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Morimoto T, Toda Y, Hakozaki M, Paholpak P, Watanabe K, Kato K, Tsukamoto M, Hirata H, Kaneuchi Y, Tome Y, Nagamine S, Nishida K, Katsuya H, Matsumoto Y, Otani K, Mawatari M, Nikaido T. A new era in the management of spinal metastasis. Front Oncol 2024; 14:1374915. [PMID: 38694784 PMCID: PMC11062132 DOI: 10.3389/fonc.2024.1374915] [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: 01/23/2024] [Accepted: 04/02/2024] [Indexed: 05/04/2024] Open
Abstract
Despite the recent advances in cancer treatment, the incidence of patients with spinal metastases continues to grow along with the total number of cancer patients. Spinal metastases can significantly impair activities of daily living (ADL) and quality of life (QOL), compared with other types of bone metastases, as they are characterized with severe pain and paralysis caused by skeletal-related events. Reduced ADL can also lead to treatment limitations as certain anticancer agents and radiation therapy are not compatible treatments; thus, leading to a shorter life expectancy. Consequently, maintaining ADLs in patients with spinal metastases is paramount, and spine surgeons have an integral role to play in this regard. However, neurosurgeon, orthopedic and spinal surgeons in Japan do not have a proactive treatment approach to spinal metastases, which may prevent them from providing appropriate treatment when needed (clinical inertia). To overcome such endemic inertia, it is essential for 1) spine surgeons to understand and be more actively involved with patients with musculoskeletal disorders (cancer locomo) and cancer patients; 2) the adoption of a multidisciplinary approach (coordination and meetings not only with the attending oncologist but also with spine surgeons, radiologists, rehabilitation specialists, and other professionals) to preemptive treatment such as medication, radiotherapy, and surgical treatment; and 3) the integration of the latest findings associated with minimally invasive spinal treatments that have expanded the indications for treatment of spinal metastases and improved treatment outcomes. This heralds a new era in the management of spinal metastases.
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Affiliation(s)
- Tadatsugu Morimoto
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Yu Toda
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Michiyuki Hakozaki
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Permsak Paholpak
- Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kazuyuki Watanabe
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kinshi Kato
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Masatsugu Tsukamoto
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Hirohito Hirata
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Yoichi Kaneuchi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yasunori Tome
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Satomi Nagamine
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Kotaro Nishida
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Hiroo Katsuya
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Yoshihiro Matsumoto
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Koji Otani
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Masaaki Mawatari
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Takuya Nikaido
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
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Kosmin M, Padhani AR, Gogbashian A, Woolf D, Ah-See ML, Ostler P, Sutherland S, Miles D, Noble J, Koh DM, Marshall A, Dunn J, Makris A. Comparison of Whole-Body MRI, CT, and Bone Scintigraphy for Response Evaluation of Cancer Therapeutics in Metastatic Breast Cancer to Bone. Radiology 2020; 297:622-629. [PMID: 33078998 DOI: 10.1148/radiol.2020192683] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background CT and bone scintigraphy have limitations in evaluating systemic anticancer therapy (SACT) response in bone metastases from metastatic breast cancer (MBC). Purpose To evaluate whether whole-body MRI enables identification of progressive disease (PD) earlier than CT and bone scintigraphy in bone-only MBC. Materials and Methods This prospective study evaluated participants with bone-only MBC between May 2016 and January 2019 (ClinicalTrials.gov identifier: NCT03266744). Participants were enrolled at initiation of first or subsequent SACT based on standard CT and bone scintigraphy imaging. Baseline whole-body MRI was performed within 2 weeks of entry; those with extraosseous disease were excluded. CT and whole-body MRI were performed every 12 weeks until definitive PD was evident with one or both modalities. In case of PD, bone scintigraphy was used to assess for bone disease progression. Radiologists independently interpreted images from CT, whole-body MRI, or bone scintigraphy and were blinded to results with the other modalities. Systematic differences in performance between modalities were analyzed by using the McNemar test. Results Forty-five participants (mean age, 60 years ± 13 [standard deviation]; all women) were evaluated. Median time on study was 36 weeks (range, 1-120 weeks). Two participants were excluded because of unequivocal evidence of liver metastases at baseline whole-body MRI, two participants were excluded because they had clinical progression before imaging showed PD, and one participant was lost to follow-up. Of the 33 participants with PD at imaging, 67% (22 participants) had PD evident at whole-body MRI only and 33% (11 participants) had PD at CT and whole-body MRI concurrently; none had PD at CT only (P < .001, McNemar test). There was only slight agreement between whole-body MRI and CT (Cohen κ, 0.15). PD at bone scintigraphy was reported in 50% of participants (13 of 26) with bone progression at CT and/or whole-body MRI (P < .001, McNemar test). Conclusion Whole-body MRI enabled identification of progressive disease before CT in most participants with bone-only metastatic breast cancer. Progressive disease at bone scintigraphy was evident in only half of participants with bone progression at whole-body MRI. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Michael Kosmin
- From the Department of Oncology, University College London NHS Foundation Trust, 250 Euston Road, London NW1 2PG, England (M.K.); Paul Strickland Scanner Centre (A.R.P., A.G.) and Breast Cancer Research Unit (P.O., S.S., D.M., A. Makris), Mount Vernon Cancer Centre, Northwood, Middlesex, England; Department of Clinical Oncology, the Christie NHS Foundation Trust, Manchester, England (D.W.); Astra Zeneca UK Limited, Cambridge, England (M.L.A.); the Royal Marsden Hospital, Sutton, Surrey, England (J.N., D.M.K.); and Warwick Clinical Trials Unit, University of Warwick, Coventry, England (A. Marshall, J.D.)
| | - Anwar R Padhani
- From the Department of Oncology, University College London NHS Foundation Trust, 250 Euston Road, London NW1 2PG, England (M.K.); Paul Strickland Scanner Centre (A.R.P., A.G.) and Breast Cancer Research Unit (P.O., S.S., D.M., A. Makris), Mount Vernon Cancer Centre, Northwood, Middlesex, England; Department of Clinical Oncology, the Christie NHS Foundation Trust, Manchester, England (D.W.); Astra Zeneca UK Limited, Cambridge, England (M.L.A.); the Royal Marsden Hospital, Sutton, Surrey, England (J.N., D.M.K.); and Warwick Clinical Trials Unit, University of Warwick, Coventry, England (A. Marshall, J.D.)
| | - Andrew Gogbashian
- From the Department of Oncology, University College London NHS Foundation Trust, 250 Euston Road, London NW1 2PG, England (M.K.); Paul Strickland Scanner Centre (A.R.P., A.G.) and Breast Cancer Research Unit (P.O., S.S., D.M., A. Makris), Mount Vernon Cancer Centre, Northwood, Middlesex, England; Department of Clinical Oncology, the Christie NHS Foundation Trust, Manchester, England (D.W.); Astra Zeneca UK Limited, Cambridge, England (M.L.A.); the Royal Marsden Hospital, Sutton, Surrey, England (J.N., D.M.K.); and Warwick Clinical Trials Unit, University of Warwick, Coventry, England (A. Marshall, J.D.)
| | - David Woolf
- From the Department of Oncology, University College London NHS Foundation Trust, 250 Euston Road, London NW1 2PG, England (M.K.); Paul Strickland Scanner Centre (A.R.P., A.G.) and Breast Cancer Research Unit (P.O., S.S., D.M., A. Makris), Mount Vernon Cancer Centre, Northwood, Middlesex, England; Department of Clinical Oncology, the Christie NHS Foundation Trust, Manchester, England (D.W.); Astra Zeneca UK Limited, Cambridge, England (M.L.A.); the Royal Marsden Hospital, Sutton, Surrey, England (J.N., D.M.K.); and Warwick Clinical Trials Unit, University of Warwick, Coventry, England (A. Marshall, J.D.)
| | - Mei-Lin Ah-See
- From the Department of Oncology, University College London NHS Foundation Trust, 250 Euston Road, London NW1 2PG, England (M.K.); Paul Strickland Scanner Centre (A.R.P., A.G.) and Breast Cancer Research Unit (P.O., S.S., D.M., A. Makris), Mount Vernon Cancer Centre, Northwood, Middlesex, England; Department of Clinical Oncology, the Christie NHS Foundation Trust, Manchester, England (D.W.); Astra Zeneca UK Limited, Cambridge, England (M.L.A.); the Royal Marsden Hospital, Sutton, Surrey, England (J.N., D.M.K.); and Warwick Clinical Trials Unit, University of Warwick, Coventry, England (A. Marshall, J.D.)
| | - Peter Ostler
- From the Department of Oncology, University College London NHS Foundation Trust, 250 Euston Road, London NW1 2PG, England (M.K.); Paul Strickland Scanner Centre (A.R.P., A.G.) and Breast Cancer Research Unit (P.O., S.S., D.M., A. Makris), Mount Vernon Cancer Centre, Northwood, Middlesex, England; Department of Clinical Oncology, the Christie NHS Foundation Trust, Manchester, England (D.W.); Astra Zeneca UK Limited, Cambridge, England (M.L.A.); the Royal Marsden Hospital, Sutton, Surrey, England (J.N., D.M.K.); and Warwick Clinical Trials Unit, University of Warwick, Coventry, England (A. Marshall, J.D.)
| | - Stephanie Sutherland
- From the Department of Oncology, University College London NHS Foundation Trust, 250 Euston Road, London NW1 2PG, England (M.K.); Paul Strickland Scanner Centre (A.R.P., A.G.) and Breast Cancer Research Unit (P.O., S.S., D.M., A. Makris), Mount Vernon Cancer Centre, Northwood, Middlesex, England; Department of Clinical Oncology, the Christie NHS Foundation Trust, Manchester, England (D.W.); Astra Zeneca UK Limited, Cambridge, England (M.L.A.); the Royal Marsden Hospital, Sutton, Surrey, England (J.N., D.M.K.); and Warwick Clinical Trials Unit, University of Warwick, Coventry, England (A. Marshall, J.D.)
| | - David Miles
- From the Department of Oncology, University College London NHS Foundation Trust, 250 Euston Road, London NW1 2PG, England (M.K.); Paul Strickland Scanner Centre (A.R.P., A.G.) and Breast Cancer Research Unit (P.O., S.S., D.M., A. Makris), Mount Vernon Cancer Centre, Northwood, Middlesex, England; Department of Clinical Oncology, the Christie NHS Foundation Trust, Manchester, England (D.W.); Astra Zeneca UK Limited, Cambridge, England (M.L.A.); the Royal Marsden Hospital, Sutton, Surrey, England (J.N., D.M.K.); and Warwick Clinical Trials Unit, University of Warwick, Coventry, England (A. Marshall, J.D.)
| | - Jillian Noble
- From the Department of Oncology, University College London NHS Foundation Trust, 250 Euston Road, London NW1 2PG, England (M.K.); Paul Strickland Scanner Centre (A.R.P., A.G.) and Breast Cancer Research Unit (P.O., S.S., D.M., A. Makris), Mount Vernon Cancer Centre, Northwood, Middlesex, England; Department of Clinical Oncology, the Christie NHS Foundation Trust, Manchester, England (D.W.); Astra Zeneca UK Limited, Cambridge, England (M.L.A.); the Royal Marsden Hospital, Sutton, Surrey, England (J.N., D.M.K.); and Warwick Clinical Trials Unit, University of Warwick, Coventry, England (A. Marshall, J.D.)
| | - Dow-Mu Koh
- From the Department of Oncology, University College London NHS Foundation Trust, 250 Euston Road, London NW1 2PG, England (M.K.); Paul Strickland Scanner Centre (A.R.P., A.G.) and Breast Cancer Research Unit (P.O., S.S., D.M., A. Makris), Mount Vernon Cancer Centre, Northwood, Middlesex, England; Department of Clinical Oncology, the Christie NHS Foundation Trust, Manchester, England (D.W.); Astra Zeneca UK Limited, Cambridge, England (M.L.A.); the Royal Marsden Hospital, Sutton, Surrey, England (J.N., D.M.K.); and Warwick Clinical Trials Unit, University of Warwick, Coventry, England (A. Marshall, J.D.)
| | - Andrea Marshall
- From the Department of Oncology, University College London NHS Foundation Trust, 250 Euston Road, London NW1 2PG, England (M.K.); Paul Strickland Scanner Centre (A.R.P., A.G.) and Breast Cancer Research Unit (P.O., S.S., D.M., A. Makris), Mount Vernon Cancer Centre, Northwood, Middlesex, England; Department of Clinical Oncology, the Christie NHS Foundation Trust, Manchester, England (D.W.); Astra Zeneca UK Limited, Cambridge, England (M.L.A.); the Royal Marsden Hospital, Sutton, Surrey, England (J.N., D.M.K.); and Warwick Clinical Trials Unit, University of Warwick, Coventry, England (A. Marshall, J.D.)
| | - Janet Dunn
- From the Department of Oncology, University College London NHS Foundation Trust, 250 Euston Road, London NW1 2PG, England (M.K.); Paul Strickland Scanner Centre (A.R.P., A.G.) and Breast Cancer Research Unit (P.O., S.S., D.M., A. Makris), Mount Vernon Cancer Centre, Northwood, Middlesex, England; Department of Clinical Oncology, the Christie NHS Foundation Trust, Manchester, England (D.W.); Astra Zeneca UK Limited, Cambridge, England (M.L.A.); the Royal Marsden Hospital, Sutton, Surrey, England (J.N., D.M.K.); and Warwick Clinical Trials Unit, University of Warwick, Coventry, England (A. Marshall, J.D.)
| | - Andreas Makris
- From the Department of Oncology, University College London NHS Foundation Trust, 250 Euston Road, London NW1 2PG, England (M.K.); Paul Strickland Scanner Centre (A.R.P., A.G.) and Breast Cancer Research Unit (P.O., S.S., D.M., A. Makris), Mount Vernon Cancer Centre, Northwood, Middlesex, England; Department of Clinical Oncology, the Christie NHS Foundation Trust, Manchester, England (D.W.); Astra Zeneca UK Limited, Cambridge, England (M.L.A.); the Royal Marsden Hospital, Sutton, Surrey, England (J.N., D.M.K.); and Warwick Clinical Trials Unit, University of Warwick, Coventry, England (A. Marshall, J.D.)
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