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Van den Brande R, Van den Kieboom M, Peeters M, Billiet C, Van de Kelft E. Remineralization of lytic spinal metastases after radiation therapy - A retrospective cohort study comparing conventional external beam radiation therapy with stereotactic ablative body radiation. Clin Transl Radiat Oncol 2024; 48:100805. [PMID: 38988807 PMCID: PMC11231653 DOI: 10.1016/j.ctro.2024.100805] [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: 04/03/2024] [Revised: 06/06/2024] [Accepted: 06/08/2024] [Indexed: 07/12/2024] Open
Abstract
Introduction Osteolytic spinal metastases (SM) have a higher risk of fracture. In this study we aim to confirm the remineralization of lytic SM after radiation therapy. Secondary the influence of SBRT compared to cEBRT and tumor type will be analyzed. Methods A retrospective cohort study was performed. Results 87 patients, 100 SM were included. 29 received SBRT, 71 cEBRT. Most common primary tumors were breast (35 %), lung (26 %) and renal (11 %). Both cEBRT and SBRT resulted in a significant increase of bone mineral density (BMD) (83.76 HU ± 5.72 → 241.41 HU ± 22.58 (p < 0.001) and 82.45 ± 9.13 → 179.38 ± 47.83p = 0.026). There was a significant increase in absolute difference of BMD between the SM and reference vertebrae (p < 0.001). There was no significant difference between SBRT and cEBRT. There was no increase of BMD in renal lytic SM after radiation therapy (pre-treatment: 85.96 HU ± 19.07; 3 m 92.00 HU ± 21.86 (p = 0.882); 6 m 92.06 HU ± 23.94 (p = 0.902); 9 m 70.44 HU ± 7.45 (p = 0.213); 12 m 98.08 HU ± 11.24 (p = 0.740)). In all other primary tumors, a significant increase of BMD after radiation therapy was demonstrated (p < 0,05). Conclusion We conclude that the BMD of lytic SM increases significantly after radiation therapy. Lytic SM of primary renal tumors are the exception; there is no significant remineralization of renal lytic SM after radiation therapy. There is no benefit of SBRT over cEBRT in this remineralization. These findings should be taken into account when deciding on surgery in the potentially unstable group defined by the spinal instability neoplastic score.
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Affiliation(s)
- Ruben Van den Brande
- University of Antwerp, Belgium
- Department of Neurosurgery, AZ KLINA, Brasschaat, Belgium
| | | | - Marc Peeters
- University of Antwerp, Belgium
- Department of Oncology, Antwerp University Hospital, Belgium
| | - Charlotte Billiet
- University of Antwerp, Belgium
- Department of Radiation Oncology, Iridium Netwerk, University of Antwerp, Belgium
| | - Erik Van de Kelft
- University of Antwerp, Belgium
- Department of Neurosurgery, Vitaz, Sint-Niklaas, Belgium
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Tsuang FY, Huang YC, Liao TW, Lin YH, Lee CW. Association of CT-DSA vascular assessment and perioperative outcomes in metastatic spinal surgery. Eur J Radiol 2024; 178:111639. [PMID: 39053307 DOI: 10.1016/j.ejrad.2024.111639] [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: 11/30/2023] [Revised: 03/19/2024] [Accepted: 07/18/2024] [Indexed: 07/27/2024]
Abstract
INTRODUCTION Computed tomography-digital subtraction angiography (CT-DSA) is a radiological method for assessing spinal metastatic tumor vascularity. The study aimed to investigate the association between CT-DSA results and perioperative outcomes in spinal metastatic surgery. MATERIAL AND METHODS Patients who underwent spinal metastatic operations with preoperative CT-DSA examinations at any time between January 2018 to December 2022. CT-DSA was classified into five grades ranging from grade 0 to grade 4. Grades 3 and 4 were indicative of hypervascularity. We analyzed the perioperative outcomes of intraoperative blood loss amount, massive hemorrhage (≥2500 ml) occurrence, blood transfusion status, operation time, hospital stay duration, and 30-day and 60-day mortality rates. Logistic regression analyses were conducted to identify factors affecting the likelihood of massive hemorrhage in conjunction with CT-DSA. RESULTS Data from 212 operations involving 209 patients were analyzed. In total, 30, 36, 66, 56, and 24 operations had CT-DSA grades from grade 0 to grade 4, respectively. Eighty (38 %) studies were indicative of hypervascularity. CT-DSA grade was positively correlated with the amount of operative blood loss, the occurrence of massive hemorrhage, and the amount of blood in blood transfusion (p < 0.05). However, CT-DSA grades was not significantly associated with operation duration or mortality rate. A multivariable analysis indicated that factors such as hemoglobulin, hypervascular pathology, and spinal instability neoplastic scores were positively correlated with CT-DSA grade. CT-DSA grade (odds ratio: 2.37, p = 0.02), spinal metastatic invasiveness index, and tumor size (≥50 mL) were found to be independent predictors in a multivariable logistic regression analysis where factors associated with massive hemorrhage were included. Hypervascular pathology type was not significantly associated with the likelihood of hemorrhage in the univariable and multivariable analyses. CONCLUSIONS CT-DSA serves as an effective tool for assessing vascularity, and is associated with intra-operative blood loss and likelihood of experiencing massive hemorrhage. The predictive capability of CT-DSA surpasses that of traditional histopathology classifications, making it a useful method for preoperative planning in spinal metastatic surgeries.
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Affiliation(s)
- Fon-Yih Tsuang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan; Spine Tumor Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Cheng Huang
- Spine Tumor Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Medical Imaging, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Ting-Wei Liao
- Spine Tumor Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Heng Lin
- Spine Tumor Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan.
| | - Chung-Wei Lee
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
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Hirota R, Oshigiri T, Iesato N, Emori M, Teramoto A, Shiratani Y, Suzuki A, Terai H, Shimizu T, Kakutani K, Kanda Y, Tominaga H, Kawamura I, Ishihara M, Paku M, Takahashi Y, Funayama T, Miura K, Shirasawa E, Inoue H, Kimura A, Iimura T, Moridaira H, Nakajima H, Watanabe S, Akeda K, Takegami N, Nakanishi K, Sawada H, Matsumoto K, Funaba M, Suzuki H, Funao H, Hirai T, Otsuki B, Kobayakawa K, Uotani K, Manabe H, Tanishima S, Hashimoto K, Iwai C, Yamabe D, Hiyama A, Seki S, Goto Y, Miyazaki M, Watanabe K, Nakamae T, Kaito T, Nakashima H, Nagoshi N, Kato S, Imagama S, Watanabe K, Inoue G, Furuya T. Impact of surgical treatment on patient reported outcome in patients with spinal metastases from prostate cancer. J Orthop Sci 2024:S0949-2658(24)00152-0. [PMID: 39138048 DOI: 10.1016/j.jos.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/19/2024] [Accepted: 07/30/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVE This study aimed to elucidate postoperative outcomes in patients with spinal metastases of prostate cancer, with a focus on patient-oriented assessments. METHODS This was a prospective multicenter registry study involving 35 centers. A total of 413 patients enrolled in the Japanese Association for Spine Surgery and Oncology Multicenter Prospective Study of Surgery for Metastatic Spinal Tumors were evaluated for inclusion. The eligible patients were followed for at least 1 year after surgery. The Frankel Classification, Eastern Cooperative Oncology Group Performance Status, visual analog scale for pain, face scale, Barthel Index, vitality index, indications for oral pain medication, and the EQ-5D-5L questionnaire were used for evaluating functional status, activities of daily living, and patient motivation. RESULTS Of the 413 eligible patients, 41 with primary prostate cancer were included in the study. The patient-oriented assessments indicated that the patients experienced postoperative improvements in quality of life and motivation in most items, with the improvements extending for up to 6 months. More than half of the patients with Frankel classifications B or C showed improved neurological function at 1 month after surgery, and most patients presented maintained or improved their classification at 6 months. CONCLUSION Surgical intervention for spinal metastases of prostate cancer significantly improved neurological function, quality of life, and motivation of the patients. Consequently, our results support the validity of surgical intervention for improving the neurological function and overall well-being of patients with spinal metastases of prostate cancer.
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Affiliation(s)
- Ryosuke Hirota
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, S1 W16, Chuo-ku, Sapporo-shi, Hokkaido, 060-8543, Japan; Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, 06405, USA.
| | - Tsutomu Oshigiri
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, S1 W16, Chuo-ku, Sapporo-shi, Hokkaido, 060-8543, Japan; Department of Orthopaedic Surgery, Chitose City Hospital, Sapporo, Hokkaido, 066-8550, Japan
| | - Noriyuki Iesato
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, S1 W16, Chuo-ku, Sapporo-shi, Hokkaido, 060-8543, Japan
| | - Makoto Emori
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, S1 W16, Chuo-ku, Sapporo-shi, Hokkaido, 060-8543, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, S1 W16, Chuo-ku, Sapporo-shi, Hokkaido, 060-8543, Japan
| | - Yuki Shiratani
- Department of Orthopaedic Surgery, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba-shi, 260-8670, Japan
| | - Akinobu Suzuki
- Department of Orthopaedic Surgery, Osaka Metropolitan University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Hidetomi Terai
- Department of Orthopaedic Surgery, Osaka Metropolitan University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Takaki Shimizu
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Kenichiro Kakutani
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yutaro Kanda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Hiroyuki Tominaga
- Department of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Ichiro Kawamura
- Department of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Masayuki Ishihara
- Depertment of Orthopaedic Surgery, Kansai Medial University Hospital, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Masaaki Paku
- Depertment of Orthopaedic Surgery, Kansai Medial University Hospital, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Yohei Takahashi
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Toru Funayama
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058575, Japan
| | - Kousei Miura
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058575, Japan
| | - Eiki Shirasawa
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Hirokazu Inoue
- Rehabilitation Center, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotuke-shi, 329-0498, Japan
| | - Atsushi Kimura
- Department of Orthopaedics, Jichi Medical University, 3311-1 Yakushiji, Shimotuke-shi, 329-0498, Japan
| | - Takuya Iimura
- Department of Orthopaedic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsugagun, Tochigi, 321-0293, Japan
| | - Hiroshi Moridaira
- Department of Orthopaedic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsugagun, Tochigi, 321-0293, Japan
| | - Hideaki Nakajima
- Department of Orthopaedics and Rehabilitation Medicine, University of Fukui Faculty of Medical Sciences, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Shuji Watanabe
- Department of Orthopaedics and Rehabilitation Medicine, University of Fukui Faculty of Medical Sciences, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Koji Akeda
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, 514-8507, Japan
| | - Norihiko Takegami
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, 514-8507, Japan
| | - Kazuo Nakanishi
- Department of Orthopaedic Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Hirokatsu Sawada
- Department of Orthopaedic Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Koji Matsumoto
- Department of Orthopaedic Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Masahiro Funaba
- Department of Orthopaedics Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube City, Yamaguchi, 755-8505, Japan
| | - Hidenori Suzuki
- Department of Orthopaedics Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube City, Yamaguchi, 755-8505, Japan
| | - Haruki Funao
- Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita City, Chiba, 286-8520, Japan
| | - Takashi Hirai
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Bungo Otsuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-kawaracho, Sakyo, Kyoto, 606-8507, Japan
| | - Kazu Kobayakawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Koji Uotani
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, 700-8558, Japan
| | - Hiroaki Manabe
- Department of Orthopedics, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Shinji Tanishima
- Division of Orthopedic Surgery, Department of Sensory and Motor Organs, School of Medicine, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Ko Hashimoto
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Chizuo Iwai
- Department of Orthopaedic Surgery, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Daisuke Yamabe
- Department of Orthopaedic Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwagun, Iwate, 028-3609, Japan
| | - Akihiko Hiyama
- Department of Orthopaedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Shoji Seki
- Department of Orthopaedic Surgery, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Yuta Goto
- Department of Orthopaedic Surgery, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Masashi Miyazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan
| | - Kazuyuki Watanabe
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima City, 960-1295, Japan
| | - Toshio Nakamae
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Takashi Kaito
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hiroaki Nakashima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Show-ku, Nagoya City, 466-8550, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Satoshi Kato
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Show-ku, Nagoya City, 466-8550, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba-shi, 260-8670, Japan
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Fenn BP, Karhade AV, Groot OQ, Collins AK, Balboni TA, Oh KS, Ferrone ML, Schwab JH. Survival in Patients With Spinal Metastatic Disease Treated Nonoperatively With Radiotherapy: Are the SORG-ML Algorithms Relevant? Clin Spine Surg 2024; 37:E290-E296. [PMID: 38321614 DOI: 10.1097/bsd.0000000000001575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/29/2023] [Indexed: 02/08/2024]
Abstract
SUMMARY OF BACKGROUND DATA The SORG-ML algorithms for survival in spinal metastatic disease were developed in patients who underwent surgery and were externally validated for patients managed operatively. OBJECTIVE To externally validate the SORG-ML algorithms for survival in spinal metastatic disease in patients managed nonoperatively with radiation. STUDY DESIGN Retrospective cohort. METHODS The performance of the SORG-ML algorithms was assessed by discrimination [receiver operating curves and area under the receiver operating curve (AUC)], calibration (calibration plots), decision curve analysis, and overall performance (Brier score). The primary outcomes were 90-day and 1-year mortality. RESULTS Overall, 2074 adult patients underwent radiation for spinal metastatic disease and 29% (n=521) and 59% (n=917) had 90-day and 1-year mortality, respectively. On complete case analysis (n=415), the AUC was 0.76 (95% CI: 0.71-0.80) and 0.78 (95% CI: 0.73-0.83) for 90-day and 1-year mortality with fair calibration and positive net benefit confirmed by the decision curve analysis. With multiple imputation (n=2074), the AUC was 0.85 (95% CI: 0.83-0.87) and 0.87 (95% CI: 0.85-0.89) for 90-day and 1-year mortality with fair calibration and positive net benefit confirmed by the decision curve analysis. CONCLUSION The SORG-ML algorithms for survival in spinal metastatic disease generalize well to patients managed nonoperatively with radiation.
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Affiliation(s)
- Brian P Fenn
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School
- Tufts University School of Medicine
| | - Aditya V Karhade
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School
- Department of Orthopedic Surgery, Harvard Combined Orthopaedic Residency Program
| | - Olivier Q Groot
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School
| | - Austin K Collins
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School
| | - Tracy A Balboni
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Cancer Center
| | - Kevin S Oh
- Department of Radiation Oncology, Massachusetts General Hospital
| | - Marco L Ferrone
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School
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Chen H, Atenafu EG, Zeng KL, Chan A, Detsky J, Myrehaug S, Soliman H, Tseng CL, Sahgal A, Maralani PJ. Magnetic Resonance Imaging Frequency After Stereotactic Body Radiation Therapy for Spine Metastases. Int J Radiat Oncol Biol Phys 2024; 119:1413-1421. [PMID: 38373656 DOI: 10.1016/j.ijrobp.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/03/2024] [Accepted: 02/08/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE Stereotactic body radiation therapy (SBRT) is increasingly being used to treat spine metastases. Current post-SBRT imaging surveillance strategies in this patient population may benefit from a more data-driven and personalized approach. The objective of this study was to develop risk-stratified post-SBRT magnetic resonance imaging (MRI) surveillance strategies using quantitative methods. METHODS AND MATERIALS Adult patients with bony spine metastases treated with SBRT between 2008 and 2021 and who had at least 2 follow-up spine MRIs were reviewed retrospectively. A recursive partitioning analysis model was developed to separate patients into different risk categories for post-SBRT progression anywhere within the spine. Imaging intervals were derived for each risk category using parametric survival regression based on multiple expected spine progression rates per scan. RESULTS A total of 446 patients and 1039 vertebral segments were included. Cumulative incidence of spine progression was 19.2% at 1 year, 26.7% at 2 years, and 35.3% at 4 years. The internally validated risk stratification model was able to divide patients into 3 risk categories based on epidural disease, paraspinal disease, and Spinal Instability Neoplastic Score category. The 4-year risk of spine progression was 23.4%, 39.0%, and 51.8%, respectively, for the low-, intermediate-, and high-risk groups. Using an expected per-scan spine progression rate of 3.75%, the low-risk group would require follow-up scans every 6.0 months (95% CI, 4.9-7.6) and the intermediate-risk group would require surveillance every 3.1 months (95% CI, 2.6-3.7). At an expected spine progression rate of 5%, the high-risk group would require surveillance every 1.3 months (95% CI, 1.1-1.6) during the first 13.2 months after SBRT and every 5.9 months thereafter (95% CI, 2.8-12.3). CONCLUSIONS Data-driven follow-up MRI surveillance intervals at a range of expected spine progression rates have been determined for patients at different risks of spine progression based on an internally validated, single-institution risk stratification model.
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Affiliation(s)
- Hanbo Chen
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada.
| | - Eshetu G Atenafu
- Department of Biostatistics, University Health Network, University of Toronto, Toronto, Ontario Canada
| | - K Liang Zeng
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Aimee Chan
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jay Detsky
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Sten Myrehaug
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Hany Soliman
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Chia-Lin Tseng
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Pejman J Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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6
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Gendreau JL, Patel N, Brown NJ, Lee SJ, Sahyouni R, Chan AK, Clifton WE, Chen S. Surgical Intervention for Primary B-cell Lymphoma of the Spine: A Systematic Review and Meta-analysis of Clinical Presentation, Treatment, Postoperative Outcomes, and Histologic Markers. Clin Spine Surg 2024; 37:296-304. [PMID: 37684726 DOI: 10.1097/bsd.0000000000001522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 07/19/2023] [Indexed: 09/10/2023]
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE To perform a systematic review of the clinical symptoms, radiographic findings, and outcomes after spinal decompression in B-cell lymphoma. SUMMARY OF BACKGROUND DATA B-cell lymphoma is a potential cause of spinal cord compression that presents ambiguously with nonspecific symptoms and variable imaging findings. Surgical decompression is a mainstay for both diagnosis and management, especially in patients with acute neurological deficits; however, the efficacy of surgical intervention compared with nonoperative management is still unclear. METHODS The databases of Medline, PubMed, and the Cochrane Database of Systemic Reviews were queried for all articles reporting spinal B-cell lymphoma. Data on presenting symptoms, treatments, survival outcomes, and histologic markers were extracted. Using the R software "survival" package, we generated bivariate and multivariate Cox survival regression models and Kaplan-Meier curves. RESULTS In total, 65 studies were included with 72 patients diagnosed with spinal B-cell lymphoma. The mean age was 56.22 (interquartile range: 45.00-70.25) with 68% of patients being males and 4.2% of patients being immunocompromised. Back pain was the most common symptom (74%), whereas B symptoms and cauda equina symptoms were present in 6% and 29%, respectively. The average duration of symptoms before presentation was 3.81 months (interquartile range: 0.45-3.25). The most common location was the thoracic spine (53%), with most lesions being hyperintense (28%) on T2 magnetic resonance imaging. Surgical resection was performed in 83% of patients. Symptoms improved in 91% of patients after surgery and in 80% of patients treated nonoperatively. For all 72 patients, the overall survival at 1 and 5 years was 85% (95% CI: 0.749-0.953; n = 72) and 66% (95% CI: 0.512-0.847; n = 72), respectively. CONCLUSION Although surgery is usually offered in patients with acute spinal cord compression from B-cell lymphoma, chemotherapy and radiation alone offer a hopeful alternative to achieve symptomatic relief, particularly in patients who are unable to undergo surgery.
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Affiliation(s)
- Julian L Gendreau
- Department of Biomedical Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, MD
| | - Neal Patel
- Department of Neurosurgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Nolan J Brown
- Department of Neurosurgery, University of California Irvine, Irvine, CA
| | - Seung Jin Lee
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL
| | - Ronald Sahyouni
- Department of Neurosurgery, University of California San Diego, La Jolla, CA
| | - Andrew K Chan
- Department of Neurological Surgery, Neurological Institute of New York, New York-Presbyterian Columbia University Irving Medical Center, New York, NY
| | - William E Clifton
- Department of Neurological Surgery, Neurological Institute of New York, New York-Presbyterian Columbia University Irving Medical Center, New York, NY
| | - Selby Chen
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL
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De la Garza Ramos R, Ryvlin J, Bangash AH, Hamad MK, Fourman MS, Shin JH, Gelfand Y, Murthy S, Yassari R. Predictors of Clavien-Dindo Grade III-IV or Grade V Complications after Metastatic Spinal Tumor Surgery: An Analysis of Sociodemographic, Socioeconomic, Clinical, Oncologic, and Operative Parameters. Cancers (Basel) 2024; 16:2741. [PMID: 39123469 PMCID: PMC11311255 DOI: 10.3390/cancers16152741] [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: 06/02/2024] [Revised: 07/28/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024] Open
Abstract
The rate of major complications and 30-day mortality after surgery for metastatic spinal tumors is relatively high. While most studies have focused on baseline comorbid conditions and operative parameters as risk factors, there is limited data on the influence of other parameters such as sociodemographic or socioeconomic data on outcomes. We retrospectively analyzed data from 165 patients who underwent surgery for spinal metastases between 2012-2023. The primary outcome was development of major complications (i.e., Clavien-Dindo Grade III-IV complications), and the secondary outcome was 30-day mortality (i.e., Clavien-Dindo Grade V complications). An exploratory data analysis that included sociodemographic, socioeconomic, clinical, oncologic, and operative parameters was performed. Following multivariable analysis, independent predictors of Clavien-Dindo Grade III-IV complications were Frankel Grade A-C, lower modified Bauer score, and lower Prognostic Nutritional Index. Independent predictors of Clavien-Dindo Grade V complications) were lung primary cancer, lower modified Bauer score, lower Prognostic Nutritional Index, and use of internal fixation. No sociodemographic or socioeconomic factor was associated with either outcome. Sociodemographic and socioeconomic factors did not impact short-term surgical outcomes for metastatic spinal tumor patients in this study. Optimization of modifiable factors like nutritional status may be more important in improving outcomes in this complex patient population.
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Affiliation(s)
- Rafael De la Garza Ramos
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA; (J.R.); (A.H.B.); (M.K.H.); (M.S.F.); (Y.G.); (S.M.); (R.Y.)
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | - Jessica Ryvlin
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA; (J.R.); (A.H.B.); (M.K.H.); (M.S.F.); (Y.G.); (S.M.); (R.Y.)
| | - Ali Haider Bangash
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA; (J.R.); (A.H.B.); (M.K.H.); (M.S.F.); (Y.G.); (S.M.); (R.Y.)
| | - Mousa K. Hamad
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA; (J.R.); (A.H.B.); (M.K.H.); (M.S.F.); (Y.G.); (S.M.); (R.Y.)
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | - Mitchell S. Fourman
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA; (J.R.); (A.H.B.); (M.K.H.); (M.S.F.); (Y.G.); (S.M.); (R.Y.)
- Department of Orthopedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | - John H. Shin
- Department of Neurological Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Yaroslav Gelfand
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA; (J.R.); (A.H.B.); (M.K.H.); (M.S.F.); (Y.G.); (S.M.); (R.Y.)
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | - Saikiran Murthy
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA; (J.R.); (A.H.B.); (M.K.H.); (M.S.F.); (Y.G.); (S.M.); (R.Y.)
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | - Reza Yassari
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA; (J.R.); (A.H.B.); (M.K.H.); (M.S.F.); (Y.G.); (S.M.); (R.Y.)
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA
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Denti M, Pecorari A, Accogli MA, Costi S, Mainini C, Pellegrini M, Boni C, Barbara B, Braglia L, Fugazzaro S. Facing the COVID-19 pandemic: An Italian feasibility study of a mixed in-person/telerehabilitation intervention for cancer patients. Cancer Med 2024; 13:e70022. [PMID: 39095954 PMCID: PMC11296954 DOI: 10.1002/cam4.70022] [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: 02/21/2024] [Revised: 06/23/2024] [Accepted: 07/04/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION The COVID-19 pandemic impacted healthcare organizations, necessitating a rapid transition from in-person to virtual care. Our study explored the feasibility of a mixed in-person/telerehabilitation intervention for cancer patients and its effects on cancer-related fatigue (CRF), quality of life (QoL), physical function, patient satisfaction, and perceived usefulness. METHODS TRACE 2020 is an observational prospective study that enrolled adult cancer patients, between January 2021 and March 2023, who were eligible for a rehabilitation program to be provided also in telerehabilitation. Patients were assessed at baseline and after the rehabilitation program. Adherence to sessions, reasons for non-adherence and adverse events were collected. RESULTS Of the 23 patients enrolled, 87% received a mixed intervention, with an average of 60% in-person sessions and 40% telerehabilitation sessions. Adherence was very high (91%). Evaluation scales showed an improvement in CRF, QoL, and lower limb strength and a relevant increase in patients' level of physical activity (PA). Most patients reported good satisfaction; the few criticisms mainly concerned difficulties in connectivity, lack of physical contact and difficulties in understanding how to perform exercises during telerehabilitation sessions. The physiotherapist underlined the usefulness of the innovative approach and suggested ways to facilitate future implementation. CONCLUSION A mixed intervention including telerehabilitation is feasible and accepted by cancer patients. It may have a positive effect on their CRF, QoL, and level of PA and render patient care more flexible. The findings suggest what characteristics the target population for telerehabilitation should have, in order to integrate telerehabilitation in standard care for cancer patients.
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Affiliation(s)
- Monica Denti
- Physical Medicine and Rehabilitation UnitAzienda Unità Sanitaria Locale—IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Alessia Pecorari
- Physical Medicine and Rehabilitation UnitAzienda Unità Sanitaria Locale—IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Monia A. Accogli
- Physical Medicine and Rehabilitation UnitAzienda Unità Sanitaria Locale—IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Stefania Costi
- Physical Medicine and Rehabilitation UnitAzienda Unità Sanitaria Locale—IRCCS di Reggio EmiliaReggio EmiliaItaly
- Unit of Dentistry and Oral‐Maxillo‐Facial Surgery, Department of Surgery, Medicine, Dentistry and Morphological Sciences, with Transplant Surgery, Oncology and Regenerative Medicine Relevance (CHIMOMO)University of Modena and Reggio EmiliaModenaItaly
| | - Carlotta Mainini
- Physical Medicine and Rehabilitation UnitAzienda Unità Sanitaria Locale—IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Martina Pellegrini
- Physical Medicine and Rehabilitation UnitAzienda Unità Sanitaria Locale—IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Chiara Boni
- Department of Surgery, Medicine, Dentistry and Morphological SciencesUniversity of Modena and Reggio EmiliaModenaItaly
| | - Bressi Barbara
- Physical Medicine and Rehabilitation UnitAzienda Unità Sanitaria Locale—IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Luca Braglia
- Clinical Trials Center, Azienda USL‐IRCSS di Reggio EmiliaReggio EmiliaItaly
| | - Stefania Fugazzaro
- Physical Medicine and Rehabilitation UnitAzienda Unità Sanitaria Locale—IRCCS di Reggio EmiliaReggio EmiliaItaly
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9
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Kow CY, Castle-Kirszbaum M, Kam JK, Goldschlager T. Advances in Surgery for Metastatic Disease of the Spine: An Update for Oncologists. Global Spine J 2024:21925682231155847. [PMID: 39069655 DOI: 10.1177/21925682231155847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVE Metastatic spine disease is an increasingly common clinical challenge that requires individualised multidisciplinary care from spine surgeons and oncologists. In this article, the authors describe the recent surgical advances in patients presenting with spinal metastases. METHODS We present an overview of the presentation, assessment, and management of spinal metastases from the perspective of the spine surgeon, highlighting advances in surgical technology and techniques, to facilitate multidisciplinary care for this complex patient group. Neither institutional review board approval nor patient consent was needed for this review. RESULTS Advances in radiotherapy delivery and systemic therapy (including immunotherapy and targeted therapy) have refined operative indications for decompression of neural structures and spinal stabilisation, while advances in surgical technology and technique enable these goals to be achieved with reduced morbidity. Formulating individualised management strategies that optimise outcome, while meeting patient goals and expectations, requires a comprehensive understanding of the factors important to patient management. CONCLUSION Spinal metastases require prompt diagnosis and expert management by a multidisciplinary team. Improvements in systemic, radiation, and surgical therapies have broadened operative indications and increased operative candidacy, and future advances are likely to continue this trend.
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Affiliation(s)
- Chien Yew Kow
- Department of Neurosurgery, Auckland City Hospital, Auckland, New Zealand
| | - Mendel Castle-Kirszbaum
- Department of Neurosurgery, Monash Health, Melbourne, AU-VIC, Australia
- Department of Surgery, Monash University, Melbourne, AU-VIC, Australia
| | - Jeremy Kt Kam
- Department of Neurosurgery, Monash Health, Melbourne, AU-VIC, Australia
- Department of Surgery, Monash University, Melbourne, AU-VIC, Australia
| | - Tony Goldschlager
- Department of Neurosurgery, Monash Health, Melbourne, AU-VIC, Australia
- Department of Surgery, Monash University, Melbourne, AU-VIC, Australia
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10
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Saillard E, Gardegaront M, Levillain A, Bermond F, Mitton D, Pialat JB, Confavreux C, Grenier T, Follet H. Finite element models with automatic computed tomography bone segmentation for failure load computation. Sci Rep 2024; 14:16576. [PMID: 39019937 PMCID: PMC11255209 DOI: 10.1038/s41598-024-66934-w] [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: 12/21/2023] [Accepted: 07/05/2024] [Indexed: 07/19/2024] Open
Abstract
Bone segmentation is an important step to perform biomechanical failure load simulations on in-vivo CT data of patients with bone metastasis, as it is a mandatory operation to obtain meshes needed for numerical simulations. Segmentation can be a tedious and time consuming task when done manually, and expert segmentations are subject to intra- and inter-operator variability. Deep learning methods are increasingly employed to automatically carry out image segmentation tasks. These networks usually need to be trained on a large image dataset along with the manual segmentations to maximize generalization to new images, but it is not always possible to have access to a multitude of CT-scans with the associated ground truth. It then becomes necessary to use training techniques to make the best use of the limited available data. In this paper, we propose a dedicated pipeline of preprocessing, deep learning based segmentation method and post-processing for in-vivo human femurs and vertebrae segmentation from CT-scans volumes. We experimented with three U-Net architectures and showed that out-of-the-box models enable automatic and high-quality volume segmentation if carefully trained. We compared the failure load simulation results obtained on femurs and vertebrae using either automatic or manual segmentations and studied the sensitivity of the simulations on small variations of the automatic segmentation. The failure loads obtained using automatic segmentations were comparable to those obtained using manual expert segmentations for all the femurs and vertebrae tested, demonstrating the effectiveness of the automated segmentation approach for failure load simulations.
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Affiliation(s)
- Emile Saillard
- INSERM, LYOS UMR 1033, Université Claude Bernard Lyon 1, 69008, Lyon, France
- INSA-Lyon, CREATIS UMR5220, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Marc Gardegaront
- INSERM, LYOS UMR 1033, Université Claude Bernard Lyon 1, 69008, Lyon, France
- Univ Eiffel, LBMC UMRT9406, Université Claude Bernard Lyon 1, 69622, Lyon, France
| | - Aurélie Levillain
- Univ Eiffel, LBMC UMRT9406, Université Claude Bernard Lyon 1, 69622, Lyon, France
| | - François Bermond
- Univ Eiffel, LBMC UMRT9406, Université Claude Bernard Lyon 1, 69622, Lyon, France
| | - David Mitton
- Univ Eiffel, LBMC UMRT9406, Université Claude Bernard Lyon 1, 69622, Lyon, France
| | - Jean-Baptiste Pialat
- INSA-Lyon, CREATIS UMR5220, Université Claude Bernard Lyon 1, Villeurbanne, France
- Hospices Civils de Lyon, Lyon, France
| | - Cyrille Confavreux
- INSERM, LYOS UMR 1033, Université Claude Bernard Lyon 1, 69008, Lyon, France
- Hospices Civils de Lyon, Lyon, France
| | - Thomas Grenier
- INSA-Lyon, CREATIS UMR5220, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Hélène Follet
- INSERM, LYOS UMR 1033, Université Claude Bernard Lyon 1, 69008, Lyon, France.
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11
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Asunis E, Cini C, De Robertis M, Griffoni C, Bandiera S, Righi A, Ghermandi R, Pipola V, Girolami M, Tedesco G, Gambarotti M, Gasbarrini A. Epithelioid Hemangioma of the Spine: A Case Series and Treatment Flow Chart-Experience from a Single Centre. Cancers (Basel) 2024; 16:2557. [PMID: 39061195 PMCID: PMC11274583 DOI: 10.3390/cancers16142557] [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: 05/29/2024] [Revised: 07/05/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
Epithelioid hemangioma is recognized by the World Health Organization as a distinct benign neoplasm; however, it is characterized by locally aggressive and rarely metastasizing behavior. Epithelioid vascular tumors are rare bony vascular lesions with varying degrees of malignant potential that remain controversial because of their rarity, unusual morphological features, and unpredictable biological behavior. The application of new molecular tools, such as massive parallel sequencing technologies, have provided new diagnostic markers and an opportunity to further refine the classification of bone vascular neoplasms. Very few cases of EH of the spine have been reported in the literature; therefore, it is difficult to make evidence-based therapeutic decisions for these patients. We report herein our experience with eleven patients suffering from EH of the spine. The study population included three males and eight females treated in our center from 2016 to the present; the average age was 44.8 years (range 14-75 years). The surgical, clinical, and radiographic data were retrospectively analyzed. The mean follow-up was 34.8 months. All patients presented lytic vertebral body lesions, six of them with pathological fracture. The majority of patients (80%) presented myelo-radicular compression. All patients were surgically treated, and preoperative embolization was performed in all cases. In light of the literature review and the clinical experience of our center, we can consider EH a locally aggressive tumor that requires surgical treatment in case of symptoms. Here, we propose a treatment algorithm that could be useful in the management of patients with this rare disease.
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Affiliation(s)
- Emanuela Asunis
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (E.A.); (C.C.); (S.B.); (R.G.); (V.P.); (M.G.); (G.T.); (A.G.)
| | - Chiara Cini
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (E.A.); (C.C.); (S.B.); (R.G.); (V.P.); (M.G.); (G.T.); (A.G.)
| | - Mario De Robertis
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy;
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Cristiana Griffoni
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (E.A.); (C.C.); (S.B.); (R.G.); (V.P.); (M.G.); (G.T.); (A.G.)
| | - Stefano Bandiera
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (E.A.); (C.C.); (S.B.); (R.G.); (V.P.); (M.G.); (G.T.); (A.G.)
| | - Alberto Righi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (A.R.); (M.G.)
| | - Riccardo Ghermandi
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (E.A.); (C.C.); (S.B.); (R.G.); (V.P.); (M.G.); (G.T.); (A.G.)
| | - Valerio Pipola
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (E.A.); (C.C.); (S.B.); (R.G.); (V.P.); (M.G.); (G.T.); (A.G.)
| | - Marco Girolami
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (E.A.); (C.C.); (S.B.); (R.G.); (V.P.); (M.G.); (G.T.); (A.G.)
| | - Giuseppe Tedesco
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (E.A.); (C.C.); (S.B.); (R.G.); (V.P.); (M.G.); (G.T.); (A.G.)
| | - Marco Gambarotti
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (A.R.); (M.G.)
| | - Alessandro Gasbarrini
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (E.A.); (C.C.); (S.B.); (R.G.); (V.P.); (M.G.); (G.T.); (A.G.)
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
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12
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Park SJ, Kim JH, Ahn YC, Koom WS, Byun HK, Kim YH, Kim SI, Kang DH. Surgical Interventions Following Radiotherapy in Spinal Metastases with Intermediate Instability: A Risk Factor Analysis: The Korean Society of Spinal Tumor Multicenter Study (KSST 2022-02). Cancers (Basel) 2024; 16:2554. [PMID: 39061193 PMCID: PMC11275119 DOI: 10.3390/cancers16142554] [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: 06/21/2024] [Revised: 07/09/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND One important determinant in choosing a treatment modality is spinal instability. Clear management guidelines are suggested for stable and unstable spinal metastatic lesions, but lesions in the intermediate instability category (SINS [spinal instability neoplastic score] score of 7-12) remain a clinical dilemma. This study aims to analyze the risk factors necessitating surgical intervention after radiotherapy (RT) in patients with those lesions. METHODS A multicenter cohort of 469 patients with spinal metastases of intermediate instability who received radiotherapy (RT) as the initial treatment between 2019 and 2021 were retrospectively enrolled. All patients were neurologically intact at the time of RT. According to the performance of surgical intervention after RT, various clinical and radiographic risk factors for surgical intervention were compared between surgery and non-surgery groups using uni- and multivariate analyses. A recursive partitioning analysis (RPA) was performed using significant determinants identified in multivariate analysis. RESULTS The mean age at the time of RT was 59.9 years and there were 198 females. The lung was the most common primary site. During the mean follow-up duration of 18.2 months, surgical treatment was required in 79 (17.9%) of patients. The most common surgical method was decompressive laminectomy with stabilization (62.0%), followed by vertebrectomy with stabilization (22.8%) and stabilization only (15.2%). The mean SINS for the total cohort was 9.0. Multivariate regression analyses revealed that the primary tumor site of the lung, liver, and kidney, higher Bilsky grades of ESCC, lytic bone lesions, and higher EQD210 were significant risk factors for surgical intervention after RT. Among them, Bilsky grade, primary tumor type of the lung, liver, and kidney, and EQD210 were the most important determinants for expecting the probability of surgical intervention on RPA. CONCLUSIONS Surgical intervention was performed in 17.9% of patients with intermediate instability after RT as the initial treatment. The primary tumor site of the lung, liver, and kidney, higher Bilsky grade of ESCC, and EQD210 were the most important determinants for expecting the probability of surgical intervention. Therefore, the optimal treatment strategy needs to be devised by carefully evaluating the risk of surgical intervention.
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Affiliation(s)
- Se-Jun Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University, Seoul 06351, Republic of Korea;
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University, Seoul 03080, Republic of Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University, Seoul 06351, Republic of Korea;
| | - Woong Sub Koom
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University, Seoul 03722, Republic of Korea
| | - Hwa Kyung Byun
- Department of Radiation Oncology, Yongin Severance Hospital, College of Medicine, Yonsei University, Yongin 16995, Republic of Korea;
| | - Young-Hoon Kim
- Department of Orthopedic Surgery, Seoul St. Mary’s Hospital, Catholic University, Seoul 06591, Republic of Korea; (Y.-H.K.); (S.-I.K.)
| | - Sang-Il Kim
- Department of Orthopedic Surgery, Seoul St. Mary’s Hospital, Catholic University, Seoul 06591, Republic of Korea; (Y.-H.K.); (S.-I.K.)
| | - Dong-Ho Kang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University, Seoul 06351, Republic of Korea;
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13
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Hong S, Shinya Y, Lakomkin N, Mahajan A, Laack NN, O'Brien E, Stokken JK, Janus JR, Pinheiro Neto C, Choby GW, Peris Celda M, Link MJ, Elder BD, Van Gompel JJ. Predicting the Need for Occipitocervical Fusion for Patients with Lower Clival Chordoma: A Single-Center Retrospective Study. World Neurosurg 2024; 187:e321-e330. [PMID: 38649026 DOI: 10.1016/j.wneu.2024.04.081] [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: 03/15/2024] [Revised: 04/14/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To assess the impact of tumor extension into the occipital condyle (OC) in lower clival chordoma management and the need for occipito-cervical fusion (OCF). METHODS A retrospective analysis was conducted on 35 patients with lower clival chordoma. The preoperative area of the intact OCs, Hounsfield units, and the integrity of the apical ligament and the tectorial membrane were assessed using preoperative imaging. RESULTS Seven (20%) patients were in the OCF group. The OCF group exhibited a higher prevalence of preoperative pain in the neck or head (P = 0.006), ligament absence (P = 0.022), and increased propensity for postoperative wound issues (P = 0.022) than the non-OCF group. The OCF group had less intact OCs (P < 0.001) and higher spinal instability neoplastic score (P = 0.002) than the non-OCF group. All patients with intact OCs < 60% underwent OCF, and those with OCs ≥ 70% were treated without OCF. Those with OCs between 60% and 69% underwent OCF if the ligaments were eroded, and did not undergo OCF if the ligaments were intact. Treatment strategies varied, with endoscopic endonasal approach alone being common. Radiation therapy was administered to 89% of patients. All 3 patients treated with OCF after tumor resection had wound issues; none treated with OCF before resection had wound issues. None developed atlanto-occipital instability. Survival rates did not significantly differ between groups. CONCLUSIONS In the absence of mobility-related neck pain, patients with lower clival chordoma and intact OC ≥ 60%, intact apical ligament, and intact tectorial membrane, may not require OCF.
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Affiliation(s)
- Sukwoo Hong
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Yuki Shinya
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Nikita Lakomkin
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nadia N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Erin O'Brien
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Janalee K Stokken
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeffrey R Janus
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Garret W Choby
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Maria Peris Celda
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Link
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Benjamin D Elder
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jamie J Van Gompel
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA.
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14
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Yamada K, Yoshii T, Toba M, Egawa S, Morishita S, Matsukura Y, Hirai T, Kudo A, Fushimi K. Trends in the surgical treatment for metastatic spinal tumor in Japanese administrative data between 2012 and 2020. Int J Clin Oncol 2024; 29:911-920. [PMID: 38829471 DOI: 10.1007/s10147-024-02537-9] [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: 12/12/2023] [Accepted: 04/14/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Both cancer diagnosis/treatment modality and surgical technique for the spine have been developed recently. Nationwide trends in the surgical treatment for metastatic spinal tumors have not been reported in the last decades. This study aimed to examine recent trends in the surgical treatment for spinal metastasis and in-hospital patient outcomes using nationwide administrative hospital discharge data. METHODS The Diagnosis Procedure Combination database from 2012 to 2020 was used to extract data from patients who underwent surgical procedures for spinal metastasis with the number of non-metastatic spinal surgery at the institutions that have performed metastatic spine surgeries at least one case in the same year. Trends in the surgical treatment for spinal metastasis, patients' demographics, and in-hospital mortality/outcomes were investigated. RESULTS This study analyzed 10,321 eligible patients with spinal metastasis. The surgical treatment for spinal metastasis increased 1.68 times from 2012 to 2020, especially in fusion surgery, whereas the proportion of metastatic spinal surgery retained with a slight increase in the 2%s. Distributions of the primary site did not change, whereas age was getting older. In-hospital mortality and length of stay decreased over time (9.9-6.8%, p < 0.001; 37-30 days, p < 0.001). Postoperative complication and unfavorable ambulatory retained stable and slightly decreased, respectively. CONCLUSION During the last decade, surgical treatment for spinal metastasis, especially fusion surgery, has increased in Japan. In-hospital mortality and length of stay decreased. Recent advances in cancer treatment and surgical techniques might influence this trend.
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Affiliation(s)
- Kentaro Yamada
- Department of Orthopaedics and Trauma Research, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedics, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Mikayo Toba
- Department of Quality Management Center, Tokyo Medical and Dental Univ Hospital, Tokyo, Japan
| | - Satoru Egawa
- Department of Orthopaedics, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Shingo Morishita
- Department of Orthopaedics, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Yu Matsukura
- Department of Orthopaedics, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Takashi Hirai
- Department of Orthopaedics, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Atsushi Kudo
- Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics Section, Tokyo Medical and Dental University, Tokyo, Japan
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15
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Roth C, Weiss K. Palliative Care Needs of Patients with Musculoskeletal Malignancies. Curr Oncol Rep 2024; 26:784-790. [PMID: 38789669 DOI: 10.1007/s11912-024-01543-4] [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] [Accepted: 05/03/2024] [Indexed: 05/26/2024]
Abstract
PURPOSE OF REVIEW This review aims to assess the literature regarding current treatment options for the palliative care of patients with advanced musculoskeletal malignancies whether primary or metastatic. RECENT FINDINGS The inclusion of specialized palliative care physicians, in conjunction with surgeons, medical oncologists, radiation oncologists, interventional radiologists, and mental health professionals, results in better control of end-of-life symptoms in both children and adults with terminal musculoskeletal malignancies. The palliative care of patients with musculoskeletal malignancies requires a multi-disciplinary team and benefits from specialized palliative care physicians. The unique impacts of musculoskeletal malignancies on ambulation and independence creates additional mental and physical burdens on patients and care-takers alike. Palliative care should focus on preserving ambulatory function and patient independence, in addition to managing chronic pain and other end-of-life symptoms common to these malignancies.
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Affiliation(s)
- Clark Roth
- Division of Orthopedic Oncology, Department of Orthopedic Surgery, The University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Kurt Weiss
- Division of Orthopedic Oncology, Department of Orthopedic Surgery, The University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA.
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16
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von Glinski A, Pierre CA, Elia C, Ishak B, Godolias P, Blecher R, Detorri JR, Norvell DC, Jouppi L, Gerstmeyer J, Deem SA, Golden JB, Schildhauer TA, Oskouian RJ, Chapman JR. The Postoperative Airway Compromise Score-First Steps to Developing a Postoperative Tool for the Assessment of Upper Airway-Related Complications Following Anterior Cervical Spine Surgery. World Neurosurg 2024; 187:e714-e721. [PMID: 38692566 DOI: 10.1016/j.wneu.2024.04.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Acute upper airway compromise is a rare but catastrophic complication after anterior cervical discectomy and fusion. This study aims to develop a score to identify patients at risk of acute postoperative airway compromise (PAC). METHODS Potential risk factors for acute PAC were selected by a modified Delphi process. Ten patients with acute PAC were identified of 1466 patients who underwent elective anterior cervical discectomy and fusion between July 2014 and May 2019. A comparison group was created by a randomized selection process (non-PAC group). Factors associated with PAC and a P value of < 0.10 were entered into a logistic regression model and coefficients contributed to each risk factor's overall score. Calibration of the model was evaluated using the Hosmer-Lemeshow goodness-of-fit test. Quantitative discrimination was calculated, and the final model was internally validated with bootstrap sampling. RESULTS We identified 18 potential risk factors from our Delphi process, of which 6 factors demonstrated a significant association with airway compromise: age >65 years, current smoking status, American Society of Anesthesiologists class >2, history of a bleeding disorder, surgery of upper subaxial cervical spine (above C4), and duration of surgery >179 minutes. The final prediction model included 5 predictors with very strong performance characteristics. These 5 factors formed the PAC score, with a range from 0 to 100. A score of 20 yielded the greatest balance of sensitivity (80%) and specificity (88%). CONCLUSIONS The acute PAC score demonstrates strong performance characteristics. The PAC score might help identify patients at risk of upper airway compromise caused by surgical site abnormalities.
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Affiliation(s)
- Alexander von Glinski
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA; Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany; Hansjörg Wyss Hip and Pelvic Center, Swedish Hospital, Seattle, Washington, USA; Katholisches Klinikum St. Josef, Orthopedic University Hospital Bochum, Bochum, Germany
| | - Clifford A Pierre
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA.
| | - Christopher Elia
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA; Department of Neurosurgery, Riverside University Health Systems, Moreno Valley, California, USA
| | - Basem Ishak
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA
| | - Periklis Godolias
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA; Department of Orthopedics and Trauma Surgery, St. Josef Hospital Essen-Werden, Essen, Germany
| | - Ronen Blecher
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA
| | | | | | - Luke Jouppi
- Seattle Science Foundation, Seattle, Washington, USA
| | - Julius Gerstmeyer
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA; Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Steven A Deem
- Neurocritical Care, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - J Blake Golden
- Division of Head and Neck Surgery, Swedish Cancer Institute, Seattle, Washington, USA
| | - Thomas A Schildhauer
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Rod J Oskouian
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA
| | - Jens R Chapman
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Seattle Science Foundation, Seattle, Washington, USA
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17
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Kaufmann J, Täubl AU, Nikolaidou E, Rühle A, Hopprich A, Wollschläger D, Mayer A, Nicolay NH, Schmidberger H, Bostel T. Excellent long-term pain response and local control following postoperative radiotherapy in patients with multiple myeloma. Strahlenther Onkol 2024; 200:633-641. [PMID: 38289360 PMCID: PMC11186884 DOI: 10.1007/s00066-024-02198-7] [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: 07/18/2023] [Accepted: 01/03/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE Multiple myeloma is associated with osteolytic bone lesions, often requiring surgery of the spine and postoperative radiotherapy (RT). Although common, data for clinical and informed decision-making are sparse. In this monocentric retrospective study, we aim to report the outcome of patients who underwent spinal surgery and postoperative RT due to multiple myeloma. METHODS A total of 54 patients with multiple myeloma who underwent prior spinal surgery and postoperative RT at our institution between 2009 and 2020 were analyzed. Spinal instability neoplastic score (SINS) and Bilsky score, posttherapeutic adverse events, clinical data, and outcomes were collected and analyzed. The primary endpoint of this study was overall survival (OS), secondary endpoints were progression-free survival (PFS), pain response, local control, and skeletal-related events (SRE). RESULTS The 3‑ and 5‑year overall survival (OS) was 74.9% (95% confidence interval [CI]: 63.5-88.4%) and 58% (95% CI: 44.5-75.6%), respectively. Median survival was not reached and 75% survival was 34.3 months (95% CI: 28.7-95.4 months). Median follow-up was 63 months (95% CI: 49-94 months). The number of patients with good to adequate performance status (Karnofsky performance score [KPS] ≥ 70) significantly increased after surgery (p < 0.01). We observed no grade 3/4 toxicity and only 13 (24%) grade 1/2 adverse events. Two patients (4%) experienced SRE. Overall, 92% of patients reported reduced pain after radiotherapy, with 66% reporting complete pain response. There was no difference in pain response between patients with different Bilsky scores. Bisphosphonate therapy and lower Bilsky score at the start of RT were associated with improved OS in univariate analysis (all p < 0.05). Multivariate Cox regression confirmed a Bilsky score of 2 or 3 as an independent negative prognostic factor (HR 3.89; 95 CI 1.4-10.7; p < 0.01). We observed no in-field recurrences. CONCLUSION In this study, we were able to show that the current standard of RT after spinal surgery of osteolytic lesions is safe. In addition, we observed a very low rate of SRE (4%) and no in-field recurrences, demonstrating the local efficacy of RT in multiple myeloma patients. Higher Bilsky scores were associated with worse OS in multivariate analysis, but had no effect on pain response.
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Affiliation(s)
- Justus Kaufmann
- Department of Radiation Oncology, University Medical Center Mainz, Mainz, Germany.
| | - Annika Ute Täubl
- Department of Radiation Oncology, University Medical Center Mainz, Mainz, Germany
| | - Eirini Nikolaidou
- Department of Radiation Oncology, University Medical Center Mainz, Mainz, Germany
- Department for Radiation Oncology, Charité-Universitätsmedizin Berlin, 13353, Berlin, Germany
| | - Alexander Rühle
- Department of Radiotherapy and Radiation Oncology, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Anne Hopprich
- Department of Radiation Oncology, University Medical Center Mainz, Mainz, Germany
| | - Daniel Wollschläger
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Mainz, Germany
| | - Arnulf Mayer
- Department of Radiation Oncology, University Medical Center Mainz, Mainz, Germany
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Nils Henrik Nicolay
- Department of Radiotherapy and Radiation Oncology, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Heinz Schmidberger
- Department of Radiation Oncology, University Medical Center Mainz, Mainz, Germany
| | - Tilman Bostel
- Department of Radiation Oncology, University Medical Center Mainz, Mainz, Germany
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18
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Saleh I, Hutami WD, Librianto D, Prasetyo M, Rahyussalim AJ, Hendriarto A, Noor EA, Rifki A. The Development of New Scoring System to Define the Presence of Instability and the Need of Fusion in Degenerative Lumbar Spinal Stenosis - Jakarta Instability Score. Global Spine J 2024:21925682241262713. [PMID: 38867437 DOI: 10.1177/21925682241262713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
STUDY DESIGN Systematic review, expert opinion and Delphi technique, and validity and reliability studies. OBJECTIVE We developed Jakarta Instability Score (JIS) to identify spinal instability and the need of fusion in degenerative lumbar spinal stenosis (LSS). METHODS This study consisted of systematic review to find predictors of spinal instability, expert opinion and modified Delphi technique to develop JIS, and validity and reliability studies of the newly developed JIS. RESULTS A total of 54 studies were included in the systematic reviews to obtain predictors of spinal instability. Through expert opinion and modified Delphi technique, JIS was developed and consisted of the clinical component (back pain), dynamic radiograph component (dynamic translation and angulation), and MRI component (facet joint effusion), each of the component would be scored, and the total scoring would be from 0 to 14. The final scoring would classify patients into three groups: stable group (score of 0 to 4) in which the fusion is not needed, potentially unstable group (score of 5 to 8) in which the decision of fusion is based on surgeon's clinical judgment, and unstable group (score of 9 to 14) in which the fusion is needed. Final step of study concluded that this JIS had a high validity and reliability. CONCLUSION The newly developed JIS was a valid and reliable scoring system that could help to identify the presence of instability in LSS and can be used as a guideline to decide whether spinal fusion will be needed.
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Affiliation(s)
- Ifran Saleh
- Department of Orthopaedic and Traumatology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National Central Public Hospital, Jakarta, Indonesia
| | - Witantra Dhamar Hutami
- Department of Orthopaedic and Traumatology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National Central Public Hospital, Jakarta, Indonesia
| | - Didik Librianto
- Department of Orthopaedic and Traumatology, Universitas Indonesia, Fatmawati Central General Hospital, Jakarta, Indonesia
| | - Marcel Prasetyo
- Department of Radiology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National Central Public Hospital, Jakarta, Indonesia
| | - Ahmad Jabir Rahyussalim
- Department of Orthopaedic and Traumatology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National Central Public Hospital, Jakarta, Indonesia
| | - Andra Hendriarto
- Department of Orthopaedic and Traumatology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National Central Public Hospital, Jakarta, Indonesia
| | - Erwin Ardian Noor
- Department of Orthopaedic and Traumatology, Universitas Indonesia, Fatmawati Central General Hospital, Jakarta, Indonesia
| | - Aliyya Rifki
- Department of Radiology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National Central Public Hospital, Jakarta, Indonesia
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19
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Issany A, Iovoli AJ, Wang R, Shekher R, Ma SJ, Goulenko V, Fekrmandi F, Prasad D. Vertebral body collapse after spine stereotactic body radiation therapy: a single-center institutional experience. Radiol Oncol 2024; 0:raon-2024-0033. [PMID: 38861691 DOI: 10.2478/raon-2024-0033] [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: 12/26/2023] [Accepted: 04/26/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Spine stereotactic body radiation therapy (SBRT) for the treatment of metastatic disease is increasingly utilized owing to improved pain and local control over conventional regimens. Vertebral body collapse (VBC) is an important toxicity following spine SBRT. We investigated our institutional experience with spine SBRT as it relates to VBC and spinal instability neoplastic score (SINS). PATIENTS AND METHODS Records of 83 patients with 100 spinal lesions treated with SBRT between 2007 and 2022 were reviewed. Clinical information was abstracted from the medical record. The primary endpoint was post-treatment VBC. Logistic univariate analysis was performed to identify clinical factors associated with VBC. RESULTS Median dose and number of fractions used was 24 Gy and 3 fractions, respectively. There were 10 spine segments that developed VBC (10%) after spine SBRT. Median time to VBC was 2.4 months. Of the 11 spine segments that underwent kyphoplasty prior to SBRT, none developed subsequent VBC. No factors were associated with VBC on univariate analysis. CONCLUSIONS The rate of vertebral body collapse following spine SBRT is low. Prophylactic kyphoplasty may provide protection against VBC and should be considered for patients at high risk for fracture.
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Affiliation(s)
- Arsh Issany
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, New York, USA
| | - Austin J Iovoli
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, New York, USA
| | - Richard Wang
- Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, USA
| | - Rohil Shekher
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, New York, USA
| | - Sung Jun Ma
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, New York, USA
| | - Victor Goulenko
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, New York, USA
| | - Fatemeh Fekrmandi
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, New York, USA
| | - Dheerendra Prasad
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, New York, USA
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Scaramuzzo L, Perna A, Velluto C, Borruto MI, Gorgoglione FL, Proietti L. Rethinking Strategies for Multi-Metastatic Patients: A Comprehensive Retrospective Analysis on Open Posterior Fusion Versus Percutaneous Osteosynthesis in the Treatment of Vertebral Metastases. J Clin Med 2024; 13:3343. [PMID: 38893054 PMCID: PMC11173164 DOI: 10.3390/jcm13113343] [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: 03/15/2024] [Revised: 05/16/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Managing vertebral metastases (VM) is still challenging in oncology, necessitating the use of effective surgical strategies to preserve patient quality of life (QoL). Traditional open posterior fusion (OPF) and percutaneous osteosynthesis (PO) are well-documented approaches, but their comparative efficacy remains debated. Methods: This retrospective study compared short-term outcomes (6-12 months) between OPF and PO in 78 cancer patients with spinal metastases. This comprehensive evaluation included functional, clinical, and radiographic parameters. Statistical analysis utilized PRISM software (version 10), with significance set at p < 0.05. Results: PO demonstrated advantages over OPF, including shorter surgical durations, reduced blood loss, and hospital stay, along with lower perioperative complication rates. Patient quality of life and functional outcomes favored PO, particularly at the 6-month mark. The mortality rates at one year were significantly lower in the PO group. Conclusions: Minimally invasive techniques offer promising benefits in VM management, optimizing patient outcomes and QoL. Despite limitations, this study advocates for the adoption of minimally invasive approaches to enhance the care of multi-metastatic patients with symptomatic VM.
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Affiliation(s)
- Laura Scaramuzzo
- Department of Aging, Orthopaedic and Rheumatological Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (L.S.); (M.I.B.); (L.P.)
| | - Andrea Perna
- Department of Orthopaedics and Traumatology, Fondazione Casa Sollievo della Sofferenza IRCCS, 71013 San Giovanni Rotondo, Italy; (A.P.); (F.L.G.)
| | - Calogero Velluto
- Department of Aging, Orthopaedic and Rheumatological Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (L.S.); (M.I.B.); (L.P.)
| | - Maria Ilaria Borruto
- Department of Aging, Orthopaedic and Rheumatological Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (L.S.); (M.I.B.); (L.P.)
| | - Franco Lucio Gorgoglione
- Department of Orthopaedics and Traumatology, Fondazione Casa Sollievo della Sofferenza IRCCS, 71013 San Giovanni Rotondo, Italy; (A.P.); (F.L.G.)
| | - Luca Proietti
- Department of Aging, Orthopaedic and Rheumatological Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (L.S.); (M.I.B.); (L.P.)
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21
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Barzilai O, Sahgal A, Rhines LD, Versteeg AL, Sciubba DM, Lazary A, Weber MH, Schuster JM, Boriani S, Bettegowda C, Arnold PM, Clarke MJ, Laufer I, Fehlings MG, Gokaslan ZL, Fisher CG. Patient-Reported and Clinical Outcomes of Surgically Treated Patients With Symptomatic Spinal Metastases: Results From Epidemiology, Process, and Outcomes of Spine Oncology (EPOSO), a Prospective, Multi-Institutional and International Study. Neurosurgery 2024:00006123-990000000-01181. [PMID: 38832791 DOI: 10.1227/neu.0000000000002989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/18/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The palliative impact of spine surgery for metastatic disease is evolving with improvements in surgical technique and multidisciplinary cancer care. The goal of this study was to prospectively evaluate long-term clinical outcomes including health-related quality-of-life (HRQOL) measures, using spine cancer-specific patient-reported-outcome (PRO) measures, in patients with symptomatic spinal metastases who underwent surgical management. METHODS The Epidemiology, Process, and Outcomes of Spine Oncology (EPOSO, ClinicalTrials.gov identifier: NCT01825161) trial is a prospective-observational cohort study that included 10 specialist centers in North America and Europe. Patients aged 18 to 75 years who underwent surgery for spinal metastases were included. Prospective assessments included both spine tumor-specific and generic PRO tools which were collected for a minimum of 2 years post-treatment or until death. RESULTS Two hundred and eighty patients (51.8% female, mean age 57.9 years) were included. At presentation, the mean Charlson Comorbidity Index was 6.0, 35.7% had neurological deficits as defined by the American Spinal Cord Injury Association scores, 47.2% had high-grade epidural spinal cord compression (2-3), and 89.6% had impending or frank instability as measured by a Spinal Instability Neoplastic Score of ≥7. The most common primary tumor sites were breast (20.2%), lung (18.8%), kidney (16.2%), and prostate (6.5%). The median overall survival postsurgery was 501 days, and the 2-year progression-free-survival rate was 38.4%. Compared with baseline, significant and durable improvements in HRQOL were observed at the 6-week, 12-week, 26-week, 1-year, and 2-year follow-up assessments from a battery of PRO questionnaires including the spine cancer-specific, validated, Spine Oncology Study Group Outcomes Questionnaire v2.0, the Short Form 36 version 2, EuroQol-5 Dimension (3L), and pain numerical rating scale score. CONCLUSION Multi-institutional, prospective-outcomes data confirm that surgical decompression and/or stabilization provides meaningful and durable improvements in multiple HRQOL domains, including spine-specific outcomes based on the Spine Oncology Study Group Outcomes Questionnaire v2.0, for patients with metastatic spine disease.
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Affiliation(s)
- Ori Barzilai
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York , New York , USA
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto , Ontario , Canada
| | - Laurence D Rhines
- Division of Surgery, Department of Neurosurgery, The University of Texas MD Anderson Cancer Centre, Houston , Texas , USA
| | - Anne L Versteeg
- Division of Surgery, Department of Orthopaedic Surgery, University of Toronto, Toronto , Ontario , Canada
| | - Daniel M Sciubba
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset , New York , USA
| | - Aron Lazary
- National Center for Spinal Disorders, Buda Health Center, Budapest , Hungary
| | - Michael H Weber
- Spine Surgery Program, Department of Surgery, McGill University, Montreal , Québec , Canada
| | - James M Schuster
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia , Pennsylvania , USA
| | | | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Paul M Arnold
- Department of Neurosurgery, Carle Foundation Hospital, Urbana , Illinois , USA
| | - Michelle J Clarke
- Department of Neurosurgery, Mayo Clinic, Rochester , Minnesota , USA
| | - Ilya Laufer
- Department of Neurosurgery, New York University Langone Health, New York , New York , USA
| | - Michael G Fehlings
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, University Health Network, Toronto , Ontario , Canada
| | - Ziya L Gokaslan
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Charles G Fisher
- Spine Surgery Institute, Vancouver General Hospital, University of British Columbia, Vancouver , British Columbia , Canada
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22
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Steinvoort-Draat IN, Otto-Vollaard L, Quint S, Tims JL, de Pree IMN, Nuyttens JJ. Palliative radiotherapy: New prognostic factors for patients with bone metastasis. Cancer Radiother 2024; 28:236-241. [PMID: 38871605 DOI: 10.1016/j.canrad.2023.09.003] [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: 02/24/2023] [Revised: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 06/15/2024]
Abstract
PURPOSE Many cancer patients develop bone metastases, however the prognosis of overall survival differs. To provide an optimal treatment for these patients, especially towards the end of life, a reliable prediction of survival is needed. The goal of this study was to find new clinical factors in relation to overall survival. MATERIALS AND METHODS Prospectively 22 clinical factors were collected from 734 patients. The Kaplan-Meier and Cox regression models were used. RESULTS Most patients were diagnosed with lung cancer (29%), followed by prostate (19.8%) and breast cancer (14.7%). Median overall survival was 6.4months. Fourteen clinical factors showed significance in the univariate analyses. In the multivariate analyses 6 factors were found to be significant for the overall survival: Karnofsky performance status, primary tumor, gender, total organs affected, morphine use and systemic treatment options after radiotherapy. CONCLUSION Morphine use and systemic treatment options after radiotherapy, Karnofsky performance status, primary tumor, gender and total organs affected are strong prediction factors on overall survival after palliative radiotherapy in patients with bone metastasis. These factors are easily applicable in the clinic.
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Affiliation(s)
- I N Steinvoort-Draat
- Department of radiotherapy, Erasmus MC Cancer Institute, Postbus 2040, 3000 CA Rotterdam, The Netherlands.
| | - L Otto-Vollaard
- Department of radiotherapy, Erasmus MC Cancer Institute, Postbus 2040, 3000 CA Rotterdam, The Netherlands
| | - S Quint
- Department of radiotherapy, Erasmus MC Cancer Institute, Postbus 2040, 3000 CA Rotterdam, The Netherlands
| | - J L Tims
- Department of radiotherapy, Erasmus MC Cancer Institute, Postbus 2040, 3000 CA Rotterdam, The Netherlands
| | - I M N de Pree
- Department of radiotherapy, Erasmus MC Cancer Institute, Postbus 2040, 3000 CA Rotterdam, The Netherlands
| | - J J Nuyttens
- Department of radiotherapy, Erasmus MC Cancer Institute, Postbus 2040, 3000 CA Rotterdam, The Netherlands
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23
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Koide Y, Haimoto S, Shimizu H, Aoyama T, Kitagawa T, Shindo Y, Nagai N, Hashimoto S, Tachibana H, Kodaira T. Re-irradiation spine stereotactic body radiotherapy following high-dose conventional radiotherapy for metastatic epidural spinal cord compression: a retrospective study. Jpn J Radiol 2024; 42:662-672. [PMID: 38413551 PMCID: PMC11139739 DOI: 10.1007/s11604-024-01539-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/22/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE We aimed to evaluate the efficacy and safety of re-irradiation stereotactic body radiation therapy (SBRT) in patients with metastatic epidural spinal cord compression (MESCC) following high-dose conventional radiotherapy. MATERIALS AND METHODS Twenty-one patients met the following eligibility criteria: with an irradiation history of 50 Gy2 equivalent dose in 2-Gy fractions (EQD2) or more, diagnosed MESCC in the cervical or thoracic spines, and treated with re-irradiation SBRT of 24 Gy in 2 fractions between April 2018 and March 2023. Prior treatment was radiotherapy alone, not including surgery. The primary endpoint was a 1-year local failure rate. Overall survival (OS) and treatment-related adverse events were assessed as the secondary endpoints. Since our cohort includes one treatment-related death (TRD) of esophageal perforation, the cumulative esophageal dose was evaluated to find the dose constraints related to severe toxicities. RESULTS The median age was 68, and 14 males were included. The primary tumor sites (esophagus/lung/head and neck/others) were 6/6/7/2, and the median initial radiotherapy dose was 60 Gy2 EQD2 (range: 50-105 Gy2, 60-70/ > 70 Gy2 were 11/4). Ten patients underwent surgery followed by SBRT and 11 SBRT alone. At the median follow-up time of 10.4 months, 17 patients died of systemic disease progression including one TRD. No radiation-induced myelopathy or nerve root injuries occurred. Local failure occurred in six patients, with a 1-year local failure rate of 29.3% and a 1-year OS of 55.0%. Other toxicities included five cases of vertebral compression fractures (23.8%) and one radiation pneumonitis. The cumulative esophageal dose was recommended as follows: Dmax < 203, D0.035 cc < 187, and D1cc < 167 (Gy3 in biological effective dose). CONCLUSION Re-irradiation spine SBRT may be effective for selected patients with cervical or thoracic MESCC, even with high-dose irradiation histories. The cumulative dose assessment across the original and re-irradiated esophagus was recommended to decrease the risk of severe esophageal toxicities.
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Affiliation(s)
- Yutaro Koide
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-Ku, Nagoya, Aichi, Japan.
| | - Shoichi Haimoto
- Department of Neurosurgery, Aichi Cancer Center Hospital, Chikusa-Ku, Nagoya, Japan
| | - Hidetoshi Shimizu
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-Ku, Nagoya, Aichi, Japan
| | - Takahiro Aoyama
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-Ku, Nagoya, Aichi, Japan
| | - Tomoki Kitagawa
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-Ku, Nagoya, Aichi, Japan
| | - Yurika Shindo
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-Ku, Nagoya, Aichi, Japan
| | - Naoya Nagai
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-Ku, Nagoya, Aichi, Japan
| | - Shingo Hashimoto
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-Ku, Nagoya, Aichi, Japan
| | - Hiroyuki Tachibana
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-Ku, Nagoya, Aichi, Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-Ku, Nagoya, Aichi, Japan
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24
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Di Perna G, Baldassarre B, Armocida D, De Marco R, Pesaresi A, Badellino S, Bozzaro M, Petrone S, Buffoni L, Sonetto C, De Luca E, Ottaviani D, Tartara F, Zenga F, Ajello M, Marengo N, Lanotte M, Altieri R, Certo F, Pesce A, Pompucci A, Frati A, Ricardi U, Barbagallo GM, Garbossa D, Cofano F. Application of the NSE score (Neurology-Stability-Epidural compression assessment) to establish the need for surgery in spinal metastases of elderly patients: a multicenter investigation. 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 2024:10.1007/s00586-024-08328-0. [PMID: 38822150 DOI: 10.1007/s00586-024-08328-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 01/08/2024] [Accepted: 05/23/2024] [Indexed: 06/02/2024]
Abstract
PURPOSE This retropective multicentric study aims to investigate the clinical applicability of the NSE score in the elderly, to verify the role of this tool as an easy help for decision making also for this class of patients. METHODS All elderly patients (> 65 years) suffering from spinal metastases undergoing surgical or non-surgical treatment at the authors' Institutions between 2015 and 2022 were recruited. An agreement group (AG) and non-agreement group (NAG) were identified accordingly to the agreement between the NSE score indication and the performed treatment. Neurological status and axial pain were evaluated for both groups at follow-up (3 and 6 months). The same analysis was conducted specifically grouping patients older than 75 years. RESULTS A strong association with improvement or preservation of clinical status (p < 0.001) at follow-up was obtained in AG. The association was not statistically significant in NAG at the 3-month follow-up (p 1.00 and 0.07 respectively) and at 6 months (p 0.293 and 0.09 respectively). The group of patients over 75 years old showed similar results in terms of statistical association between the agreement group and better outcomes. CONCLUSION Far from the need or the aim to build dogmatic algorithms, the goal of preserving a proper performance status plays a key role in a modern oncological management: functional outcomes of the multicentric study group showed that the NSE score represents a reliable tool to establish the need for surgery also for elderly patients.
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Affiliation(s)
- Giuseppe Di Perna
- Spine Surgery Unit, Casa di Cura Città di Bra, Bra, Italy
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco, 15, Turin, 10126, Italy
| | - Bianca Baldassarre
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco, 15, Turin, 10126, Italy
| | - Daniele Armocida
- Neurosurgery Division, Università "La Sapienza" di Roma, Roma, Italy
- Neurosurgery, IRCCS-"Neuromed", Pozzilli, Italy
| | - Raffaele De Marco
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco, 15, Turin, 10126, Italy.
| | - Alessandro Pesaresi
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco, 15, Turin, 10126, Italy
| | - Serena Badellino
- Radiation Oncology, Department of Oncology, University of Turin, Turin, Italy
| | - Marco Bozzaro
- Spine Surgery Unit, Humanitas Gradenigo Hospital, Turin, Italy
| | | | - Lucio Buffoni
- Department of Medical Oncology, Humanitas Gradenigo Hospital, Turin, Italy
- IRCCS Humanitas, Humanitas University, Milan, Italy
| | - Cristina Sonetto
- Department of Medical Oncology, Humanitas Gradenigo Hospital, Turin, Italy
| | - Emmanuele De Luca
- Department of Medical Oncology, Humanitas Gradenigo Hospital, Turin, Italy
| | - Davide Ottaviani
- Department of Medical Oncology, Humanitas Gradenigo Hospital, Turin, Italy
| | - Fulvio Tartara
- Neurosurgery Unit, Istituto Clinico Città Studi, Milan, Italy
| | - Francesco Zenga
- Neurosurgery Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Marco Ajello
- Neurosurgery Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Nicola Marengo
- Neurosurgery Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Michele Lanotte
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco, 15, Turin, 10126, Italy
- Neurosurgery Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Roberto Altieri
- Department of Neurological Surgery, Policlinico "G.Rodolico-S.Marco" University Hospital, Catania, Italy
- Interdisciplinary Research Center on Brain Tumors Diagnosis and Treatment, University of Catania, Catania, Italy
| | - Francesco Certo
- Department of Neurological Surgery, Policlinico "G.Rodolico-S.Marco" University Hospital, Catania, Italy
- Interdisciplinary Research Center on Brain Tumors Diagnosis and Treatment, University of Catania, Catania, Italy
| | - Alessandro Pesce
- Neurosurgery Division, A.O. "Santa Maria Goretti", Latina, Italy
| | - Angelo Pompucci
- Neurosurgery Division, A.O. "Santa Maria Goretti", Latina, Italy
| | | | - Umberto Ricardi
- Radiation Oncology, Department of Oncology, University of Turin, Turin, Italy
| | - Giuseppe Maria Barbagallo
- Department of Neurological Surgery, Policlinico "G.Rodolico-S.Marco" University Hospital, Catania, Italy
- Interdisciplinary Research Center on Brain Tumors Diagnosis and Treatment, University of Catania, Catania, Italy
| | - Diego Garbossa
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco, 15, Turin, 10126, Italy
- Neurosurgery Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Fabio Cofano
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco, 15, Turin, 10126, Italy
- Spine Surgery Unit, Humanitas Gradenigo Hospital, Turin, Italy
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25
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Chou KN, Park DJ, Hori YS, Persad AR, Chuang C, Emrish SC, Ustrzynski L, Tayag A, Kumar K, Usoz M, Mendoza M, Rahimy E, Pollom E, Soltys SG, Lai SW, Chang SD. Primary Stereotactic Body Radiotherapy for Spinal Bone Metastases From Lung Adenocarcinoma. Clin Lung Cancer 2024:S1525-7304(24)00106-2. [PMID: 38897849 DOI: 10.1016/j.cllc.2024.05.007] [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: 11/26/2023] [Revised: 04/09/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE This study aimed to assess the results of primary stereotactic body radiotherapy (SBRT) for spinal bone metastases (SBM) originating from lung adenocarcinoma (ADC). We considered the revised Tokuhashi score (rTS), Spinal Instability Neoplastic Score (SINS), and genetic characteristics. METHODS We examined adult patients with lung ADC who underwent primary SBRT (using the CyberKnife System) for SBM between March 2012 and January 2023. RESULTS We analyzed data from 99 patients, covering 152 SBM across 194 vertebrae. The overall local control (LC) rate was 77.6% for SBM from lung ADC, with a LC rate of 90.7% at 1 year. The median period for local progression (LP) occurrence was recorded at 10.0 (3-52) months. Additionally, Asian patients demonstrated higher LC rates than White patients. Utilizing the rTS and SINS as predictive tools, we revealed that a poor survival prognosis and an unstable spinal structure were associated with increased rates of LP. Furthermore, the presence of osteolytic bone destructions and pain complaints were significantly correlated with the occurrence of LP. In the cohort of this study, 108 SBM underwent analysis to determine the expression levels of programmed cell death ligand 1 (PD-L1). Additionally, within this group, 60 showed mutations in the epidermal growth factor receptor (EGFR) alongside PD-L1 expression. Nevertheless, these genetic differences did not result in statistically significant differences in the LC rate. CONCLUSION The one-year LC rate for primary SBRT targeting SBM from lung ADC stood at 90.7%, particularly with the use of the CyberKnife System. Patients achieving LC exhibited significantly longer survival times compared to those with LP.
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Affiliation(s)
- Kuan-Nien Chou
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA; Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - David J Park
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Yusuke S Hori
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Amit R Persad
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Cynthia Chuang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Sara C Emrish
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Louisa Ustrzynski
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Armine Tayag
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Kiran Kumar
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Melissa Usoz
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Maria Mendoza
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Elham Rahimy
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Erqi Pollom
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Scott G Soltys
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Shiue-Wei Lai
- Division of Hematology/Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Steven D Chang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA.
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26
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Alcorn S, Cortés ÁA, Bradfield L, Brennan M, Dennis K, Diaz DA, Doung YC, Elmore S, Hertan L, Johnstone C, Jones J, Larrier N, Lo SS, Nguyen QN, Tseng YD, Yerramilli D, Zaky S, Balboni T. External Beam Radiation Therapy for Palliation of Symptomatic Bone Metastases: An ASTRO Clinical Practice Guideline. Pract Radiat Oncol 2024:S1879-8500(24)00099-7. [PMID: 38788923 DOI: 10.1016/j.prro.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/26/2024]
Abstract
PURPOSE This guideline provides evidence-based recommendations for palliative external beam radiation therapy (RT) in symptomatic bone metastases. METHODS The ASTRO convened a task force to address 5 key questions regarding palliative RT in symptomatic bone metastases. Based on a systematic review by the Agency for Health Research and Quality, recommendations using predefined consensus-building methodology were established; evidence quality and recommendation strength were also assessed. RESULTS For palliative RT for symptomatic bone metastases, RT is recommended for managing pain from bone metastases and spine metastases with or without spinal cord or cauda equina compression. Regarding other modalities with RT, for patients with spine metastases causing spinal cord or cauda equina compression, surgery and postoperative RT are conditionally recommended over RT alone. Furthermore, dexamethasone is recommended for spine metastases with spinal cord or cauda equina compression. Patients with nonspine bone metastases requiring surgery are recommended postoperative RT. Symptomatic bone metastases treated with conventional RT are recommended 800 cGy in 1 fraction (800 cGy/1 fx), 2000 cGy/5 fx, 2400 cGy/6 fx, or 3000 cGy/10 fx. Spinal cord or cauda equina compression in patients who are ineligible for surgery and receiving conventional RT are recommended 800 cGy/1 fx, 1600 cGy/2 fx, 2000 cGy/5 fx, or 3000 cGy/10 fx. Symptomatic bone metastases in selected patients with good performance status without surgery or neurologic symptoms/signs are conditionally recommended stereotactic body RT over conventional palliative RT. Spine bone metastases reirradiated with conventional RT are recommended 800 cGy/1 fx, 2000 cGy/5 fx, 2400 cGy/6 fx, or 2000 cGy/8 fx; nonspine bone metastases reirradiated with conventional RT are recommended 800 cGy/1 fx, 2000 cGy/5 fx, or 2400 cGy/6 fx. Determination of an optimal RT approach/regimen requires whole person assessment, including prognosis, previous RT dose if applicable, risks to normal tissues, quality of life, cost implications, and patient goals and values. Relatedly, for patient-centered optimization of treatment-related toxicities and quality of life, shared decision making is recommended. CONCLUSIONS Based on published data, the ASTRO task force's recommendations inform best clinical practices on palliative RT for symptomatic bone metastases.
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Affiliation(s)
- Sara Alcorn
- Department of Radiation Oncology, University of Minnesota, Minneapolis, Minnesota.
| | - Ángel Artal Cortés
- Department of Medical Oncology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Lisa Bradfield
- American Society for Radiation Oncology, Arlington, Virginia
| | | | - Kristopher Dennis
- Division of Radiation Oncology, Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Dayssy A Diaz
- Department of Radiation Oncology, Ohio State University, Columbus, Ohio
| | - Yee-Cheen Doung
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, Oregon
| | - Shekinah Elmore
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Lauren Hertan
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Candice Johnstone
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Joshua Jones
- Department of Radiation Oncology, Rochester Regional Health, Rochester, New York
| | - Nicole Larrier
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Quynh-Nhu Nguyen
- Department of Radiation Oncology, University of Texas - MD Anderson Cancer Center, Houston, Texas
| | - Yolanda D Tseng
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Divya Yerramilli
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sandra Zaky
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Tracy Balboni
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
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27
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Shah AA, Schwab JH. Predictive Modeling for Spinal Metastatic Disease. Diagnostics (Basel) 2024; 14:962. [PMID: 38732376 PMCID: PMC11083521 DOI: 10.3390/diagnostics14090962] [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: 03/14/2024] [Revised: 04/27/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
Spinal metastasis is exceedingly common in patients with cancer and its prevalence is expected to increase. Surgical management of symptomatic spinal metastasis is indicated for pain relief, preservation or restoration of neurologic function, and mechanical stability. The overall prognosis is a major driver of treatment decisions; however, clinicians' ability to accurately predict survival is limited. In this narrative review, we first discuss the NOMS decision framework used to guide decision making in the treatment of patients with spinal metastasis. Given that decision making hinges on prognosis, multiple scoring systems have been developed over the last three decades to predict survival in patients with spinal metastasis; these systems have largely been developed using expert opinions or regression modeling. Although these tools have provided significant advances in our ability to predict prognosis, their utility is limited by the relative lack of patient-specific survival probability. Machine learning models have been developed in recent years to close this gap. Employing a greater number of features compared to models developed with conventional statistics, machine learning algorithms have been reported to predict 30-day, 6-week, 90-day, and 1-year mortality in spinal metastatic disease with excellent discrimination. These models are well calibrated and have been externally validated with domestic and international independent cohorts. Despite hypothesized and realized limitations, the role of machine learning methodology in predicting outcomes in spinal metastatic disease is likely to grow.
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Affiliation(s)
- Akash A. Shah
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Joseph H. Schwab
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
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28
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Landriel F, White K, Guiroy A, Silva Á, Carazzo C, Simões C, Giraldo G, Cabrera JP, Molina M, Valacco M, Astur N, Teixeira W, Hem S. Navigating the Indeterminate Zone: Surgeons' Decision-Making Factors in Treating Vertebral Metastases with Spinal Instability Scores of 7-12. World Neurosurg 2024; 185:e1338-e1347. [PMID: 38521221 DOI: 10.1016/j.wneu.2024.03.084] [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: 03/15/2024] [Accepted: 03/16/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND The Spinal Instability Neoplastic Score (SINS) classification system is a validated and the most widely accepted instrument for defining instability in vertebral metastasis (VM), in which lesions scoring between 7 and 12 are defined as indeterminate and the treatment is controversial. This study aimed to determine which variables more frequently are considered by spine surgeons for choosing between the conservative and the surgical treatment of VMs among patients with an indeterminate SINS. METHODS A single-round online survey was conducted with 10 spine surgeons with expertise in the management of VMs from our AO Spine Region. In this survey, each surgeon independently reviewed demographic and cancer-related variables of 36 real-life cases of patients with vertebral metastases scored between 7 and 12 in the SINS. Bivariate and multivariate analyses were performed to identify significant SINS and non-SINS variables influencing the decision-making on surgical treatment. RESULTS The most commonly variables considered important were the SINS element "mechanical pain", rated important for 44.4% of the cases, "lesion type" for 36.1%, and "degree of vertebral collapse" and the non-SINS factor "tumor histology" rated for 13.9% of cases. By far the factor most commonly rated unimportant was "posterior element compromise" (in 72.2% of cases). CONCLUSIONS Surgeons relied on mechanical pain and type of metastatic lesion for treatment choices. Vertebral collapse, spinal malalignment, and mobility were less influential. Spinal mobility was a predictor of surgical versus non-surgical treatment. The only variables not identified either by surgeons themselves or as a predictor of surgery selection was the presence/degree of posterolateral/posterior element involvement.
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Affiliation(s)
- Federico Landriel
- Neurosurgical Department, Spine Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Kevin White
- ScienceRight Research Consulting, Ontario, Canada
| | | | - Álvaro Silva
- Orthopedics Department, Clínica Alemana - Universidad del Desarrollo, Santiago, Chile
| | - Charles Carazzo
- Department of Neurosurgery, Hospital São Vicente de Paula/Universidade de Passo Fundo, Passo Fundo, Brazil
| | - Christiano Simões
- Department of Orthopedic, Hospital Felício Rocho, Belo Horizonte, Brazil
| | - Gustavo Giraldo
- Department of Neurosurgery, Hospital Pablo Tobón Uribe, Clínica Las Américas, Medellín, Colombia
| | - Juan Pablo Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile
| | - Marcelo Molina
- Orthopedics Department, Spine Unit, Clínica Alemana, Universidad Finis Terrae, Santiago, Chile
| | - Marcelo Valacco
- Orthopedics Department, Spine Unit, Hospital Churruca, Buenos Aires, Argentina
| | - Nelson Astur
- Orthopedics Department, Spine Unit, Hospital Israelita Albert Einstein, Sao Paulo, Sao Paulo, Brazil
| | - William Teixeira
- Department of Orthopedic, Spine Unit, DWO Médicos Associados, São Paulo, Brazil
| | - Santiago Hem
- Neurosurgical Department, Spine Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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29
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Saha P, Cady-McCrea C, Puvanesarajah V, Mesfin A. Patient-Reported Outcomes for Spine Oncology: A Narrative Review. World Neurosurg 2024; 185:165-170. [PMID: 38364898 DOI: 10.1016/j.wneu.2024.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 02/07/2024] [Indexed: 02/18/2024]
Abstract
Spine tumors, both primary and metastatic, impose significant morbidity and mortality on patients and physicians. Patient-reported outcomes are valuable tools to assess a patient's impression of their health status and enhance communication between physicians and patients. Various spine generic patient-reported outcome tools have traditionally been used but have not been validated in the spine tumor patient population. The Spine Oncology Study Group Outcome Questionnaire, which is disease-specific for the metastatic spine patient population, has been shown to have strong validity, even across multiple languages. Patient-Reported Outcomes Measurement Information System, which has recently been developed, employs computerized adaptive testing to assess multiple health domains. It has been shown to capture information in both generic and specific questionnaires and has the potential to be used as a universal tool in the spine oncology patient population. Further long-term studies, as well as, cross-cultural adaptations, are needed to validate Patient-Reported Outcomes Measurement Information System's applicability and effectiveness.
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Affiliation(s)
| | - Clarke Cady-McCrea
- Department of Orthopedic Surgery and Physical Performance, School of Medicine & Dentistry, University of Rochester, Rochester, New York, USA
| | - Varun Puvanesarajah
- Medstar Orthopaedic Institute, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Addisu Mesfin
- Medstar Orthopaedic Institute, Georgetown University School of Medicine, Washington, District of Columbia, USA
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30
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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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31
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Lenschow M, Lenz M, Telentschak S, von Spreckelsen N, Sircar K, Oikonomidis S, Kernich N, Walter SG, Knöll P, Perrech M, Goldbrunner R, Eysel P, Neuschmelting V. Preoperative Performance Status Threshold for Favorable Surgical Outcome in Metastatic Spine Disease. Neurosurgery 2024:00006123-990000000-01116. [PMID: 38587396 DOI: 10.1227/neu.0000000000002941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/08/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Surgical treatment is an integral component of multimodality management of metastatic spine disease but must be balanced against the risk of surgery-related morbidity and mortality, making tailored surgical counseling a clinical challenge. The aim of this study was to investigate the potential predictive value of the preoperative performance status for surgical outcome in patients with spinal metastases. METHODS Performance status was determined using the Karnofsky Performance Scale (KPS), and surgical outcome was classified as "favorable" or "unfavorable" based on postoperative changes in neurological function and perioperative complications. The correlation between preoperative performance status and surgical outcome was assessed to determine a KPS-related performance threshold. RESULTS A total of 463 patients were included. The mean age was 63 years (range: 22-87), and the mean preoperative KPS was 70 (range: 30-100). Analysis of clinical outcome in relation to the preoperative performance status revealed a KPS threshold between 40% and 50% with a relative risk of an unfavorable outcome of 65.7% in KPS ≤40% compared with the relative chance for a favorable outcome of 77.1% in KPS ≥50%. Accordingly, we found significantly higher rates of preserved or restored ambulatory function in KPS ≥50% (85.7%) than in KPS ≤40% (48.6%; P < .001) as opposed to a significantly higher risk of perioperative mortality in KPS ≤40% (11.4%) than in KPS ≥50% (2.1%, P = .012). CONCLUSION Our results underline the predictive value of the KPS in metastatic spine patients for counseling and decision-making. The study suggests an overall clinical benefit of surgical treatment of spinal metastases in patients with a preoperative KPS score ≥50%, while a high risk of unfavorable outcome outweighing the potential clinical benefit from surgery is encountered in patients with a KPS score ≤40%.
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Affiliation(s)
- Moritz Lenschow
- Center for Neurosurgery, University of Cologne, Cologne, Germany
| | - Maximilian Lenz
- Department of Orthopedics and Trauma Surgery, University of Cologne, Cologne, Germany
| | | | | | - Krishnan Sircar
- Department of Orthopedics and Trauma Surgery, University of Cologne, Cologne, Germany
| | - Stavros Oikonomidis
- Department of Orthopedics and Trauma Surgery, University of Cologne, Cologne, Germany
| | - Nikolaus Kernich
- Department of Orthopedics and Trauma Surgery, University of Cologne, Cologne, Germany
| | - Sebastian G Walter
- Department of Orthopedics and Trauma Surgery, University of Cologne, Cologne, Germany
| | - Peter Knöll
- Department of Orthopedics and Trauma Surgery, University of Cologne, Cologne, Germany
| | - Moritz Perrech
- Center for Neurosurgery, University of Cologne, Cologne, Germany
| | | | - Peer Eysel
- Department of Orthopedics and Trauma Surgery, University of Cologne, Cologne, Germany
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Tomasian A, Levy J, Jennings JW. Percutaneous Vertebral Augmentation and Thermal Ablation in Patients with Spinal Metastases. Semin Intervent Radiol 2024; 41:170-175. [PMID: 38993602 PMCID: PMC11236444 DOI: 10.1055/s-0044-1787166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
Vertebral augmentation and thermal ablation offer radiologists a robust minimally invasive option for treatment of patients with spinal metastases. Such interventions are commonly combined and have proved safe and effective in the management of selected patients with vertebral metastases with durable treatment effects. Special attention to procedure techniques including choice of vertebral augmentation technique, choice of ablation modality, and thermal protection is essential for improved patient outcomes. This article provides a review of the most recent advances in vertebral augmentation and thermal ablation for the treatment of spinal metastases.
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Affiliation(s)
- Anderanik Tomasian
- Division of Radiological Sciences, Department of Radiology, University of California, Irvine, California
| | - Jason Levy
- Department of Radiology, Northside Radiology Associates, Atlanta, Georgia
| | - Jack W Jennings
- Department of Radiology, Mallinckrodt Institute of Radiology, St. Louis, Missouri
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El-Ghandour NMF. Commentary: Vertebral Compression Fracture After Spine Stereotactic Body Radiotherapy: The Role of Vertebral Endplate Disruption. Neurosurgery 2024; 94:e50-e51. [PMID: 37902332 DOI: 10.1227/neu.0000000000002743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
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Kovarik PDE, Fadulelmola A, Hashmi A, Kelly C, West N, Patil R, Iqbal MS. Metastatic spinal cord compression: the Spinal Instability Neoplastic Score and early surgical intervention. BMJ Support Palliat Care 2024:spcare-2023-004537. [PMID: 38458653 DOI: 10.1136/spcare-2023-004537] [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: 08/03/2023] [Accepted: 02/13/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVES To evaluate the value of Spinal Instability Neoplastic Score (SINS) in patients with spine metastasis who subsequently developed or did not develop metastatic spinal cord compression (MSCC). METHODS In this single institutional retrospective descriptive observational study, of 589 patients with MSCC who were referred for radiotherapy, 34 patients (with 41 compression sites) met the inclusion criteria: availability of diagnostic MRI spine pre-development of MSCC (MRI-1) and at the time of MSCC development (MRI-2) (CordGroup).For comparison, NoCordGroup consisted of 152 patients (160 sites) treated with radiotherapy to spinal metastases. SINS was compared between the two groups. RESULTS In CordGroup, the median interval between MRI-1 and MRI-2 was 11 weeks. The median SINS was 8 (range: 4-14) and 9 (range: 7-14) on MRI-1 and MRI-2, respectively. In NoCordGroup, the median SINS was 6 (range: 4-10). CONCLUSIONS Our study showed a trend in difference in SINS value between the two groups. This difference should be a subject of future prospective research in this patient population with poor survival.
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Affiliation(s)
| | - Ahmed Fadulelmola
- Department of Trauma and Orthopaedics, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Ahmed Hashmi
- Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne, UK
| | - Charles Kelly
- Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne, UK
| | - Nick West
- Radiotherapy Physics, Northern Centre for Cancer Care, Newcastle upon Tyne, UK
| | - Rahul Patil
- Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne, UK
| | - Muhammad Shahid Iqbal
- Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne, UK
- Newcastle University, Newcastle upon Tyne, UK
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Sacino AN, Chen H, Sahgal A, Bettegowda C, Rhines LD, Maralani P, Redmond KJ. Stereotactic body radiation therapy for spinal metastases: A new standard of care. Neuro Oncol 2024; 26:S76-S87. [PMID: 38437670 PMCID: PMC10911798 DOI: 10.1093/neuonc/noad225] [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] [Indexed: 03/06/2024] Open
Abstract
Advancements in systemic therapies for patients with metastatic cancer have improved overall survival and, hence, the number of patients living with spinal metastases. As a result, the need for more versatile and personalized treatments for spinal metastases to optimize long-term pain and local control has become increasingly important. Stereotactic body radiation therapy (SBRT) has been developed to meet this need by providing precise and conformal delivery of ablative high-dose-per-fraction radiation in few fractions while minimizing risk of toxicity. Additionally, advances in minimally invasive surgical techniques have also greatly improved care for patients with epidural disease and/or unstable spines, which may then be combined with SBRT for durable local control. In this review, we highlight the indications and controversies of SBRT along with new surgical techniques for the treatment of spinal metastases.
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Affiliation(s)
- Amanda N Sacino
- Department of Neurosurgery, John Hopkins University, Baltimore, Maryland, USA
| | - Hanbo Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Chetan Bettegowda
- Department of Neurosurgery, John Hopkins University, Baltimore, Maryland, USA
| | - Laurence D Rhines
- Department of Neurosurgery, MD Anderson Cancer Center, Houston, Texas, USA
| | - Pejman Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Kristin J Redmond
- Department of Radiation and Molecular Oncology, John Hopkins University, Baltimore, Maryland, USA
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Tomasian A, Jennings JW. Essentials of Spinal Tumor Ablation. Radiol Clin North Am 2024; 62:303-309. [PMID: 38272622 DOI: 10.1016/j.rcl.2023.09.007] [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] [Indexed: 01/27/2024]
Abstract
Recent advances in percutaneous minimally invasive thermal ablation and vertebral augmentation provide radiologists with important arsenal for treatment of selected patients with spinal metastases. These interventions have proven to be safe, effective, and durable in treatment of selected patients with vertebral metastases. Attention to procedure techniques, including choice of ablation modality, vertebral augmentation technique, and thermal protection, is essential for improved patient outcomes. A detailed knowledge of such interventions and implementation of procedural safety measures will further heighten radiologists' role in the management of patients with spinal metastases.
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Affiliation(s)
| | - Jack W Jennings
- Mallinckrodt Institute of Radiology, 510 S Kingshighway Boulevard, Saint Louis, MO, USA.
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Mamiya D, Kijima T, Takada‐Owada A, Kokubun H, Uematsu T, Takei K, Kambara T, Ishida K, Taneichi H, Kamai T. A patient with oligometastatic hormone-sensitive prostate cancer who achieved long-term progression-free survival following cytoreductive radical prostatectomy and metastasectomy. IJU Case Rep 2024; 7:165-168. [PMID: 38440717 PMCID: PMC10909147 DOI: 10.1002/iju5.12693] [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: 11/30/2023] [Accepted: 01/14/2024] [Indexed: 03/06/2024] Open
Abstract
Introduction Oligometastatic prostate cancer can be well-controlled through combined local and metastasis-directed therapies. However, the effects of cytoreductive radical prostatectomy and metastasectomy remain unclear. Case presentation A 52-year-old man presented with prostate cancer and isolated bone metastasis to the thoracic spine. Six months after neoadjuvant hormonal therapy, the patient underwent cytoreductive radical prostatectomy and total en bloc spondylectomy. The postoperative course was uneventful. Hormonal therapy was terminated 5 years after surgery, and no biochemical or radiological progression was observed at 7 years postoperatively. Conclusion Although careful patient selection is necessary, cytoreductive radical prostatectomy and metastasectomy are effective treatments for well-selected patients with oligometastatic prostate cancer.
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Affiliation(s)
- Daisuke Mamiya
- Department of UrologyDokkyo Medical UniversityShimotsugaTochigiJapan
| | - Toshiki Kijima
- Department of UrologyDokkyo Medical UniversityShimotsugaTochigiJapan
| | - Atsuko Takada‐Owada
- Department of Diagnostic PathologyDokkyo Medical UniversityShimotsugaTochigiJapan
| | - Hidetoshi Kokubun
- Department of UrologyDokkyo Medical UniversityShimotsugaTochigiJapan
| | - Toshitaka Uematsu
- Department of UrologyDokkyo Medical UniversityShimotsugaTochigiJapan
| | - Kohei Takei
- Department of UrologyDokkyo Medical UniversityShimotsugaTochigiJapan
| | | | - Kazuyuki Ishida
- Department of Diagnostic PathologyDokkyo Medical UniversityShimotsugaTochigiJapan
| | - Hiroshi Taneichi
- Department of Orthopaedic SurgeryDokkyo Medical UniversityShimotsugaTochigiJapan
| | - Takao Kamai
- Department of UrologyDokkyo Medical UniversityShimotsugaTochigiJapan
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Bindels BJJ, Mercier C, Gal R, Verlaan JJ, Verhoeff JJC, Dirix P, Ost P, Kasperts N, van der Linden YM, Verkooijen HM, van der Velden JM. Stereotactic Body and Conventional Radiotherapy for Painful Bone Metastases: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e2355409. [PMID: 38345820 PMCID: PMC10862159 DOI: 10.1001/jamanetworkopen.2023.55409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/12/2023] [Indexed: 02/15/2024] Open
Abstract
Importance Conventional external beam radiotherapy (cEBRT) and stereotactic body radiotherapy (SBRT) are commonly used treatment options for relieving metastatic bone pain. The effectiveness of SBRT compared with cEBRT in pain relief has been a subject of debate, and conflicting results have been reported. Objective To compare the effectiveness associated with SBRT vs cEBRT for relieving metastatic bone pain. Data Sources A structured search was performed in the PubMed, Embase, and Cochrane databases on June 5, 2023. Additionally, results were added from a new randomized clinical trial (RCT) and additional unpublished data from an already published RCT. Study Selection Comparative studies reporting pain response after SBRT vs cEBRT in patients with painful bone metastases. Data Extraction and Synthesis Two independent reviewers extracted data from eligible studies. Data were extracted for the intention-to-treat (ITT) and per-protocol (PP) populations. The study is reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Main Outcomes and Measures Overall and complete pain response at 1, 3, and 6 months after radiotherapy, according to the study's definition. Relative risk ratios (RRs) with 95% CIs were calculated for each study. A random-effects model using a restricted maximum likelihood estimator was applied for meta-analysis. Results There were 18 studies with 1685 patients included in the systematic review and 8 RCTs with 1090 patients were included in the meta-analysis. In 7 RCTs, overall pain response was defined according to the International Consensus on Palliative Radiotherapy Endpoints in clinical trials (ICPRE). The complete pain response was reported in 6 RCTs, all defined according to the ICPRE. The ITT meta-analyses showed that the overall pain response rates did not differ between cEBRT and SBRT at 1 (RR, 1.14; 95% CI, 0.99-1.30), 3 (RR, 1.19; 95% CI, 0.96-1.47), or 6 (RR, 1.22; 95% CI, 0.96-1.54) months. However, SBRT was associated with a higher complete pain response at 1 (RR, 1.43; 95% CI, 1.02-2.01), 3 (RR, 1.80; 95% CI, 1.16-2.78), and 6 (RR, 2.47; 95% CI, 1.24-4.91) months after radiotherapy. The PP meta-analyses showed comparable results. Conclusions and Relevance In this systematic review and meta-analysis, patients with painful bone metastases experienced similar overall pain response after SBRT compared with cEBRT. More patients had complete pain alleviation after SBRT, suggesting that selected subgroups will benefit from SBRT.
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Affiliation(s)
- Bas J. J. Bindels
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Carole Mercier
- Department of Radiation Oncology, Iridium Netwerk, Antwerpen, Belgium
- Integrated Personalised and Precision Oncology Network, University Antwerp, Antwerp, Belgium
| | - Roxanne Gal
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Jorrit-Jan Verlaan
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joost J. C. Verhoeff
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Piet Dirix
- Department of Radiation Oncology, Iridium Netwerk, Antwerpen, Belgium
- Integrated Personalised and Precision Oncology Network, University Antwerp, Antwerp, Belgium
| | - Piet Ost
- Department of Radiation Oncology, Iridium Netwerk, Antwerpen, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Nicolien Kasperts
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Yvette M. van der Linden
- Department of Radiation Oncology and Centre of Expertise in Palliative Care, Leiden University Medical Center, Leiden, the Netherlands
- Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - Helena M. Verkooijen
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
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Amelot A, Terrier LM, Farah K, Aggad M, Le Nail LR, Francois P, Beaufort Q, Mathon B. Impact of metastatic epidural spinal cord compression (MESCC) and pathological vertebral compression fracture (pVCF) in neurological and survival prognosis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107935. [PMID: 38199005 DOI: 10.1016/j.ejso.2023.107935] [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: 11/01/2023] [Revised: 12/11/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Metastatic epidural spinal cord compression (MESCC) and pathological vertebral compression fractures (pVCF) are the most serious debilitating morbidities of spine metastases (SpMs) causing devastating neurological damages. The respective impact of these two metastasis-spreading entities on survival and on neurological damage is debated. METHODS A French prospective cohort study collected 279 consecutive patients presenting with SpMs between January 2017 and 2021. We compared 174 patients with MESCC and 105 patients with pVCF. RESULTS The median Overall Survival (OS) for the MESCC group was 13.4 months (SD 1.5) vs 19.2 months (SD 2.3) for pVCF patients (p = 0.085). Sixty-five patients (23.3 %) were operated on: 49/65 (75.4 %) in the MESCC group and 16/65 (15.2 %) in the pVCF group, p < 0.0001. At 6 months FU, in the MESCC group, 21/44 (45.4 %) of non-ambulatory patients at onset improved to ambulatory status (Frankel D-E) vs 10/13 (76.9 %) in the pVCF group (p = 0.007). In multivariable analysis with the Cox proportional hazard model, good ECOG-PS and SINS Score 7-12 [HR: 6.755, 95 % CI 2.40-19.00; p = 0.001] were good prognostic factors for preserved ambulatory neurological status. However, SpMs diagnosed synchronously with the primary tumor [HR: 0.397, 95 % CI 0.185-0.853; p = 0.018] and MESCC [HR: 0.058, 95 % CI 0.107-0.456; p = 0.007] were independent risk factors for impaired neurological function. CONCLUSION Contrary to pVCF, MESCC causes neurological damage. Nevertheless, neurological recovery remains possible. MESCC and pVCF have no impact on survival. The management of MESCC remains to be clarified and optimized to reduce neurological damage.
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Affiliation(s)
- Aymeric Amelot
- Department of Neurosurgery, Hopital Bretonneau, Tours, France.
| | - Louis-Marie Terrier
- Department of Neurosurgery, Clairval Private Hopital, Ramsay Generale de Sante, Marseille, France
| | - Kaissar Farah
- Department of Neurosurgery, Hopital Timone, AP-HM, Marseille, France
| | - Mourad Aggad
- Department of Neurosurgery, Hopital Bretonneau, Tours, France
| | | | | | | | - Bertrand Mathon
- Department of Neurosurgery, Hopital La Pitié-Salpêtrière, AP-HP, Paris, France
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40
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Chen W, Yang C, Chen B, Xi M, Chen B, Li Q. Management of metastatic bone disease of melanoma. Melanoma Res 2024; 34:22-30. [PMID: 37939058 DOI: 10.1097/cmr.0000000000000937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
One of the most aggressive tumors arising from the skin, mucosa, and uvea is malignant melanoma, which easily metastasizes. Bone tissue is one of the most typical locations for distant metastasis, and around 5%-20% of patients eventually acquired skeletal metastases. For decades, the incidence of bone metastases was higher, bringing greater burden on the family, society, and healthcare system owing to the progress of targeted therapy and immunotherapy, which prolonging the survival time substantially. Moreover, bone metastases result in skeletal-related events, which influence the quality of life, obviously. Appropriate intervention is therefore crucial. To obtain the optimum cost-effectiveness, existing treatment algorithm must be integrated, which is still controversial. We have aimed to throw light on current views concerning the formation, biological and clinical features, and treatment protocol of melanoma bone metastases to guide the decision-making process.
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Affiliation(s)
- Wenyan Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine
- Guangdong Esophageal Cancer Research Institute
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, P. R. China
| | - Chen Yang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine
- Guangdong Esophageal Cancer Research Institute
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, P. R. China
| | - Biqi Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine
- Guangdong Esophageal Cancer Research Institute
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, P. R. China
| | - Mian Xi
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine
- Guangdong Esophageal Cancer Research Institute
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, P. R. China
| | - Baoqing Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine
- Guangdong Esophageal Cancer Research Institute
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, P. R. China
| | - Qiaoqiao Li
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine
- Guangdong Esophageal Cancer Research Institute
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, P. R. China
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Ujkic L, Sutanto R, Knöll P, Zarghooni K, Rosenbrock J, Walter S. [Acute spinal cord compression under systemic therapy - radiotherapy or surgery?]. Aktuelle Urol 2024; 55:50-53. [PMID: 37758040 DOI: 10.1055/a-2099-1847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Vertebral bodies are one of the most common metastasis sites found in advanced prostate cancer and have a significant impact on patients' quality of life. Spinal metastases frequently cause severe back pain and in some occasions can lead to secondary complications, with serious neurological deficits and loss of function. The main treatment goals include adequate pain management, controlling tumour growth and restoring spinal stability. Publications on the role of surgery - both conventional and stereotactic radiotherapy, and either as an individual modality or in combination - have been inconclusive. The NOMS score has proven to be useful in making treatment decisions. Existing data show better outcomes in patients with surgical therapy, both when performed in isolation and also combined with radiotherapy, in which some of the cohorts studied including patients with primary cancer other than prostate cancer. Comparative studies that specifically investigate the superiority of specific therapy modalities for metastatic prostate carcinoma are scarce. Similarly, there are limited data on microsurgical interventions for spinal metastases. Radiotherapy alone is crucial in the setting of palliation, especially for pain relief, and its effectiveness has been shown in many studies. The patient's life expectancy plays a crucial role in deciding the most appropriate treatment approach. Given the complexity of the patient population, a multimodal therapy approach is necessary. Current trends in therapy favour greater use of surgical interventions, particularly in the early detection of spinal metastases.
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Affiliation(s)
- Lidija Ujkic
- Klinik für Orthopädie, Unfallchirurgie und plastisch-ästhetische Chirurgie, Uniklinik Köln, Köln, Germany
| | - Ricardo Sutanto
- Klinik für Radioonkologie, Cyberknife und Strahlentherapie, Uniklinik Köln, Köln, Germany
| | - Peter Knöll
- Klinik für Orthopädie, Unfallchirurgie und plastisch-ästhetische Chirurgie, Uniklinik Köln, Köln, Germany
| | - Kourosh Zarghooni
- Klinik für Orthopädie und Unfallchirurgie, HELIOS Klinikum Hildesheim, Hildesheim, Germany
| | - Johannes Rosenbrock
- Klinik für Radioonkologie, Cyberknife und Strahlentherapie, Uniklinik Köln, Köln, Germany
| | - Sebastian Walter
- Klinik für Orthopädie, Unfallchirurgie und plastisch-ästhetische Chirurgie, Uniklinik Köln, Köln, Germany
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Redmond KJ, Hattangadi-Gluth J, Pollum EL, Trifiletti DM, Kim MM, Milano M. Navigating the Spinal Frontier: Recent Data on Stereotactic Body Radiation Therapy for Spine Metastases. Int J Radiat Oncol Biol Phys 2024; 118:313-317. [PMID: 38220248 DOI: 10.1016/j.ijrobp.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/07/2023] [Accepted: 11/07/2023] [Indexed: 01/16/2024]
Affiliation(s)
- Kristin J Redmond
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | | | - Erqi Liu Pollum
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, California
| | | | - Michelle M Kim
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Michael Milano
- Department of Radiation Oncology, University of Rochester, Rochester, New York
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43
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Sari SY, Demir N, Yazici G. Stereotactic Radiosurgery vs Conventional Radiotherapy for Spine Metastases. JAMA Oncol 2024; 10:259. [PMID: 38127328 DOI: 10.1001/jamaoncol.2023.6077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- Sezin Yuce Sari
- Department of Radiation Oncology, Hacettepe University Medical School, Ankara, Turkey
| | - Nihat Demir
- Department of Radiation Oncology, Hacettepe University Medical School, Ankara, Turkey
| | - Gozde Yazici
- Department of Radiation Oncology, Hacettepe University Medical School, Ankara, Turkey
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V Bonm A, Taylor LP. Management of Neurologic Complications in Patients with Brain and Spine Tumors. Semin Neurol 2024; 44:53-63. [PMID: 38176424 DOI: 10.1055/s-0043-1777422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
Patients with brain and spine tumors represent a distinct population with unique needs. We provide a practical review of neurologic care in this group with an emphasis on familiarizing the general neurologist to the nuances of neuro-oncologic supportive care. We review the management of cerebral edema, steroid dosing, and pertinent side effects. We discuss seizure management, including choice of anticonvulsants, putative antitumor effects, and important seizure mimics like drop attacks. We review the presentation and symptomatology of stroke-like migraine attack after radiation therapy (SMART syndrome). We describe the signs and symptoms that should prompt concern for metastatic spinal cord compression, as well as both acute and definitive treatment options. Finally, we discuss the underappreciated incidence of venous thromboembolic events, particularly in patients with gliomas, and review the data on management.
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Affiliation(s)
- Alipi V Bonm
- Department of Neurology, Swedish Neuroscience Institute, Seattle, Washington
| | - Lynne P Taylor
- Department of Neurology, University of Washington, Seattle, Washington
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Peters C, Vandewiele J, Lievens Y, van Eijkeren M, Fonteyne V, Boterberg T, Deseyne P, Veldeman L, De Neve W, Monten C, Braems S, Duprez F, Vandecasteele K, Ost P. Incidence and radiotherapy treatment patterns of complicated bone metastases. J Bone Oncol 2024; 44:100519. [PMID: 38179260 PMCID: PMC10765249 DOI: 10.1016/j.jbo.2023.100519] [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: 10/23/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/06/2024] Open
Abstract
Background Despite the encouraging results of the SCORAD trial, single fraction radiotherapy (SFRT) remains underused for patients with complicated bone metastases with rates as low as 18-39%. We aimed to evaluate the incidence and treatment patterns of these metastases in patients being referred to a tertiary centre for palliative radiotherapy. Materials and methods We performed a retrospective review of all bone metastases treated at our centre from January 2013 until December 2017. Lesions were classified as uncomplicated or complicated. Complicated was defined as associated with (impending) fracture, existing spinal cord or cauda equina compression. Our protocol suggests using SFRT for all patients with complicated bone metastases, except for those with symptomatic neuraxial compression and a life expectancy of ≥28 weeks. Results Overall, 37 % of all bone metastases were classified as complicated. Most often as a result of an (impending) fracture (56 %) or spinal cord compression (44 %). In 93 % of cases, complicated lesions were located in the spine, most commonly originating from prostate, breast and lung cancer (60 %). Median survival of patients with complicated bone metastases was 4 months. The use of SFRT for complicated bone metastases increased from 51 % to 85 % over the study period, reaching 100 % for patients with the poorest prognosis. Conclusions Approximately 37 % of bone metastases are classified as complicated with the majority related to (impending) fracture. Patients with complicated bone metastases have a median survival of 4 months and were mostly treated with SFRT.
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Affiliation(s)
- Cedric Peters
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Julie Vandewiele
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Marc van Eijkeren
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Valérie Fonteyne
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Tom Boterberg
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Pieter Deseyne
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Liv Veldeman
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Wilfried De Neve
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Chris Monten
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Sabine Braems
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Fréderic Duprez
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Katrien Vandecasteele
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Piet Ost
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
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Debono B, Perez A, Lonjon G, Hamel O, Dandine JB, Dupuy M, Dutertre G, Braticevic C, Latorzeff I, Amelot A. Enhancing the referral process for surgical management of spinal metastases: insights from a 12-year, bi-institutional study of 533 patients. Front Oncol 2024; 14:1301305. [PMID: 38352892 PMCID: PMC10861661 DOI: 10.3389/fonc.2024.1301305] [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: 09/24/2023] [Accepted: 01/16/2024] [Indexed: 02/16/2024] Open
Abstract
Introduction Delayed surgical management of spinal metastases (SMs) can have detrimental effects on patient survival and quality of life, leading to pain and potential neurological impairment. This study aimed to assess the impact of delayed referral for SMs on clinical outcomes by analyzing patients managed in emergency situations. Methods We retrospectively reviewed the data of all patients admitted on either emergency or elective basis who underwent surgery for the treatment of neoplastic spine lesions at our two institutions (tertiary referral neurosurgical units) between January 2008 and December 2019. Results We analyzed 210 elective (EGp) and 323 emergency patients (UGp); emergencies increased significantly over the 12-year period, with a Friday peak (39.3%) and frequent neurological impairment (61.6% vs. 20%). Among the UGp patients, 186 (7.5%) had a previously monitored primitive cancer, including 102 (31.6%) with known SMs. On admission, 71 of the 102 (69.9%) patients presented with neurological deficits. UGp patients were more likely to undergo a single decompression without fixation. Outcomes at the 3-month follow-up were significantly worse for UGp patients ([very] poor, 29.2 vs. 13.8%), and the median overall survival for UGp patients was statistically lower. Risk factors for patients with SM undergoing emergency management included short delay between onset of symptoms and first contact with a spine surgeon, and an initial motor deficit. Conclusion Many patients with previously identified metastases, including those with neurological deficits, are urgently referred. Optimization is needed in the oncology pathway, and all stakeholders must be made aware of the factors contributing to the improvement in the clinical and radiological identification of potential complications affecting patient survival and quality of life.
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Affiliation(s)
- Bertrand Debono
- Department of Neurosurgery, Paris-Versailles Spine Center, Hôpital privé de Versailles, Versailles, France
| | - Alexis Perez
- Department of Neurosurgery, Clinique de l’Union, Toulouse, France
| | - Guillaume Lonjon
- Department of Orthopedic Surgery, Orthosud, Clinique St-Jean-Sud de France, Santé Cite Group, Montpellier Metropole, France
| | - Olivier Hamel
- Department of Neurosurgery, Clinique des Cédres, Toulouse, France
| | | | - Martin Dupuy
- Department of Neurosurgery, Clinique de l’Union, Toulouse, France
| | - Guillaume Dutertre
- Institut Curie, Paris Sciences et Lettres (PSL) Research University, Surgical Oncology Department, Paris, France
| | - Cécile Braticevic
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Igor Latorzeff
- Department of Radiotherapy, Groupe ONCORAD Garonne, Clinique Pasteur, Toulouse, France
| | - Aymeric Amelot
- Department of Neurosurgery, Hopital Bretonneau, Tours, France
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Yaouanq M, Gibson N, Boudoussier A, Edouard L, Pouvreau P, Taleb I, Bouleftour W, Sargos P, Magné N, Benziane-Ouaritini N. Emergency radiation therapy in modern-day practice: Now or never, or never again ? Support Care Cancer 2024; 32:114. [PMID: 38240886 DOI: 10.1007/s00520-024-08322-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/11/2024] [Indexed: 01/23/2024]
Abstract
Radiation therapy plays a fundamental role in oncological emergencies such as superior vena cava syndrome (SVCS) and metastatic epidural spinal cord compression (MESCC). These are two examples of critical complications of metastatic cancer in terms of pain and functional impact (respiratory and/or neurological). The aim of this review is to explore the current indications, treatment options and outcomes for emergency radiotherapy regarding to these complications.Regarding SVCS, studies are mostly retrospective and unanimously demonstrated a beneficial effect of radiotherapy on symptom relief. Spinal cord compression remains an indication for urgent radiotherapy, and should be combined with surgery when possible. The innovative stereotactic body radiotherapy (SBRT) showed promising results, however this technique requires small volumes and more time preparation and therefore is often unsuitable for SVCS and MESCC emergencies.This review concluded that radiotherapy has a central role to play within a multimodal approach for SVCS and MESCC treatment. Further prospective studies are needed to confirm the effectiveness of radiation and establish the criteria for selecting patients to benefit from this treatment option.
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Affiliation(s)
- Margaux Yaouanq
- Department of Radiation Oncology, Institut Bergonié, Bordeaux, France
| | - Nyere Gibson
- Department of Radiation Oncology, Institut Bergonié, Bordeaux, France
| | | | - Lucas Edouard
- Department of Radiation Oncology, Institut Bergonié, Bordeaux, France
| | - Pierre Pouvreau
- Department of Radiation Oncology, Institut Bergonié, Bordeaux, France
| | - Imed Taleb
- Department of Radiation Oncology, Institut Bergonié, Bordeaux, France
| | - Wafa Bouleftour
- Cancerology and Hematology Institute, Department of Medical Oncology, Saint-Etienne University Hospital, 42055, Saint-Etienne, France.
| | - Paul Sargos
- Department of Radiation Oncology, Institut Bergonié, Bordeaux, France
| | - Nicolas Magné
- Department of Radiation Oncology, Institut Bergonié, Bordeaux, France
- Cellular and Molecular Radiobiology Laboratory, Lyon-Sud Medical School, Unité Mixte de Recherche CNRS5822/IP2I, University of Lyon, Lyon, France
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Rothrock RJ, Ozair A, Avendano MC, Herrera S, Appel H, Ramos S, Starosciak AK, Leon-Ariza DS, Rubens M, McDermott MW, Ahluwalia MS, Mehta MP, Kotecha RR. Prophylactic Radiotherapy Of MInimally Symptomatic Spinal Disease (PROMISSeD): study protocol for a randomized controlled trial. Trials 2024; 25:41. [PMID: 38217032 PMCID: PMC10785467 DOI: 10.1186/s13063-023-07850-8] [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: 06/18/2023] [Accepted: 12/03/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Early palliative/pre-emptive intervention improves clinical outcomes and quality of life for patients with metastatic cancer. A previous signal-seeking randomized controlled trial (RCT) demonstrated that early upfront radiotherapy to asymptomatic or minimally symptomatic high-risk osseous metastases led to reduction in skeletal-related events (SREs), a benefit driven primarily by subgroup of high-risk spine metastasis. The current RCT aims to determine whether early palliative/pre-emptive radiotherapy in patients with high-risk, asymptomatic or minimally symptomatic spine metastases will lead to fewer SREs within 1 year. METHODS This is a single-center, parallel-arm, in-progress RCT in adults (≥ 18 years) with ECOG performance status 0-2 and asymptomatic or minimally symptomatic (not requiring opioids) high-risk spine metastases from histologically confirmed solid tumor malignancies with > 5 sites of metastatic disease on cross-sectional imaging. High-risk spine metastases are defined by the following: (a) bulkiest disease sites ≥ 2 cm; (b) junctional disease (occiput to C2, C7-T1, T12-L2, L5-S1); (c) posterior element involvement; or (d) vertebral body compression deformity > 50%. Patients are randomized 1:1 to receive either standard-of-care systemic therapy (arm 1) or upfront, early radiotherapy to ≤ 5 high-risk spine lesions plus standard-of-care systemic therapy (arm 2), in the form of 20-30 Gy of radiation in 2-10 fractions. The primary endpoint is SRE, a composite outcome including spinal fracture, spinal cord compression, need for palliative radiotherapy, interventional procedures, or spinal surgery. Secondary endpoints include (1) surrogates of health care cost, including the number and duration of SRE-related hospitalizations; (2) overall survival; (3) pain-free survival; and (4) quality of life. Study instruments will be captured pre-treatment, at baseline, during treatment, and at 1, 3, 6, 12, and 24 months post-treatment. The trial aims to accrue 74 patients over 2 years to achieve > 80% power in detecting difference using two-sample proportion test with alpha < 0.05. DISCUSSION The results of this RCT will demonstrate the value, if any, of early radiotherapy for high-risk spine metastases. The trial has received IRB approval, funding, and prospective registration (NCT05534321) and has been open to accrual since August 19, 2022. If positive, the trial will expand the scope and utility of spine radiotherapy. TRIAL REGISTRATION ClinicalTrials.Gov NCT05534321 . Registered September 9, 2022. TRIAL STATUS Version 2.0 of the protocol (2021-KOT-002), revised last on September 2, 2022, was approved by the WCG institutional review board (Study Number 1337188, IRB tracking number 20223735). The trial was first posted on ClinicalTrials.Gov on September 9, 2022 (NCT05534321). Patient enrollment commenced on August 19, 2022, and is expected to be completed in 2 years, likely by August 2024.
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Affiliation(s)
- Robert J Rothrock
- Office 1R203, Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, 33176, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Miami Neuroscience Institute, Baptist Health South Florida, Miami, FL, USA
| | - Ahmad Ozair
- Office 1R203, Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, 33176, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Maria C Avendano
- Office 1R203, Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, 33176, USA
| | - Susana Herrera
- Office 1R203, Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, 33176, USA
| | - Haley Appel
- Office 1R203, Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, 33176, USA
| | - Suyen Ramos
- Office 1R203, Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, 33176, USA
| | - Amy K Starosciak
- Office 1R203, Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, 33176, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Daniel S Leon-Ariza
- Office 1R203, Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, 33176, USA
| | - Muni Rubens
- Office 1R203, Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, 33176, USA
| | - Michael W McDermott
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Miami Neuroscience Institute, Baptist Health South Florida, Miami, FL, USA
| | - Manmeet S Ahluwalia
- Office 1R203, Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, 33176, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Minesh P Mehta
- Office 1R203, Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, 33176, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Rupesh R Kotecha
- Office 1R203, Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, 33176, USA.
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA.
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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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Sawada R, Shinoda Y, Ohki T, Ishibashi Y, Kobayashi H, Matsubayashi Y, Tanaka S, Haga N. End-of-life walking ability in cancer patients with spinal metastases. Jpn J Clin Oncol 2024; 54:81-88. [PMID: 37815145 DOI: 10.1093/jjco/hyad138] [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: 07/20/2023] [Accepted: 09/21/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Even terminal cancer patients desire to walk to the toilet by themselves until the very last day. This study aimed to describe the walking ability of patients with spinal metastases at the end-of-life stage and identify the factors affecting this ability. METHODS Among 527 patients who first visited our multidisciplinary team for bone metastasis between 2013 and 2016, 56 patients who had spinal metastases with a Spinal Instability Neoplastic Score ≥7 and died during follow-up were included. We collected general clinical data, performance status, Frankel classification, epidural spinal cord compression scale and Spinal Instability Neoplastic Score at the first consultation. Patients' last day of walking and date of death were also examined. Univariate analyses (chi-squared tests) were performed to identify the factors that impacted walking ability 30 and 14 days before patients' death. RESULTS A total of 56 patients were extracted, and 57.1% (32/56) and 32.7% (16/49) of patients were ambulatory 30 and 14 days before death, respectively. Their performance status (P = 0.0007), Frankel grade (P = 0.012) and epidural spinal cord compression grade (P = 0.006) at the first examination, and administration of bone modifying agents during follow-up period (P = 0.029) were significantly related to walking ability 30 days before death. Among ambulatory patients 30 days before death, those with Spinal Instability Neoplastic Score ≥10 (P = 0.005), especially with high scores of collapse (P = 0.002) and alignment (P = 0.002), were less likely to walk 14 days before death. The walking period in the last month of their life was significantly longer in patients with total Spinal Instability Neoplastic Score 7-9 (P = 0.009) and in patients without collapse (P = 0.040) by the Wilcoxon test. CONCLUSION The progression of spinal metastasis, especially neurological deficit, at the initial consultation were associated with walking ability 30 days before death, and spinal stability might be crucial for preserving walking ability during the last month. Early diagnosis and implementation of appropriate bone management might be important for the end-of-life walking ability.
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Affiliation(s)
- Ryoko Sawada
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, Tokyo, Japan
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yusuke Shinoda
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, Tokyo, Japan
- Department of Rehabilitation Medicine, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Takahiro Ohki
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Yuki Ishibashi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Kobayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshitaka Matsubayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuhiko Haga
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, Tokyo, Japan
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