and Interventional Radiology, Businco Hospital, Via Edward Jenner 1, 09121 Cagliari, Italy
| | - Luca Melis
- Nuclear Medicine Department, Businco Hospital, Via Edward Jenner 1, 09121 Cagliari, Italy
| | - Carlo de Felice
- Department of Radiological Sciences, Oncology and Pathology, Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 105, 00161 Rome, Italy
| | - Alessandro Calabrese
- Department of Radiological Sciences, Oncology and Pathology, Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 105, 00161 Rome, Italy
| | - Domiziana Santucci
- Department of Radiology, Sant’Anna Hospital, Via Ravona 20, San Fermo della Battaglia, 22042 Como, Italy
- Unit of Computer Systems and Bioinformatics, Department of Engineering, Campus Bio-medico University, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Eliodoro Faiella
- Department of Radiology, Sant’Anna Hospital, Via Ravona 20, San Fermo della Battaglia, 22042 Como, Italy
- Correspondence: ; Tel.: +39-3314557202
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12
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Yang W, Pan Q, Huang F, Hu H, Shao Z. Research progress of bone metastases: From disease recognition to clinical practice. Front Oncol 2023; 12:1105745. [PMID: 36761418 PMCID: PMC9905420 DOI: 10.3389/fonc.2022.1105745] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/21/2022] [Indexed: 01/26/2023] Open
Abstract
Bone metastases, as one of the common types of metastatic tumors, have a great impact on the survival period and quality of life of patients. Bone metastases are usually characterized by bone destruction. Skeletal related events caused by bone destruction often lead to pain, pathological fractures and even paralysis. In this review, we provide a detailed explanation of bone metastases from the epidemiology, clinical features, pathogenesis, and recently developed clinical treatment viewpoints. We concluded that the incidence of bone metastases is increasing gradually, with serious clinical symptoms, complex pathogenesis and diverse clinical treatment. Tumor cells, immune cells, osteoblasts/osteoclasts and other cells as well as cytokines and enzymes all play a key role in the pathogenesis of bone metastases. We believe that the future treatment of bone metastases will be diversified and comprehensive. Some advanced technologies, such as nanomedicine, could be used for treatment, but this depends on understanding how disease occurs. With the development of treatment, the survival time and quality of life of patients will be improved.
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Affiliation(s)
| | | | | | - Hongzhi Hu
- *Correspondence: Hongzhi Hu, ; Zengwu Shao,
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13
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Shiber M, Kimchi G, Knoller N, Harel R. The Evolution of Minimally Invasive Spine Tumor Resection and Stabilization: From K-Wires to Navigated One-Step Screws. J Clin Med 2023; 12:jcm12020536. [PMID: 36675466 PMCID: PMC9865379 DOI: 10.3390/jcm12020536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/03/2023] [Accepted: 01/07/2023] [Indexed: 01/11/2023] Open
Abstract
Minimization of the surgical approaches to spinal extradural metastases resection and stabilization was advocated by the 2012 Oncological Guidelines for Spinal Metastases Management. Minimally invasive approaches to spine oncology surgery (MISS) are continually advancing. This paper will describe the evolution of minimally invasive surgical techniques for the resection of metastatic spinal lesions and stabilization in a single institute. A retrospective analysis of patients who underwent minimally invasive extradural spinal metastases resection during the years 2013-2019 by a single surgeon was performed. Medical records, imaging studies, operative reports, rates of screw misplacement, operative time and estimated blood loss were reviewed. Detailed description of the surgical technique is provided. Of 138 patients operated for extradural spinal tumors during the study years, 19 patients were treated in a minimally invasive approach and met the inclusion criteria for this study. The mortality rate was significantly improved over the years with accordance of improve selection criteria to better prognosis patients. The surgical technique has evolved over the study years from fluoroscopy to intraoperative 3D imaging and navigation guidance and from k-wire screw insertion technique to one-step screws. Minimally invasive spinal tumor surgery is an evolving technique. The adoption of assistive devices such as intraoperative 3D imaging and one-step screw insertion systems was safe and efficient. Oncologic patients may particularly benefit from the minimization of surgical decompression and fusion in light of the frailty of this population and the mitigated postoperative outcomes associated with MIS oncological procedures.
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Affiliation(s)
- Mai Shiber
- Department of Neurological Surgery, Sheba Medical Center, Ramat Gan 52621, Israel
- Sackler Medical School, Tel-Aviv University, Tel Aviv 69978, Israel
- Adelson School of Medicine, Ariel University, Ariel 40700, Israel
| | - Gil Kimchi
- Department of Neurological Surgery, Sheba Medical Center, Ramat Gan 52621, Israel
- Sackler Medical School, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Nachshon Knoller
- Department of Neurological Surgery, Sheba Medical Center, Ramat Gan 52621, Israel
- Sackler Medical School, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Ran Harel
- Department of Neurological Surgery, Sheba Medical Center, Ramat Gan 52621, Israel
- Sackler Medical School, Tel-Aviv University, Tel Aviv 69978, Israel
- Correspondence: ; Tel.: +972-3-5302650
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14
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Li P, Bai Y, Yuan Q, Man Q, Xing C, Ren Y, Zhang K. Efficacy and safety of CT-guided 125I seed implantation by coplanar template as a salvage therapy for vertebral metastases after failure of external beam radiation therapy: a retrospective study. Front Oncol 2023; 13:1084904. [PMID: 37188195 PMCID: PMC10175603 DOI: 10.3389/fonc.2023.1084904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
Purpose To evaluate the efficacy safety of computed tomography (CT)-guided 125I seed implantation by coplanar template for vertebral metastases after failure of external beam radiation therapy (EBRT). Material and methods Retrospective analysis of the clinical outcomes of 58 patients with vertebral metastases after failure of EBRT, who underwent 125I seed implantation as a salvage treatment with a CT-guided coplanar template-assisted technique from January 2015 to January 2017. Results The mean post-operative NRS score decreased significantly at T4w (3.5 ± 0.9, p<0.01), T8w (2.1 ± 0.9, p<0.01), T12w (1.5 ± 0.7, p< 0.01) and T6m (1.2 ± 0.6, p< 0.01) respectively. The local control rates after 3, 6, 9 and 12 months were 100% (58/58), 93.1% (54/58), 87.9% (51/58), and 81% (47/58), respectively. The median overall survival time was 18.52months (95% CI, 16.24-20.8), and 1- and 2-year survival rates were 81% (47/58) and 34.5% (20/58), respectively. By performing a paired t-test analysis, there was no significant difference in D90, V90, D100, V100, V150, V200, GTV volume, CI, EI and HI between preoperative and postoperative (p>0.05). Conclusions 125I seed implantation can be used as a salvage treatment for patients with vertebral metastases after failure of EBRT.
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15
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Liu WC, Li MP, Hong WY, Zhong YX, Sun BL, Huang SH, Liu ZL, Liu JM. A practical dynamic nomogram model for predicting bone metastasis in patients with thyroid cancer. Front Endocrinol (Lausanne) 2023; 14:1142796. [PMID: 36950687 PMCID: PMC10025497 DOI: 10.3389/fendo.2023.1142796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/17/2023] [Indexed: 03/08/2023] Open
Abstract
PURPOSE The aim of this study was to established a dynamic nomogram for assessing the risk of bone metastasis in patients with thyroid cancer (TC) and assist physicians to make accurate clinical decisions. METHODS The clinical data of patients with TC admitted to the First Affiliated hospital of Nanchang University from January 2006 to November 2016 were included in this study. Demographic and clinicopathological parameters of all patients at primary diagnosis were analyzed. Univariate and multivariate logistic regression analysis was applied to build a predictive model incorporating parameters. The discrimination, calibration, and clinical usefulness of the nomogram were evaluated using the C-index, ROC curve, calibration plot, and decision curve analysis. Internal validation was evaluated using the bootstrapping method. RESULTS A total of 565 patients were enrolled in this study, of whom 25 (4.21%) developed bone metastases. Based on logistic regression analysis, age (OR=1.040, P=0.019), hemoglobin (HB) (OR=0.947, P<0.001) and alkaline phosphatase (ALP) (OR=1.006, P=0.002) levels were used to construct the nomogram. The model exhibited good discrimination, with a C-index of 0.825 and good calibration. A C-index value of 0.815 was achieved on interval validation analysis. Decision curve analysis showed that the nomogram was clinically useful when intervention was decided at a bone metastases possibility threshold of 1%. CONCLUSIONS This dynamic nomogram, with relatively good accuracy, incorporating age, HB, and ALP, could be conveniently used to facilitate the prediction of bone metastasis risk in patients with TC.
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Affiliation(s)
- Wen-Cai Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
- The First Clinical Medical College of Nanchang University, Nanchang, China
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Meng-Pan Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
- The First Clinical Medical College of Nanchang University, Nanchang, China
| | - Wen-Yuan Hong
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
- The First Clinical Medical College of Nanchang University, Nanchang, China
| | - Yan-Xin Zhong
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Institute of Spine and Spinal Cord, Nanchang University, Nanchang, China
| | - Bo-Lin Sun
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Institute of Spine and Spinal Cord, Nanchang University, Nanchang, China
| | - Shan-Hu Huang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Institute of Spine and Spinal Cord, Nanchang University, Nanchang, China
| | - Zhi-Li Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Institute of Spine and Spinal Cord, Nanchang University, Nanchang, China
| | - Jia-Ming Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Institute of Spine and Spinal Cord, Nanchang University, Nanchang, China
- *Correspondence: Jia-Ming Liu,
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Harel R, Kaisman-Elbaz T, Emch T, Elson P, Chao ST, Suh JH, Angelov L. A quantitative and comparative evaluation of stereotactic spine radiosurgery local control: proposing a consistent measurement methodology. Neurosurg Focus 2022; 53:E10. [DOI: 10.3171/2022.8.focus22363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE
Stereotactic body radiotherapy (SBRT) is a precise and conformal treatment modality used in the management of metastatic spine tumors. Multiple studies have demonstrated its safety and efficacy for pain and tumor control. However, no uniform quantitative imaging methodology exists to evaluate response to treatment in these patients. This study presents radiographic local control rates post-SBRT, systematically compares measurements acquired according to WHO and Response Evaluation Criteria in Solid Tumors (RECIST) criteria, and explores the relationship to patient outcome.
METHODS
The authors performed a retrospective review of prospectively obtained data from a cohort of 59 consecutive patients (81 metastatic isocenters) treated with SBRT and followed with serial MRI scans. Measurements were performed by a neuroradiologist blinded to the patients’ clinical course. Local control status was determined according to both WHO and RECIST measurements, and agreement between the measuring methodologies was calculated and reported.
RESULTS
Eighty-one isocenters (111 vertebral bodies) were treated with SBRT. The mean treatment dose was 13.96 Gy and the median follow-up duration was 10.8 months, during which 408 MRI scans were evaluated with both WHO and RECIST criteria for each scan point. Imaging demonstrated a mean unidimensional size decrease of 0.2 cm (p = 0.14) and a mean area size decrease of 0.99 cm2 (p = 0.03). Although 88% of the case classifications were concordant and the agreement was significant, WHO criteria were found to be more sensitive to tumor size change. The local control rates according to WHO and RECIST were 95% and 98%, respectively.
CONCLUSIONS
Although WHO volumetric measurements are admittedly superior for tumor size measurement, RECIST is simpler, reproducible, and for the first time is shown here to be comparable to WHO criteria. Thus, the application of RECIST methodology appears to be a suitable standard for evaluating post-SBRT treatment response. Moreover, using comprehensive and consistent measuring approaches, this study substantiates the efficacy of SBRT in the treatment of spine metastases.
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Affiliation(s)
- Ran Harel
- Department of Neurosurgery, Sheba Medical Center Affiliated to Tel-Aviv University, Tel-Aviv, Israel
| | - Tehila Kaisman-Elbaz
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland
| | - Todd Emch
- Imaging Institute, Cleveland Clinic, Cleveland
| | - Paul Elson
- Quantitative Health Sciences, Cleveland Clinic, Cleveland; and
| | - Samuel T Chao
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - John H Suh
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lilyana Angelov
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland
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17
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Hamed M, Brandecker S, Rana S, Potthoff AL, Eichhorn L, Bode C, Schmeel FC, Radbruch A, Schäfer N, Herrlinger U, Köksal M, Giordano FA, Vatter H, Schneider M, Banat M. Postoperative prolonged mechanical ventilation correlates to poor survival in patients with surgically treated spinal metastasis. Front Oncol 2022; 12:940790. [PMID: 36387073 PMCID: PMC9647167 DOI: 10.3389/fonc.2022.940790] [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: 05/10/2022] [Accepted: 10/13/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Patients with spinal metastasis (SM) are at advanced stages of systemic cancer disease. Surgical therapy for SM is a common treatment modality enabling histopathological diagnosis and the prevention of severe neurological deficits. However, surgery for SM in this vulnerable patient cohort may require prolonged postoperative intensive care treatment, which could adversely affect the anticipated benefit of the surgery. We therefore assessed postoperative prolonged mechanical ventilation (PMV) as an indicator for intensive care treatment with regard to potential correlations with early postoperative mortality and overall survival (OS). Methods Between 2015 and 2019, 198 patients were surgically treated for SM at the author´s neurosurgical department. PMV was defined as postoperative mechanical ventilation of more than 24 hours. A multivariate analysis was performed to identify pre- and perioperative collectable predictors for 30 days mortality. Results Twenty out of 198 patients (10%) with SM suffered from postoperative PMV. Patients with PMV exhibited a median OS rate of 1 month compared to 12 months for patients without PMV (p < 0.0001). The 30 days mortality was 70% and after one year 100%. The multivariate analysis identified “PMV > 24 hrs” (p < 0.001, OR 0.3, 95% CI 0.02-0.4) as the only significant and independent predictor for 30 days mortality (Nagelkerke’s R2 0.38). Conclusions Our data indicate postoperative PMV to significantly correlate to high early postoperative mortality rates as well as to poor OS in patients with surgically treated SM. These findings might encourage the initiation of further multicenter studies to comprehensively investigate PMV as a so far underestimated negative prognostic factor in the course of surgical treatment for SM.
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Affiliation(s)
- Motaz Hamed
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Simon Brandecker
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Shaleen Rana
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | | | - Lars Eichhorn
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Christian Bode
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | | | | | - Niklas Schäfer
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Mümtaz Köksal
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | | | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | | | - Mohammed Banat
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
- *Correspondence: Mohammed Banat,
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18
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Wipplinger C, Lener S, Orban C, Wipplinger TM, Abramovic A, Lang A, Hartmann S, Thomé C. Technical nuances and approach-related morbidity of anterolateral and posterolateral lumbar corpectomy approaches-a systematic review of the literature. Acta Neurochir (Wien) 2022; 164:2243-2256. [PMID: 35689694 PMCID: PMC9338118 DOI: 10.1007/s00701-022-05240-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 04/29/2022] [Indexed: 11/27/2022]
Abstract
Purpose Approaches for lumbar corpectomies can be roughly categorized into anterolateral (AL) and posterolateral (PL) approaches. It remains controversial to date whether one approach is superior to the other, and no comparative studies exist for the two approaches for lumbar corpectomies. Methods A systematic review of the literature was performed through a MEDLINE/PubMed search. Studies and case reports describing technique plus outcomes and possible complications were included. Thereafter, estimated blood loss (EBL), length of operation (LOO), utilized implants, neurological outcomes, complication rates, and reoperation rates were analyzed. Results A total of 64 articles reporting on 702 patients including 513 AL and 189 PL corpectomies were included in this paper. All patients in the PL group were instrumented via the same approach used for corpectomy, while in the AL group the majority (68.3%) of authors described the use of an additional approach for instrumentation. The EBL was higher in the AL group (1393 ± 1341 ml vs. 982 ± 567 ml). The LOO also was higher in the AL group (317 ± 178 min vs. 258 ± 93 min). The complication rate (20.5% vs. 29.1%, p = 0.048) and the revision rate (3.1% vs. 9.5%, p = 0.004) were higher in the PL group. Neurological improvement rates were 43.8% (AL) vs. 39.2% (PL), and deterioration was only noted in the AL group (6.0%), while 50.2% (AL) and 60.8% (PL) showed no change from initial presentation to the last follow-up. Conclusion While neurological outcomes of both approaches are comparable, the results of the present review demonstrated lower complication and revision rates in anterolateral corpectomies. Nevertheless, individual patient characteristics must be considered in decision-making.
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Affiliation(s)
- Christoph Wipplinger
- Department of Neurosurgery, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - Sara Lener
- Department of Neurosurgery, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Christoph Orban
- Department of Neurosurgery, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Tamara M Wipplinger
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Anto Abramovic
- Department of Neurosurgery, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Anna Lang
- Department of Neurosurgery, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Sebastian Hartmann
- Department of Neurosurgery, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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Rispoli R, Reverberi C, Targato G, D'Agostini S, Fasola G, Trovò M, Calci M, Fanin R, Cappelletto B. Multidisciplinary Approach to Patients With Metastatic Spinal Cord Compression: A Diagnostic Therapeutic Algorithm to Improve the Neurological Outcome. Front Oncol 2022; 12:902928. [PMID: 35747823 PMCID: PMC9210572 DOI: 10.3389/fonc.2022.902928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The morbidity associated with metastatic spinal disease is significant because of spinal cord and/or nerve root compression. The purpose of this paper is to define a diagnostic-therapeutic path for patients with vertebral metastases and from this path to build an algorithm to reduce the devastating consequences of spinal cord compression. Materials and Methods The algorithm is born from the experience of a primary care center. A spine surgeon, an emergency room (ER) physician, a neuroradiologist, a radiation oncologist, and an oncologist form the multidisciplinary team. The ER physician or the oncologist intercept the patient with symptoms and signs of a metastatic spinal cord compression. Once the suspicion is confirmed, the following steps of the flow-chart must be triggered. The spine surgeon takes charge of the patient and, on the base of the anamnestic data and neurological examination, defines the appropriate timing for magnetic resonance imaging (MRI) in collaboration with the neuroradiologist. From the MRI outcome, the spine surgeon and the radiation oncologist consult each other to define further therapeutic alternatives. If indicated, surgical treatment should precede radiation therapy. The oncologist gets involved after surgery for systemic therapy. Results In 2021, the Spine and Spinal Cord Surgery department evaluated 257 patients with vertebral metastasis. Fifty-three patients presented with actual or incipient spinal cord compression. Among these, 27 were admitted due to rapid progression of symptoms, neurological deficits and/or spine instability signs. The level was thoracic in 21 cases, lumbar in 4 cases, cervical in 1 case, sacral in 1 case. Fifteen were operated on, 10 of these programmed and 5 in emergency. Discussion Patients with a history of malignancy can present to the ER or to the oncology department with symptoms that must be correctly framed in the context of a metastatic involvement. Even when there is no previous cancer history, the patient's pain characteristics and clinical signs must be interpreted to yield the correct diagnosis of vertebral metastasis with incipient or current spinal cord compression. The awareness of the alert symptoms and the application of an integrated paradigm consent to frame the patients with spinal cord compression, obtaining the benefits of a homogeneous step-by-step diagnostic and therapeutic path. Early surgical or radiation therapy treatment gives the best hope for preventing the worsening, or even improving, the deficits. Conclusions Metastatic spinal cord compression can cause neurological deficits compromising quality of life. Treatment strategies should be planned comprehensively. A multidisciplinary approach and the application of the proposed algorithm is of paramount importance to optimize the outcomes of these patients.
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Affiliation(s)
- Rossella Rispoli
- SOC Chirurgia Vertebro-Midollare, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Universitario "Santa Maria della Misericordia" di Udine, Udine, Italy
| | - Chiara Reverberi
- SOC Radioterapia, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Universitario "Santa Maria della Misericordia" di Udine, Udine, Italy
| | - Giada Targato
- SOC Oncologia, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Universitario "Santa Maria della Misericordia" di Udine, Udine, Italy
| | - Serena D'Agostini
- SOC Neuroradiologia, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Universitario "Santa Maria della Misericordia" di Udine, Udine, Italy
| | - Gianpiero Fasola
- SOC Oncologia, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Universitario "Santa Maria della Misericordia" di Udine, Udine, Italy
| | - Marco Trovò
- SOC Radioterapia, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Universitario "Santa Maria della Misericordia" di Udine, Udine, Italy
| | - Mario Calci
- SOC Pronto Soccorso e Medicina d'Urgenza, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Universitario "Santa Maria della Misericordia" di Udine, Udine, Italy
| | - Renato Fanin
- Clinica di Ematologia, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Universitario "Santa Maria della Misericordia" di Udine, Udine, Italy
| | - Barbara Cappelletto
- SOC Chirurgia Vertebro-Midollare, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Universitario "Santa Maria della Misericordia" di Udine, Udine, Italy
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Keyak JH, Eijansantos ML, Rosecrance KG, Wong D, Feizi S, Meldosian AL, Peddinti P, Les CM, Skinner HB, Sehgal V. A preliminary safety assessment of vertebral augmentation with 32P brachytherapy bone cement. Phys Med Biol 2022; 67. [PMID: 35294928 PMCID: PMC9045587 DOI: 10.1088/1361-6560/ac5e5d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/16/2022] [Indexed: 11/12/2022]
Abstract
Abstract
Comprehensive treatment for vertebral metastatic lesions commonly involves vertebral augmentation (vertebroplasty or kyphoplasty) to relieve pain and stabilize the spine followed by multiple sessions of radiotherapy. We propose to combine vertebral augmentation and radiotherapy into a single treatment by adding 32P, a β-emitting radionuclide, to bone cement, thereby enabling spinal brachytherapy to be performed without irradiating the spinal cord. The goal of this study was to address key dosimetry and safety questions prior to performing extensive animal studies. The 32P was in the form of hydroxyapatite powder activated by neutron bombardment in a nuclear reactor. We performed ex vivo dosimetry experiments to establish criteria for safe placement of the cement within the sheep vertebral body. In an in vivo study, we treated three control ewes and three experimental ewes with brachytherapy cement containing 2.23–3.03 mCi 32P ml−1 to identify the preferred surgical approach, to determine if 32P leaches from the cement and into the blood, urine, or feces, and to identify unexpected adverse effects. Our ex vivo experiments showed that cement with 4 mCi 32P ml−1 could be safely implanted in the vertebral body if the cement surface is at least 4 mm from the spinal cord in sheep and 5 mm from the spinal cord in humans. In vivo, a lateral retroperitoneal surgical approach, ventral to the transverse processes, was identified as easy to perform while allowing a safe distance to the spinal cord. The blood, urine, and feces of the sheep did not contain detectable levels of 32P, and the sheep did not experience any neurologic or other adverse effects from the brachytherapy cement. These results demonstrate, on a preliminary level, the relative safety of this brachytherapy cement and support additional development and testing.
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21
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Kubihal V, Sharma R, Krishna Kumar R, Chandrashekhara S, Garg R. Imaging update in spinal tuberculosis. J Clin Orthop Trauma 2022; 25:101742. [PMID: 34956831 PMCID: PMC8671643 DOI: 10.1016/j.jcot.2021.101742] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 02/07/2023] Open
Abstract
Tuberculosis is ancient disease known to mankind. Diagnosis and management of spinal tuberculosis has immensely improved in last few decades. Imaging, particularly MRI, plays important role in diagnosis of spinal tuberculosis and its complications. Four common imaging patterns of spinal tuberculosis include paradiscal type, central type, Anterior subligamentous type, and posterior type. Imaging also plays important role in differentiation of spinal tuberculosis from its mimics, particularly pyogenic spondylitis, and metastasis. Radiological interventions, such as CT guided vertebral biopsy, and percutaneous drainage of cold abscess, are commonly used in management of spinal tuberculosis. Monitoring of therapeutic response is often based on clinical evaluation and imaging. MRI is most common imaging modality used. Signs of healing include bony ankylosis, resolution of marrow edema, decrease in contrast enhancement, and fatty change with in bone marrow. PET CT is recently evaluated for response assessment with promising results. This review summarizes pathophysiology, clinical presentation, imaging features, radiological interventions, and response assessment in spinal tuberculosis.
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Affiliation(s)
- Vijay Kubihal
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Raju Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - R.G. Krishna Kumar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - S.H. Chandrashekhara
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
- Corresponding author. Department of Radiodiagnosis, IRCH All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Rakesh Garg
- Department of Onco-anesthesiology and Palliative Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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Candido PBM, Peria FM, Pinheiro RP, Costa HRT, Defino HLA. Outcomes and survival of spinal metastasis with epidural compression. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2021; 12:287-293. [PMID: 34728996 PMCID: PMC8501823 DOI: 10.4103/jcvjs.jcvjs_33_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 06/07/2021] [Indexed: 12/02/2022] Open
Abstract
Objective: The goal of the study was to retrospectively evaluate the demographics, clinical manifestation, outcomes, treatment result, and survival of patients with spinal metastasis with epidural metastasis who underwent surgical treatment. Materials and Methods: A retrospective evaluation of 103 patients with spinal metastasis and epidural compression who underwent surgical treatment between 2009 and 2015 was performed. The recorded parameters selected for the study were general demographic data (gender, age, and educational level) and clinical data (primary tumor, performance status according to Karnofsky score, neurological status according to Frankel scale, pain, surgical treatment outcomes, and patient survival). Results: The mean age of the patients was 55.28 ± 15.79 years, and spinal metastasis was more frequent in males (61.7%). The two most frequent tumors were malignant breast cancer (26.21%) and prostate cancer (22.33%). Preoperative pain was presented in 96 (94.12%) patients and improvement was observed in 44 (47.31%) patients. Symptoms of spinal cord compression were the initial clinical manifestation of the primary tumor in 35 (33.98%) patients. Neurological deficit was observed in 66 (64.07%) patients, and improvement was observed in 43 (41.74%) patients. Improvement of functional outcome and pain was observed in 34 (37.38%) patients. The mean survival was 12.26 months. Longer survival (mean 19.13 months) was observed in patients who showed improvement in their ability to walk or kept it preserved (Frankel D or E). Conclusions: Surgical treatment of spinal metastasis can improve pain and functional activities. Longer survival was observed in patients that keep or recovery the walking ability.
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Affiliation(s)
| | - Fernanda Maris Peria
- Division of Clinical Oncology, Department of Medical Images, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Rômulo Pedroza Pinheiro
- Department of Orthopaedic and Anesthesiology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Herton Rodrigo Tavares Costa
- Department of Orthopaedic and Anesthesiology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Helton Luiz Aaparecido Defino
- Department of Orthopaedic and Anesthesiology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
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Akezaki Y, Nakata E, Kikuuchi M, Sugihara S, Katayama Y, Katayama H, Hamada M, Ozaki T. Factors Affecting the Quality of Life of Patients with Painful Spinal Bone Metastases. Healthcare (Basel) 2021; 9:healthcare9111499. [PMID: 34828545 PMCID: PMC8625781 DOI: 10.3390/healthcare9111499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/19/2021] [Accepted: 10/30/2021] [Indexed: 11/21/2022] Open
Abstract
This study examined changes in the quality of life (QOL), as well as the factors affecting QOL, among patients with painful spinal bone metastases without paralysis for 1 month after radiotherapy. Methods: This study included 79 participants (40 male and 39 female; median age, 65 (42–88) years) who had undergone radiotherapy for painful spinal bone metastases without paralysis. Patients’ age, sex, activities of daily living (Barthel index), pain, spinal instability (spinal instability neoplastic score [SINS]), and QOL (EORTC QLQ-C30) were investigated. Results: Having an unstable SINS score was a positive factor for global health status (p < 0.05). The improvement in activities of daily living and response to pain were positive factors for physical function (p < 0.05). A positive effect on emotional function was confirmed among female patients (p < 0.05). Conclusion: Engaging in rehabilitation along with radiotherapy leads to improvements in QOL for patients with spinal bone metastases.
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Affiliation(s)
- Yoshiteru Akezaki
- Division of Physical Therapy, Kochi Professional University of Rehabilitation, Kochi 781-1102, Japan;
| | - Eiji Nakata
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama 700-8558, Japan; (H.K.); (T.O.)
- Correspondence:
| | - Masato Kikuuchi
- Department of Rehabilitation Medicine, National Hospital Organization Shikoku Cancer Center, Ehime 791-0280, Japan; (M.K.); (S.S.)
| | - Shinsuke Sugihara
- Department of Rehabilitation Medicine, National Hospital Organization Shikoku Cancer Center, Ehime 791-0280, Japan; (M.K.); (S.S.)
| | - Yoshimi Katayama
- Department of Rehabilitation Medicine, Okayama University Hospital, Okayama 700-8558, Japan; (Y.K.); (M.H.)
| | - Haruki Katayama
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama 700-8558, Japan; (H.K.); (T.O.)
| | - Masanori Hamada
- Department of Rehabilitation Medicine, Okayama University Hospital, Okayama 700-8558, Japan; (Y.K.); (M.H.)
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama 700-8558, Japan; (H.K.); (T.O.)
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Decision curve analysis to evaluate the clinical benefit of prediction models. Spine J 2021; 21:1643-1648. [PMID: 33676020 PMCID: PMC8413398 DOI: 10.1016/j.spinee.2021.02.024] [Citation(s) in RCA: 114] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/10/2020] [Accepted: 02/27/2021] [Indexed: 02/03/2023]
Abstract
There is increased interest in the use of prediction models to guide clinical decision-making in orthopedics. Prediction models are typically evaluated in terms of their accuracy: discrimination (area-under-the-curve [AUC] or concordance index) and calibration (a plot of predicted vs. observed risk). But it can be hard to know how high an AUC has to be in order to be "high enough" to warrant use of a prediction model, or how much miscalibration would be disqualifying. Decision curve analysis was developed as a method to determine whether use of a prediction model in the clinic to inform decision-making would do more good than harm. Here we give a brief introduction to decision curve analysis, explaining the critical concepts of net benefit and threshold probability. We briefly review some prediction models reported in the orthopedic literature, demonstrating how use of decision curves has allowed conclusions as to the clinical value of a prediction model. Conversely, papers without decision curves were unable to address questions of clinical value. We recommend increased use of decision curve analysis to evaluate prediction models in the orthopedics literature.
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Spinal metastasis: The rise of minimally invasive surgery. Surgeon 2021; 20:328-333. [PMID: 34563452 DOI: 10.1016/j.surge.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 07/31/2021] [Accepted: 08/20/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Bone is the third most common site of metastatic cancer, of which the spine is the most frequently involved. As metastatic cancer prevalence rises and surgical techniques advance, operative intervention for spinal metastases is expected to rise. In the first operative cohort of spinal metastasis in Ireland, we describe the move towards less invasive surgery, the causative primary types and post-operative survival. METHODS This is a retrospective cohort study of all operative interventions for spinal metastasis in a tertiary referral centre over eight years. Primary spinal tumours and local invasion to the spine were excluded. Median follow up was 1895 days. RESULTS 225 operative procedures in 196 patients with spinal metastasis were performed over eight years. Average cases per year increased form 20 per year to 29 per year. Percutaneous procedures became more common, accounting for the majority (53%) in the final two years. The most common primary types were breast, myeloma, lung, prostate and renal. Overall survival at 1 year was 51%. Primary type was a major determinant of survival, with breast and the haematological cancers demonstrating good survival, while lung had the worst prognosis. CONCLUSION This is the first descriptive cohort of operative interventions for spinal metastasis in an Irish context. Surgery for spinal metastasis is performed at an increasing rate, especially through minimally-invasive means. The majority of patients survive for at least one year post-operatively. Prudent resource planning is necessary to prepare for this growing need.
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Elsamadicy AA, Koo AB, David WB, Zogg CK, Kundishora AJ, Hong CS, Kuzmik GA, Gorrepati R, Coutinho PO, Kolb L, Laurans M, Abbed K. Thirty- and 90-day Readmissions After Spinal Surgery for Spine Metastases: A National Trend Analysis of 4423 Patients. Spine (Phila Pa 1976) 2021; 46:828-835. [PMID: 33394977 PMCID: PMC8278805 DOI: 10.1097/brs.0000000000003907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The aim of this study was to investigate differences in 30- and 90-day readmissions for spine metastases treated with decompression and/or fusion spine surgery in a nationwide readmission database. SUMMARY OF BACKGROUND DATA Patients with metastases to the spine represent a particularly vulnerable patient group that may encounter frequent readmissions. However, the 30- and 90-day rates for readmission following surgery for spine metastases have not been well described. METHODS The Nationwide Readmission Database years 2013 to 2015 was queried. Patients were grouped by no readmission (non-R), readmission within 30 days (30-R), and readmission within 31 to 90 days (90-R). Weighted multivariate analysis assessed impact of treatment approach and clinical factors associated with 30- and 90-day readmissions. RESULTS There were a total of 4423 patients with a diagnosis of spine metastases identified who underwent spine surgery, of which 1657 (37.5%) encountered either a 30-or 90-day unplanned readmission (30-R: n = 1068 [24-.1%]; 90-R: n = 589 [13.3%]; non-R: n = 2766). The most prevalent inpatient complications observed were postoperative infection (30-R: 16.3%, 90-R: 14.3%, non-R: 11.5%), acute post-hemorrhagic anemia (30-R: 13.4%, 90-R: 14.2%, non-R: 14.5%), and genitourinary complication (30-R: 5.7%, 90-R: 2.9%, non-R: 6.2%). The most prevalent 30-day and 90-day reasons for admission were sepsis (30-R: 10.2%, 90-R: 10.8%), postoperative infection (30-R: 13.7%, 90-R: 6.5%), and genitourinary complication (30-R: 3.9%, 90-R: 4.1%). On multivariate regression analysis, surgery type, age, hypertension, and renal failure were independently associated with 30-day readmission; rheumatoid arthritis/collagen vascular diseases, and coagulopathy were independently associated with 90-day readmission. CONCLUSION In this study, we demonstrate several patient-level factors independently associated with unplanned hospital readmissions after surgical treatment intervention for spine metastases. Furthermore, we find that the most common reasons for readmission are sepsis, postoperative infection, and genitourinary complications.Level of Evidence: 3.
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A Scoring System for Outpatient Orthopedist to Preliminarily Distinguish Spinal Metastasis from Spinal Tuberculosis: A Retrospective Analysis of 141 Patients. DISEASE MARKERS 2021; 2021:6640254. [PMID: 34136021 PMCID: PMC8179772 DOI: 10.1155/2021/6640254] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/22/2021] [Accepted: 05/13/2021] [Indexed: 11/17/2022]
Abstract
Objective Spinal tuberculosis (TB) misdiagnosed of spinal metastasis was not rarely reported, especially in outpatients department. This study was aimed to establish an outpatient scoring system to preliminarily distinguish spinal metastasis from spinal TB. Methods We retrospectively reviewed consecutive 141 patients with a pathological diagnosis of spinal metastasis (82 cases) or spinal TB (59 cases) in our hospital from January 2017 to June 2018. The following clinical characteristics which can be obtained by outpatient orthopedist were recorded and analyzed: age, gender, malignant tumor history, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and imaging features including distribution characteristics of vertebral lesions, subligamentous spread, paravertebral or psoas abscess, involved vertebral element, intervertebral disc, and sequestra formation. The prevalence of clinical characteristics in spinal metastasis was evaluated, and the scoring system was established using logistic regression analysis. The performance of the scoring system was also prospectively validated. Results The outpatient scoring system was based on five clinical characteristics confirmed as significant predictors of spinal metastasis, namely, malignant tumor history, subligamentous spread, posterior element lesions, preserved discs, and no sequestra formation. Spinal metastasis showed a significant higher score than spinal TB (8.17 points vs. 1.97 points, t = 18.621, P < 0.001), and the optimal cut-off value for the scoring system was 5 points. The sensitivity and specificity of the scoring system for predicting spinal metastasis were 97.85% and 88.33%, respectively, in the validation set. Conclusion Spinal lesions with the score of 5 to 10 would be considered a diagnosis of spinal metastasis, while the score of 0 to 4 may be spinal TB. Because the scoring system is mainly based on the clinical characteristics that can be obtained by an outpatient orthopedist, it is suitable to be used as a diagnostic tool in the outpatient department.
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Li J, Wei W, Xu F, Wang Y, Liu Y, Fu C. Clinical Therapy of Metastatic Spinal Tumors. Front Surg 2021; 8:626873. [PMID: 33937314 PMCID: PMC8084350 DOI: 10.3389/fsurg.2021.626873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
Metastatic spinal tumors (MST) have high rates of morbidity and mortality. MST can destroy the vertebral body or compress the nerve roots, resulting in an increased risk of pathological fractures and intractable pain. Here, we elaborately reviewed the currently available therapeutic options for MST according to the following four aspects: surgical management, minimally invasive therapy (MIT), radiation therapy, and systemic therapy. In particular, these aspects were classified and introduced to show their developmental process, clinical effects, advantages, and current limitations. Furthermore, with the improvement of treatment concepts and techniques, we discovered the prevalent trend toward the use of radiation therapy and MIT in clinic therapies. Finally, the future directions of these treatment options were discussed. We hoped that along with future advances and study will lead to the improvement of living standard and present status of treatment in patients with MST.
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Affiliation(s)
- Jie Li
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun, China.,Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, China
| | - Wenjie Wei
- Key Laboratory of Pathobiology, Ministry of Education, School of Basic Medical Sciences, Jilin University, Changchun, China
| | - Feng Xu
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun, China
| | - Yuanyi Wang
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun, China
| | - Yadong Liu
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun, China
| | - Changfeng Fu
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun, China
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En Bloc Resection of Isolated Spinal Metastasis: A Systematic Review Update. Clin Spine Surg 2021; 34:103-106. [PMID: 32868533 DOI: 10.1097/bsd.0000000000001057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 07/24/2020] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This work was a systematic review. OBJECTIVE The objective of this work was to review the literature on the outcomes of en bloc resection of isolated spinal metastasis. SUMMARY Of background data: En bloc resection of isolated spinal metastasis is rarely performed and its utility debated, with the last review of the literature being performed over a decade ago. With significant advances in adjunctive oncology treatments, an updated review of whether there remains a role for this type of surgery is necessary. METHODS The authors performed a systematic review of English literature over the last decade on en bloc resection of isolated spinal metastasis in adults using the PubMed, Google Scholar, OVID, and Cochrane database. They excluded studies with <5 reported cases. The studies were appraised by 2 coauthors and examined for the patient and tumor characteristics, surgical time, estimated blood loss, length of hospital stay, cost, complications, functional outcomes, rates of local recurrence, metastasis, and survival. RESULTS Only 5 articles (148 patients) were included in this study. The average operative time was 6.5 hours, and estimated blood loss was 1742 mL. Only 73% of patients maintained their functional independence, but 35.1% experienced a complication, 6.1% had local recurrence, and the overall survival was 52% with an average time to death of 15 months. CONCLUSIONS There remains a paucity of data limiting the understanding of the value of en bloc resection for isolated spinal metastasis. However, despite this limitation, our literature review suggests that en bloc resection offers a low local recurrence rate (6.1%) and maintained functional independence (73%), but requires long operative times (mean 6.5 h), causes significant blood loss (mean 1742 mL), and results in high complication rates (35.1%) with poor overall survival (52% with an average time to death of 15 mo).
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Filippiadis D, Kelekis A. Percutaneous bipolar radiofrequency ablation for spine metastatic lesions. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1603-1610. [PMID: 33783627 DOI: 10.1007/s00590-021-02947-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 03/21/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE The purpose of this review is to become familiar with the most common indications for imaging guided percutaneous bipolar radiofrequency ablation, to learn about different technical considerations during performance providing the current evidence. Controversies concerning products will be addressed. METHODS We performed a literature review excluding non-English studies and case reports. All references of the obtained articles were also evaluated for any additional information. RESULTS RFA achieves cytotoxicity by raising target area temperatures above 60 °C, and may be used to achieve total necrosis of lesions smaller than 3 cm in diameter, to debulk and reduce the pain associated with larger lesions, to prevent pathological fractures due to progressive osteolysis or for cavity creation aiming for targeted cement delivery in case of posterior vertebral wall breaching. Protective ancillary techniques should be used in order to increase safety and augment efficacy of RFA in the spine. CONCLUSION Percutaneous radiofrequency ablation of vertebral lesions is a reproducible, successful and safe procedure. Ablation should be combined with vertebral augmentation in all cases. In order to optimize maximum efficacy a patient- and a lesion-tailored approach should both be offered focusing upon clinical and performance status along with life expectancy of the patient as well as upon lesion characteristics.
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Affiliation(s)
- Dimitrios Filippiadis
- 2nd Department of Radiology, Medical School, University General Hospital "ATTIKON", National and Kapodistrian University of Athens, 1 Rimini str, 12462, Athens, Greece.
| | - Alexis Kelekis
- 2nd Department of Radiology, Medical School, University General Hospital "ATTIKON", National and Kapodistrian University of Athens, 1 Rimini str, 12462, Athens, Greece
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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.
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Gong Y, Zhuang H, Chong S, Shi Q, Wei F, Liu Z, Ouyang H, Liu X, Jiang L. Delayed postoperative radiotherapy increases the incidence of radiographic local tumor progression before radiotherapy and leads to poor prognosis in spinal metastases. Radiat Oncol 2021; 16:21. [PMID: 33482844 PMCID: PMC7825226 DOI: 10.1186/s13014-020-01740-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 12/26/2020] [Indexed: 12/28/2022] Open
Abstract
Background Most previous studies focused on the minimum interval between surgery and radiotherapy in spinal metastases, leaving the maximum interval under-investigated. However, in real world, limited radiotherapist and equipment cannot meet the needs of a large patient population to obtain timely radiotherapy after the index spine surgery in developing countries. This study aimed to estimate the clinical risks of delayed radiotherapy after surgery in patients with spinal metastases in developing country. Methods Data from 89 patients who underwent surgery and postoperative radiotherapy at a single site in a developing country were retrospectively reviewed. Patients were divided into the progression before radiotherapy (PBR) and no progression before radiotherapy (NPBR) groups. Kaplan–Meier analysis and log-rank tests were used to compare the local control (LC) and overall survival (OS) between groups. Results Within 1 month after surgery, only 20.2% of patients underwent radiotherapy. Risk of local progression before radiotherapy at 1, 3, and 6 months was 1.2%, 24.1%, and 45.1%, respectively. The LC rate at 1 year was lower in the PBR group than in the NPBR group (53.3% vs. 76.3%, P = 0.040). The OS rate at 1 year was 61.9% and 79.6% in the PBR and NPBR groups, respectively (P = 0.001). The Karnofsky performance status significantly improved only in the NPBR group (52.5 ± 17.6 vs. 66.8 ± 26.3, P < 0.001). The sphincter dysfunction significantly improved in the NPBR group (0.3 ± 0.5 vs. 0.1 ± 0.3, P = 0.007) but it tended to be deteriorated in the PBR group (0.1 ± 0.4 vs. 0.3 ± 0.5, P = 0.500). Conclusions In real world, about 80% of patients had delayed radiotherapy 1 month after spine surgery for metastases in our developing country. Patients had a higher risk for radiographic local progression before radiotherapy and poorer LC, OS, and quality of life as time to radiotherapy increased.
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Affiliation(s)
- Yining Gong
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.,Health Science Center, Peking University, Beijing, China
| | - Hongqing Zhuang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Shan Chong
- Health Science Center, Peking University, Beijing, China
| | - Qianyu Shi
- Health Science Center, Peking University, Beijing, China
| | - Feng Wei
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Zhongjun Liu
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Hanqiang Ouyang
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Xiaoguang Liu
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China. .,The Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Beijing, China.
| | - Liang Jiang
- Department of Orthopedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
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Zeng KL, Sahgal A, Husain ZA, Myrehaug S, Tseng CL, Detsky J, Sarfehnia A, Ruschin M, Campbell M, Foster M, Das S, Lipsman N, Bjarnason GA, Atenafu EG, Maralani PJ, Soliman H. Local control and patterns of failure for "Radioresistant" spinal metastases following stereotactic body radiotherapy compared to a "Radiosensitive" reference. J Neurooncol 2021; 152:173-182. [PMID: 33453002 DOI: 10.1007/s11060-020-03691-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/30/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE The concept of a radioresistant (RR) phenotype has been challenged with use of stereotactic body radiotherapy (SBRT). We compared outcomes following SBRT to RR spinal metastases to a radiosensitive cohort. METHODS Renal cell, melanoma, sarcoma, gastro-intestinal, and thyroid spinal metastases were identified as RR and prostate cancer (PCA) as radiosensitive. The primary endpoint was MRI-based local failure (LF). Secondary endpoints included overall survival (OS) and vertebral compression fracture (VCF). RESULTS From a prospectively maintained database of 1394 spinal segments in 605 patients treated with spine SBRT, 173 patients/395 RR spinal segments were compared to 94 patients/185 PCA segments. Most received 24-28 Gy in 2 fractions (68.9%) and median follow-up was 15.5 months (range, 1.4-84.2 months). 1- and 2-year LF rates were 19.2% and 22.4% for RR metastases, respectively, which were significantly greater (p < 0.001) than PCA (3.2% and 8.4%, respectively). Epidural disease (HR: 2.47, 95% CI 1.65-3.71, p < 0.001) and RR histology (HR: 2.41, 95% CI 1.45-3.99, p < 0.001) predicted for greater LF. Median OS was 17.4 and 61.0 months for RR and PCA cohorts, respectively. Lung/liver metastases, polymetastatic disease and epidural disease predicted for worse OS. 2-year VCF rates were ~ 13% in both cohorts. Coverage of the CTV V90 (clinical target volume receiving 90% of prescription dose) by ≥ 87% (HR: 2.32, 95% CI 1.29-4.18, p = 0.005), no prior spine radiotherapy (HR: 1.96, 95% CI 1.09-3.55, p = 0.025), and a greater Spinal Instability Neoplasia Score (p = 0.013) predicted for VCF. CONCLUSIONS Higher rates of LF were observed after spine SBRT in RR metastases. Optimization strategies include dose escalation and aggressive management of epidural disease.
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Affiliation(s)
- K Liang Zeng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Zain A Husain
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Sten Myrehaug
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Chia-Lin Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Jay Detsky
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Arman Sarfehnia
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Mark Ruschin
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Mikki Campbell
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Monica Foster
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Sunit Das
- Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Nir Lipsman
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Georg A Bjarnason
- Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Pejman Jabehdar Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Hany Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada.
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The rise of metastatic bone disease in Ireland. Clin Exp Metastasis 2020; 37:693-702. [PMID: 33099723 DOI: 10.1007/s10585-020-10059-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/14/2020] [Indexed: 12/24/2022]
Abstract
To describe the expected rise of metastatic bone disease in Ireland, the relative primary types, and the locations of spread within the skeleton. This was a population-based epidemiological study using cancer registry data. We included patients with known metastatic cancer to bone, within 1 year of the primary diagnosis, during the years 1994 to 2012 inclusive. Our main outcome measures were age-specific, gender-specific and age-standardised incidence rates of bone metastasis, primary types and metastatic location within the skeleton. There were 14,495 recognised cases of bone metastasis in Ireland, 1994-2012 inclusive. Cases consistently rose over the time period, with 108% case increase and 51% age-standardised incidence rise. Annual percentage change increased across both genders and over all age groups. Most of this rise was not due to demographic population change. Breast, prostate and lung accounted for the majority of primary types. GI cancers were the fourth most common primary type. There were proportional increases in breast and lung, with proportional decreases in prostate. The spine was the major metastatic site. Bone metastasis is a significant and rising healthcare concern in Ireland. This rise is disproportionate to demographic changes. Breast, prostate and lung cancers account for the majority. GI cancers are implicated in an unexpectedly high number of cases. Spine is the most common location of bony metastasis, especially at presentation. Prudent healthcare planning is necessitated to prepare for the growing consequences of bone metastasis in cancer patients.
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Abstract
The International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) led the development of a framework to help clinicians assess and manage people who may have serious spinal pathology. While rare, serious spinal pathology can have devastating and life-changing or life-limiting consequences, and must be identified early and managed appropriately. Red flags (signs and symptoms that might raise suspicion of serious spinal pathology) have historically been used by clinicians to identify serious spinal pathology. Currently, there is an absence of high-quality evidence for the diagnostic accuracy of most red flags. This framework is intended to provide a clinical-reasoning pathway to clarify the role of red flags. J Orthop Sports Phys Ther 2020;50(7):350-372. Epub 21 May 2020. doi:10.2519/jospt.2020.9971.
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Montaño CJ, Campos TPR, Lemos BRS, Yoshida MI, Almeida NGS, Aguilar MTP, Lima CV. Effects of hydroxyapatite on PMMA-HAp cement for biomedical applications. Biomed Mater Eng 2020; 31:191-201. [PMID: 32568169 DOI: 10.3233/bme-206001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The main goal of this study was to examine the influence of hydroxyapatite (HAp) macroaggreate concentrations on thermal and mechanical properties of radioactive bone cement and to study the relation of glass transition Tg with its mechanical properties. METHODS The bone cement as (1-x)PMMA-xHAp binary system was prepared in six [x] distinct concentration parameters of 0.0 up to 0.5. The HAp was synthesized using a solgel procedure following calcination by thermal treatment. The composite was prepared in cold based (non-radioactive) mixing polymethyl methacrylate (PMMA) and HAp. Differential scanning calorimetry (DSC), thermogravimetric analysis (TGA) and mechanical compressive strength (CS) were used to measure the thermal and mechanical properties. RESULTS The DSC and TGA thermal profiles in function to concentration parameter [x] were presented. The CS lies in a range of 3.71-7.37 MPa and the glass transition temperature Tg = 126.27 °C. There was a direct relationship between the PMMA-HAp thermoplastic properties with mechanical and thermal properties in function of HAp concentrations. CONCLUSION The specific PMMA-HAp composite, with a concentration ratio of 1:1 and HAp thermal treatment at the Tg, provides a material with a compression strength of 7.37 MPa and a suitable amount of porous similar to a trabecular bone, possible to apply in bone cement implants, regardless of whether they are radioactive or not.
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Affiliation(s)
- C J Montaño
- Departamento de Engenharia Nuclear, Universidade Federal de Minas Gerais, Campus Pampulha, Belo Horizonte, Brazil E-mails: , ,
| | - T P R Campos
- Departamento de Engenharia Nuclear, Universidade Federal de Minas Gerais, Campus Pampulha, Belo Horizonte, Brazil E-mails: , ,
| | - B R S Lemos
- Departamento de Química, Universidade Federal de Minas Gerais, Campus Pampulha, Belo Horizonte, Brazil E-mails: ,
| | - M I Yoshida
- Departamento de Química, Universidade Federal de Minas Gerais, Campus Pampulha, Belo Horizonte, Brazil E-mails: ,
| | - N G S Almeida
- Departamento de Engenharia Metalúrgica de Materiais, Universidade Federal de Minas Gerais, Campus Pampulha, Belo Horizonte, Brazil E-mail:
| | - M T P Aguilar
- Departamento de Materiais e Construção, Universidade Federal de Minas Gerais, Campus Pampulha, Belo Horizonte, Brazil E-mail:
| | - C V Lima
- Departamento de Engenharia Nuclear, Universidade Federal de Minas Gerais, Campus Pampulha, Belo Horizonte, Brazil E-mails: , ,
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Chen X, Gui C, Grimm J, Huang E, Kleinberg L, Lo L, Sciubba D, Khan M, Redmond KJ. Normal tissue complication probability of vertebral compression fracture after stereotactic body radiotherapy for de novo spine metastasis. Radiother Oncol 2020; 150:142-149. [PMID: 32540335 DOI: 10.1016/j.radonc.2020.06.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/27/2020] [Accepted: 06/07/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Stereotactic body radiotherapy (SBRT) for spine metastases is associated with post-treatment vertebral compression fracture (VCF). The purpose of this study is to identify clinical and radiation planning characteristics that predict post-SBRT VCF through a novel normal tissue complication probability (NTCP) analysis. METHODS Patients with de novo spine metastases treated with SBRT between 2009 and 2018 at a single institution were included. Those who had surgical stabilization or radiation to the same site prior to SBRT were excluded. VCF was defined as new development or progression of existing vertebral body height loss not attributable to tumor growth. Probit NTCP models were constructed and fitted using a maximum likelihood approach. A multivariate proportional hazard model was used to estimate time to VCF using the Fine and Gray method. RESULTS Three hundred and two vertebral segments from 193 patients were treated with a median dose of 24 Gy in 3 fractions (range 15-30 Gy in 1-5 fractions). With a median follow up of 13.9 months, local control was 89.3% at 1 year. A total of 26 SBRT-induced VCFs were observed, with 1 and 2-year cumulative incidences of 4.6% and 6.7%. NTCP modeling demonstrated a steep response of VCF risk to the dose to 80% and 50% volume of the planning target volume (PTV D80% and D50%), but not maximum dose or dose to 1 cc or 10% of PTV. D80% of 25 Gy and D50% of 28 Gy in 3 fractions corresponded to 10% VCF risk. On multivariate analysis, lower body mass index (HR 0.90 per unit increase, p = 0.04), total spinal instability neoplastic score (SINS, HR 2.44 unstable vs stable, p = 0.04), and PTV D80% (HR 1.11 for every Gy increase, p = 0.003) were associated with increased VCF risk. CONCLUSIONS SBRT provides excellent tumor control for spinal metastases and is associated with low rate of VCF in our cohort. NTCP modeling suggests that the larger volume of spine receiving lower doses are more closely associated with post-SBRT VCF than high dose regions. Under current target delineation methods, common SBRT regimens such as 24 Gy in 2 fractions or 27 Gy in 3 fractions may be inherently associated with VCF risk of 10% or greater. Consensus contouring guidelines should be reevaluated to minimize the volume of irradiated spine in light of these new data.
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Affiliation(s)
- Xuguang Chen
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Chengcheng Gui
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Jimm Grimm
- Department Radiation Oncology, Geisinger Health System, Danville, United States
| | - Ellen Huang
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Lawrence Kleinberg
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Larry Lo
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, United States; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Daniel Sciubba
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, United States; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Majid Khan
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Kristin J Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, United States.
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He S, Ye C, Gao X, Peng D, Wei H, Xu W, Xiao J. Distribution and predictive value of initial presenting symptoms in spinal metastases from primary cancer patients. 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 2020; 29:3148-3156. [PMID: 32377894 DOI: 10.1007/s00586-020-06425-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/29/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Primary cancer patients may have some symptoms and develop spinal metastases in their disease progression. This study was to report the distribution and predictive value of specific initial presenting symptoms in patients with spine metastatic disease. METHODS The clinical information about patients with primary cancers was retrospectively collected and analyzed at their initial diagnosis from January 2008 to December 2017. The distribution and specific value of initial presenting symptoms were analyzed in predicting spinal metastases. RESULTS A total of 14,603 cancer patients were finally included, of whom 1665 (11.4%) cases were confirmed with spinal metastases. 41.55% (6067/14,603) patients had initial presenting symptoms, while 92.19% (1535/1665) patients with spinal metastases presented at least one initial presenting symptoms. Among 6269 patients with symptoms, 1535 (24.49%) were diagnosed with spinal metastases. Factors including primary tumor type, local pain, night-aggravating pain, limb numbness, limb weakness, unstable gait, claudication, loss of sphincter control, and weight loss are associated with the distribution of spinal metastases. The pooled sensitivity, specificity, positive predictive value, and negative predictive value were 90.9% (89.4-92.2%), 64.9% (64.0-65.7%), 24.99% (23.91-26.11%), and 98.23% (97.92-98.50%), respectively. Positive likelihood ratio of "night-aggravating pain" was 33.25 (12.65-87.36) and 17.26 (12.25-24.32) in patients < 45 and 45-64 years old, respectively. CONCLUSIONS The distribution of spinal metastases is associated with primary tumor type and initial presenting symptoms. The predictive value of initial presenting symptoms differs in age groups, but resembles in cancer types. The presence of night-aggravating pain had relative high value in predicting metastases in cancer patients under 65 years old.
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Affiliation(s)
- Shaohui He
- Spinal Tumor Center, Department of Orthopaedic Oncology, Changzheng Hospital, The Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Chen Ye
- Spinal Tumor Center, Department of Orthopaedic Oncology, Changzheng Hospital, The Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Xin Gao
- Spinal Tumor Center, Department of Orthopaedic Oncology, Changzheng Hospital, The Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Dongyu Peng
- Spinal Tumor Center, Department of Orthopaedic Oncology, Changzheng Hospital, The Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China.,Department of Orthopaedics, Chengdu Military General Hospital, 270 Tianhui Road, Chengdu, 610000, China
| | - Haifeng Wei
- Spinal Tumor Center, Department of Orthopaedic Oncology, Changzheng Hospital, The Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China.
| | - Wei Xu
- Spinal Tumor Center, Department of Orthopaedic Oncology, Changzheng Hospital, The Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China.
| | - Jianru Xiao
- Spinal Tumor Center, Department of Orthopaedic Oncology, Changzheng Hospital, The Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China.
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Nori P, Kline-Quiroz C, Stubblefield MD. Cancer Rehabilitation:: Acute and Chronic Issues, Nerve Injury, Radiation Sequelae, Surgical and Chemo-Related, Part 2. Med Clin North Am 2020; 104:251-262. [PMID: 32035567 DOI: 10.1016/j.mcna.2019.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Cancer affects millions of individuals, and approximately half will develop functional impairments. Cancers that commonly, either from direct effects or from its treatments, result in functional impairments include breast, head and neck, brain, and spinal cord tumors. There is a plethora of potential impairments including pain, spasticity, dystonia, weakness, and neurogenic bowel or bladder. This article reviews the functional impairments frequently encountered in breast, head and neck, brain, and spinal cord tumors. The authors also discuss management and treatment options incorporated in comprehensive cancer rehabilitation to address these impairments to maximize and maintain function and quality of life.
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Affiliation(s)
- Phalgun Nori
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA
| | - Cristina Kline-Quiroz
- MedStar Health/Georgetown, National Rehabilitation Hospital, 102 Irving Street Northwest, Washington, DC 20010, USA
| | - Michael D Stubblefield
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Select Medical, Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA.
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Nakata E, Sugihara S, Sugawara Y, Nakahara R, Furumatsu T, Tetsunaga T, Kunisada T, Nakanishi K, Akezaki Y, Ozaki T. Multidisciplinary treatment system for bone metastases for early diagnosis, treatment and prevention of malignant spinal cord compression. Oncol Lett 2020; 19:3137-3144. [PMID: 32218864 PMCID: PMC7068702 DOI: 10.3892/ol.2020.11415] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/29/2019] [Indexed: 01/24/2023] Open
Abstract
Malignant spinal cord compression (MSCC) is a serious complication of cancers. The present study aimed to establish a multidisciplinary treatment system for urgent magnetic resonance imaging (MRI) and referral to orthopedists in order to prevent neurological deficits caused by MSCC. In the present study, the extent to which this system achieved early diagnosis and treatment and prevented MSCC-caused neurological deficits was examined. The records from patients with neurological deficits caused by MSCC before (between April 2007 and March 2012; group A) and after (between April 2012 and March 2017; group B) the establishment of the multidisciplinary system at the Shikoku Cancer Center (Ehime, Japan) were retrospectively evaluated. The numbers of patients with neurological deficits were 38 and 7 in groups A and B, respectively. All patients received radiotherapy. The incidence of neurological deficits was 13.2 and 3.4% in groups A and B, respectively (P<0.001). The proportion of patients with improvement in the severity of neurological deficits was 5.3 and 28.6% in groups A and B, respectively (P<0.001). The interval between physicians' recognition of a neurological deficit and MRI and the start of treatment, the number of cases, and the severity of neurological deficits were evaluated in groups A and B. The median interval between recognition of a neurological deficit by physicians and MRI was 3 and 0 days in groups A and B, respectively (P<0.001). The median interval between physicians' recognition of a neurological deficit and the start of treatment was 3 and 0 days in groups A and B, respectively (P<0.001). By using a multidisciplinary treatment system, the incidence and severity of neurological deficits following treatment were significantly improved. Therefore, the multidisciplinary treatment system used in the present study may be useful for early diagnosis, treatment and prevention of MSCC in patients with bone metastases.
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Affiliation(s)
- Eiji Nakata
- Department of Orthopedic Surgery, Okayama University Hospital, Okayama 700-8558, Japan.,Department of Orthopedic Surgery, Shikoku Cancer Center, Matsuyama, Ehime 791-0280, Japan
| | - Shinsuke Sugihara
- Department of Orthopedic Surgery, Shikoku Cancer Center, Matsuyama, Ehime 791-0280, Japan
| | - Yoshifumi Sugawara
- Department of Radiology, Shikoku Cancer Center, Matsuyama, Ehime 791-0280, Japan
| | - Ryuichi Nakahara
- Department of Orthopedic Surgery, Okayama University Hospital, Okayama 700-8558, Japan
| | - Takayuki Furumatsu
- Department of Orthopedic Surgery, Okayama University Hospital, Okayama 700-8558, Japan
| | - Tomonori Tetsunaga
- Department of Orthopedic Surgery, Okayama University Hospital, Okayama 700-8558, Japan
| | - Toshiyuki Kunisada
- Department of Orthopedic Surgery, Okayama University Hospital, Okayama 700-8558, Japan
| | - Kazuo Nakanishi
- Department of Orthopedic Surgery, Kawasaki Medical School Hospital, Okayama 701-0192, Japan
| | - Yoshiteru Akezaki
- Division of Physical Therapy, Kochi Professional University of Rehabilitation, Tosa, Kochi 781-1102, Japan
| | - Toshifumi Ozaki
- Department of Orthopedic Surgery, Okayama University Hospital, Okayama 700-8558, Japan
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Şentürk S, Ünsal ÜÜ. Percutaneous Endoscopic Interlaminar Decompression of Hypervascular Spinal Metastases. World Neurosurg 2020; 134:182-186. [DOI: 10.1016/j.wneu.2019.10.175] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 10/27/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022]
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External validation of the SORG 90-day and 1-year machine learning algorithms for survival in spinal metastatic disease. Spine J 2020; 20:14-21. [PMID: 31505303 DOI: 10.1016/j.spinee.2019.09.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND CONTEXT Preoperative survival estimation in spinal metastatic disease helps determine the appropriateness of invasive management. The SORG ML 90-day and 1-year machine learning algorithms for survival in spinal metastatic disease were previously developed in a single institutional sample but remain to be externally validated. PURPOSE The purpose of this study was to externally validate these algorithms in an independent population from another institution. STUDY DESIGN/SETTING Retrospective study at a large, tertiary care center. PATIENT SAMPLE Patients 18 years or older who underwent surgery between 2003 and 2016. OUTCOME MEASURES Ninety-day and 1-year mortality. METHODS Baseline characteristics of the validation cohort were compared to the developmental cohort for the SORG ML algorithms. Discrimination (c-statistic and receiver operating curve), calibration (calibration slope, intercept, calibration plot, and observed proportions by predicted risk groups), overall performance (Brier score), and decision curve analysis were used to assess the performance of the SORG ML algorithms in the validation cohort. RESULTS Overall, 176 patients underwent surgery for spinal metastatic disease, of which 44 (22.7%) experienced 90-day mortality and 99 (56.2%) experienced 1-year mortality. The validation cohort differed significantly from the developmental cohort on primary tumor histology, metastatic tumor burden, previous systemic therapy, overall comorbidity burden, and preoperative laboratory characteristics. Despite these differences, the SORG ML algorithms generalized well to the validation cohort on discrimination (c-statistic 0.75-0.81 for 90-day mortality and 0.77-0.78 for 1-year mortality), calibration, Brier score, and decision curve analysis. CONCLUSION AND RELEVANCE Initial results from external validation of the SORG ML 90-day and 1-year algorithms for survival prediction in spinal metastatic disease suggest potential utility of these digital decision aids in clinical practice. Further studies are needed to validate or refute these algorithms in large patient samples from prospective, international, multi-institutional trials.
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Kelly PD, Zuckerman SL, Than KD, Attia A, Jaboin JJ. Metastatic spine disease in lung cancer patients: national patterns of radiation and surgical care. JOURNAL OF SPINE SURGERY 2019; 5:320-328. [PMID: 31663043 DOI: 10.21037/jss.2019.08.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Lung cancer is the most common source of spinal metastases. As our treatment of spinal metastases evolves, national trends in radiation therapy (RT), including spinal stereotactic neurosurgery, have yet to been established. Methods We performed a retrospective review of lung cancer patients within the National Cancer Database (NCDB) between 2004 and 2014 who received radiation to the vertebral column. Results A total of 29,144 lung cancer patients received either external beam RT (EBRT), stereotactic radiosurgery (SRS), or particle-based RT to the spine. EBRT was the most common modality throughout all years, though SRS use increased over time (Spearman's rank correlation, P<0.01). A surgical procedure on a distant metastasis was performed in 1,547 (5.3%) patients. Median survival was 6.24 months for patients receiving EBRT and 9.3 months for those receiving SRS, a significant difference (log rank test, P<0.01), which persisted when adjusting for other predictors (multivariable Cox regression, P<0.01). Conclusions In conclusion, spinal SRS is steadily growing in the treatment of lung metastases to the spine, and surgery on distant metastases is becoming more frequent. There was a survival advantage for patients receiving SRS over EBRT. As the use of SRS-in addition to separation surgery-grows in radioresistant pathology, further study of improved survival and recurrence rates are needed.
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Affiliation(s)
- Patrick D Kelly
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott L Zuckerman
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Khoi D Than
- Department of Neurosurgery, Oregon Health & Science University, Portland, OR, USA
| | - Albert Attia
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jerry J Jaboin
- Department of Radiation Oncology, Oregon Health & Science University, Portland, OR, USA
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Hem S, Beltrame S, Rasmussen J, Vecchi E, Landriel F, Yampolsky C. [Usefulness of minimally invasive spine surgery for the management of thoracolumbar spinal metastases]. Surg Neurol Int 2019; 10:S1-S11. [PMID: 31123635 PMCID: PMC6416751 DOI: 10.4103/sni.sni_288_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Indexed: 11/10/2022] Open
Abstract
Objetivo: Describir los resultados quirúrgicos y evolución de pacientes con metástasis espinales toraco-lumbares operadas con técnica mínimamente invasiva (MISS) utilizando para la decisión terapéutica la evaluación: Neurológica, Oncológica, Mecánica y Sistémica (NOMS). Material y Métodos: Se incluyeron en forma prospectiva pacientes con metástasis espinales toraco-lumbares operados con técnica MISS por el Servicio de Neurocirugía del Hospital Italiano de Buenos Aires entre Junio de 2014 y Junio de 2017. Se utilizó en todos los casos el algoritmo de evaluación NOMS para la decisión terapéutica. Se analizaron los resultados quirúrgicos postoperatorios como el Karnofsky performance status, dolor (VAS – visual analog scale), Frankel, pérdida sanguínea, necesidad de transfusiones, complicaciones, uso de opioides y días de internación. Se consideró como estadísticamente significativo una P < 0.05. Resultados: Durante el período de estudio 26 pacientes cumplieron los criterios de inclusión, de los cuales 13 fueron mujeres. La edad promedio fue 57 (27-83) años. El origen más frecuente de las lesiones fue cáncer de mama (27%). El síntoma más constante fue el dolor (96%), aunque 12 pacientes manifestaron inicialmente mielopatía (46%). Se observaron grados avanzados de invasión del canal con requerimiento de descompresión en el 65% de los casos. Acorde al Spinal Instability Neoplastic Score, 23 pacientes (89%) presentaron lesiones potencialmente inestables o inestables, requiriendo estabilización. Se evidenció una mejoría estadísticamente significativa del VAS en el 77% y del Frankel en el 67% de los casos tras la cirugía. No hubo necesidad de transfusiones. Se registró sólo una complicación quirúrgica leve (4%). La media de internación fue de 5.5 días. Conclusión: En nuestra serie y utilizando como algoritmo terapéutico el NOMS, la cirugía MISS resultó efectiva tanto para la descompresión como para la estabilización espinal, con baja tasa de complicaciones y rápida recuperación postoperatoria.
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Affiliation(s)
- Santiago Hem
- Departamento de Neurocirugía, Hospital Italiano de Buenos Aires, Peron, CABA, Argentina
| | - Sofía Beltrame
- Departamento de Neurocirugía, Hospital Italiano de Buenos Aires, Peron, CABA, Argentina
| | - Jorge Rasmussen
- Departamento de Neurocirugía, Hospital Italiano de Buenos Aires, Peron, CABA, Argentina
| | - Eduardo Vecchi
- Departamento de Neurocirugía, Hospital Italiano de Buenos Aires, Peron, CABA, Argentina
| | - Federico Landriel
- Departamento de Neurocirugía, Hospital Italiano de Buenos Aires, Peron, CABA, Argentina
| | - Claudio Yampolsky
- Departamento de Neurocirugía, Hospital Italiano de Buenos Aires, Peron, CABA, Argentina
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Dieterly AM, Uzunalli G, Kemet CM, Soepriatna AH, Goergen CJ, Lyle LT. Epithelial-mesenchymal Transition Phenotypes in Vertebral Metastases of Lung Cancer. Toxicol Pathol 2019; 47:515-527. [PMID: 31064271 DOI: 10.1177/0192623319838491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Vertebral metastases of non-small cell lung cancer (NSCLC) are frequently diagnosed in the metastatic setting and are commonly identified in the thoracic vertebrae in patients. Treatment of NSCLC bone metastases, which are often multiple, is palliative, and the median survival times are 3 to 6 months. We have characterized spontaneous vertebral metastases in a brain metastases model of NSCLC and correlated these findings with epithelial-mesenchymal transition (EMT). Brain metastases were established in athymic nude mice following intracardiac injection of brain-seeking adenocarcinoma NSCLC cells. Thirty-nine percent of mice (14/36) developed spontaneous vertebral metastases, spinal cord compression, and hind-limb paralysis. Vertebral metastases consisted of an adenocarcinoma phenotype with neoplastic epithelial cells arranged in cords or acini and a mesenchymal phenotype with spindloid neoplastic cells arranged in bundles and streams. Quantitative and qualitative immunohistochemical and immunofluorescence assays demonstrated an increase in vimentin expression compared to cytokeratin expression in vertebral metastases. A correlation with EMT was supported by an increase in CD44 in vertebral metastases and parenchymal metastases. These data demonstrate a translational lung cancer metastasis model with spontaneous vertebral metastasis. The mesenchymal and epithelial phenotype of these spontaneous metastases coupled with EMT provide a conduit to improve drug delivery and overall patient survival.
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Affiliation(s)
- Alexandra M Dieterly
- 1 Department of Comparative Pathobiology, Purdue University College of Veterinary Medicine, West Lafayette, Indiana, USA
| | - Gozde Uzunalli
- 1 Department of Comparative Pathobiology, Purdue University College of Veterinary Medicine, West Lafayette, Indiana, USA
| | - Chinyere M Kemet
- 1 Department of Comparative Pathobiology, Purdue University College of Veterinary Medicine, West Lafayette, Indiana, USA
| | - Arvin H Soepriatna
- 2 Weldon School of Biomedical Engineering, Purdue University College of Engineering, West Lafayette, Indiana, USA
| | - Craig J Goergen
- 2 Weldon School of Biomedical Engineering, Purdue University College of Engineering, West Lafayette, Indiana, USA.,3 Purdue University Center for Cancer Research, West Lafayette, Indiana, USA
| | - L Tiffany Lyle
- 1 Department of Comparative Pathobiology, Purdue University College of Veterinary Medicine, West Lafayette, Indiana, USA.,3 Purdue University Center for Cancer Research, West Lafayette, Indiana, USA.,4 Center for Comparative Translational Research, Purdue University College of Veterinary Medicine, West Lafayette, Indiana, USA
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Yahanda AT, Buchowski JM, Wegner AM. Treatment, complications, and outcomes of metastatic disease of the spine: from Patchell to PROMIS. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:216. [PMID: 31297381 DOI: 10.21037/atm.2019.04.83] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Spinal metastases are common in patients with cancer. As cancer treatments improve and these patients live longer, the number who present with metastatic spine disease will increase. Treatment strategies for these patients continues to evolve. In particular, since the prospective randomized controlled study in 2005 by Patchell et al. showed increased survival with decompressive surgical treatment of spinal metastases, there is a growing body of literature focusing on surgical management and complications of surgery for this disease. Surgery is often one component of a multimodal treatment approach with chemotherapy and radiation, which makes it difficult to parse the benefits of each individual treatment in outcome studies. Additionally, there has been more recent emphasis placed on patient-reported outcomes (PRO) after treatment for metastatic spine disease. In this review, we summarize treatments of metastatic spinal disease, possible perioperative complications, and validated tools used to assess outcomes for these patients.
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Affiliation(s)
- Alexander T Yahanda
- Department of Orthopedic Surgery, Washington University, St. Louis, Missouri, USA
| | - Jacob M Buchowski
- Department of Orthopedic Surgery, Washington University, St. Louis, Missouri, USA
| | - Adam M Wegner
- Department of Orthopedic Surgery, Washington University, St. Louis, Missouri, USA
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Zhou RP, Mummaneni PV, Chen KY, Lau D, Cao K, Amara D, Zhang C, Dhall S, Chou D. Outcomes of Posterior Thoracic Corpectomies for Metastatic Spine Tumors: An Analysis of 90 Patients. World Neurosurg 2019; 123:e371-e378. [DOI: 10.1016/j.wneu.2018.11.172] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 11/17/2018] [Accepted: 11/19/2018] [Indexed: 01/22/2023]
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Karhade AV, Thio QCBS, Kuverji M, Ogink PT, Ferrone ML, Schwab JH. Prognostic value of serum alkaline phosphatase in spinal metastatic disease. Br J Cancer 2019; 120:640-646. [PMID: 30792532 PMCID: PMC6461951 DOI: 10.1038/s41416-019-0407-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 11/09/2022] Open
Abstract
Background Determination of the appropriateness of invasive management in patients with spinal metastatic disease requires accurate pre-operative estimation of survival. The purpose of this study was to examine serum alkaline phosphatase as a prognostic marker in spinal metastatic disease. Methods Chart reviews from two tertiary care centres were used to identify spinal metastatic disease patients. Bivariate and multivariate analyses were used to determine if serum alkaline phosphatase was an independent prognostic marker for survival. Results Overall, 732 patients were included with 90-day and 1-year survival of n = 539 (74.9%) and n = 324 (45.7%), respectively. The 1-year survival of patients in the first quartile of alkaline phosphatase (≤73 IU/L) was 78 (57.8%) compared to 31 (24.0%) for patients in the fourth quartile (>140 IU/L). Preoperative serum alkaline phosphatase levels were significantly elevated in patients with multiple spine metastases, non-spine bone metastasis, and visceral metastasis but not in patients with brain metastasis. On multivariate analysis, elevated serum alkaline phosphatase was identified as an independent prognostic factor for survival in spinal metastatic disease. Conclusion Serum alkaline phosphatase is associated with preoperative metastatic tumour burden and is a biomarker for overall survival in spinal metastatic disease.
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Affiliation(s)
- Aditya V Karhade
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Quirina C B S Thio
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Megna Kuverji
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul T Ogink
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marco L Ferrone
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph H Schwab
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Dai T, Pan T, Zhang X, Chen G, Lu P, Shi K. Feasibility of total en-bloc spondylectomy on L5 by a posterior-only approach: An autopsy study. J Bone Oncol 2019; 14:100204. [PMID: 30627510 PMCID: PMC6260441 DOI: 10.1016/j.jbo.2018.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 12/26/2022] Open
Abstract
Purpose To obtain a better understanding of the structures around L5 vertebra and provide some anatomical evidence of the feasibility of total en-bloc spondylectomy (TES) on L5 in a posterior-only approach. Methods 12 simulated TESs on L5 by a posterior-only approach were conducted on human cadavers. The distance between the traction point of L4 nerve root and the dural sac (Da), the anterior-posterior diameter of the vertebral body,(Va), the distance between the start point of L4 nerve root and the traction point of L5 nerve root (Dh) and the height of the vertebral body (Vh) were measured. Paired t-test and liner regression were performed to determine the difference and correlation between Da and Va, and between Dh and Vh. The risk of nerve roots or blood vessels damages, and the obstruction caused by iliac wings were evaluated. Results Liner correlations were found between Da and Va, and between Dh and Vh. The regression equations were Da = 0.6673Va + 11.28 and Dh = 1.009Vh + 1.003. There are statistical significant differences between Dh and Vh, and between Da and Va in those whose Va < 34.96 mm. Nerve roots or blood vessels damages and the obstruction caused by iliac wing were able to be avoided. Conclusions If the patient has an anterior-posterior diameter of L5 vertebral body shorter than 34.96 mm, it is possible that the vertebral body can be taken out during TES in a posterior-only approach. Prevention of nerve roots or blood vessels damages, and the obstruction caused by iliac wings are difficulties of this procedure yet not insurmountable. TES on L5 by a posterior-only approach might a possible alternative in treating diseases like L5 vertebral body tumors.
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Affiliation(s)
- Teng Dai
- Department of Orthopedics, Nanjing Medical University Affiliated Wuxi Second Hospital, Wuxi 214002, Jiangsu, China
| | - Ting Pan
- Department of Orthopedics, Nanjing Medical University Affiliated Wuxi Second Hospital, Wuxi 214002, Jiangsu, China
| | - Xing Zhang
- Department of Orthopedics, Nanjing Medical University Affiliated Wuxi Second Hospital, Wuxi 214002, Jiangsu, China
| | - Gang Chen
- Department of Orthopedics, Nanjing Medical University Affiliated Wuxi Second Hospital, Wuxi 214002, Jiangsu, China
| | - Pei Lu
- Department of Orthopedics, Nanjing Medical University Affiliated Wuxi Second Hospital, Wuxi 214002, Jiangsu, China
| | - Keqin Shi
- Department of Orthopedics, Nanjing Medical University Affiliated Wuxi Second Hospital, Wuxi 214002, Jiangsu, China
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Montaño CJ, Campos TPRD. RADIOACTIVE CEMENT OF PMMA AND HAP-Sm-153, Ho-166, OR RE-188 FOR BONE METASTASIS TREATMENT. ACTA ORTOPEDICA BRASILEIRA 2019; 27:64-68. [PMID: 30774534 PMCID: PMC6362695 DOI: 10.1590/1413-785220192701190288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Polymethylmetacrylte (PMMA) is used in the fields of dentistry and biomedicine as a constituent of bone cements. Hydroxyapatite (HAp) is a bioceramic produced naturally in the bones. PMMA and HAp are fundamental constituents in the preparation of bone cements. Bisphosphonates have also been used as radiopharmaceutical in dental implants and nuclear medicine, or as palliative systemic treatment for pain reduction in bone metastasis. Vertebroplasty and kyphoplasty are bone cement-based techniques used in orthopedics, being minimally invasive procedures with low risks of infections, applied in osteoporosis and high-impact fractures. Recently, Núcleo de Radiações Ionizantes da Universidade Federal de Minas Gerais proposed a synthetic composite of M-HAp with a metallic nuclide M. After irradiation, M-HAp was added to PMMA, compounding a radioactive bone cement that can recover bone body stabilization, pasting microfractures and recomposing the anatomy and functionality of the affected parts by the compression of bone metastases, with possible pain reduction through quick radiation-induced decompression. Computational dosimetric models, and the synthesis and characterization of bioceramics that incorporate Re-188, Ho-166, or Sm-153 have demonstrated the benefits of these biometrics as promising alternative therapies, mainly from their ability to maintain the ionization in the bone structure, thereby sparing the spinal cord. This article presents a review on this topic. Level of Evidence V, Expert Opinion.
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