CANDIDO, P. B. M. Cost analysis of spinal cord decompression surgery in patients with bone metastasis and survival association with Tokuhashi and Tomita prognostic scales. 2020. 104 f. Tese (Doutorado em

Many oncology patients were referred late to the GPC. A higher KPS was a risk factor for late referral because only severe patients were referred earlier. Metastatic patients referred with a KPS ≥70% had a longer survival.

Objective: The goal of the study was to retrospectively evaluate the demographics, clinical manifestation, outcomes, treatment result, and survival of patients with spinal metastasis with epidural metastasis who underwent surgical treatment. Materials and Methods: A retrospective evaluation of 103 patients with spinal metastasis and epidural compression who underwent surgical treatment between 2009 and 2015 was performed. The recorded parameters selected for the study were general demographic data (gender, age, and educational level) and clinical data (primary tumor, performance status according to Karnofsky score, neurological status according to Frankel scale, pain, surgical treatment outcomes, and patient survival). Results: The mean age of the patients was 55.28 ± 15.79 years, and spinal metastasis was more frequent in males (61.7%). The two most frequent tumors were malignant breast cancer (26.21%) and prostate cancer (22.33%). Preoperative pain was presented in 96 (94.12%) patients and improvement was observed in 44 (47.31%) patients. Symptoms of spinal cord compression were the initial clinical manifestation of the primary tumor in 35 (33.98%) patients. Neurological deficit was observed in 66 (64.07%) patients, and improvement was observed in 43 (41.74%) patients. Improvement of functional outcome and pain was observed in 34 (37.38%) patients. The mean survival was 12.26 months. Longer survival (mean 19.13 months) was observed in patients who showed improvement in their ability to walk or kept it preserved (Frankel D or E). Conclusions: Surgical treatment of spinal metastasis can improve pain and functional activities. Longer survival was observed in patients that keep or recovery the walking ability.

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Objective To compare Tokuhashi and Tomita scores in patients with epidural spinal metastasis who underwent surgical treatment. Methods A retrospective evaluation of 103 patients with spinal metastasis and epidural compression who underwent surgical treatment. An analysis was performed of agreement between the survival rates observed in the study sample and the survival rate estimated by the Tomita and Tokuhashi scales. Results The overall accuracy was 39.03% for the Tomita scale and 61.75% for the Tokuhashi scale. Fair agreement (0.38 weighted Cohen’s Kappa coefficient) was observed between patient survival and the Tokuhashi score, and slight agreement (0.25 weighted Kappa coefficient) for the Tomita score. The agreement for both scales was higher for patients with less than six months’ survival, with general accuracy of 79.17% for the Tomita and 70.59% for the Tokuhashi scoring system. Conclusion There was fair and slight agreement between the Tokuhashi and Tomita scores with patient survival group. The agreement was higher for patients with less than six months’ survival. Level of evidence III; Comparative retrospective study.

Objective: The goal of the study was to report the prevalence of spinal metastasis with unknown primary tumor, clinical features, treatment results and patient survival. Methods: A retrospective evaluation of 103 patients with spinal metastasis and epidural compression, who underwent surgical treatment between March 2009 and August 2015. The prevalence of metastatic spinal tumor with unknown primary tumor was evaluated, as well clinical features, survival and treatment results. Results: Of 103 patients with spinal metastasis and epidural compression, seven patients (6.8%) with unknown primary tumor site were identified; five (71.4%) male and two (28.6%) female, with ages ranging from 37 to 67 years (50.7 years). The metastasis was located in the thoracic spine in six of the patients (85.7%) and in the cervical spine in one (14.3%). The mean survival time was 44.8 days. Conclusion: Spinal metastasis with unknown primary tumor was found in 6.8% of patients. The prognosis and outcomes were poor, and patients had poor survival rates. Level of evidence III; Experimental study.

Introdução: O glioblastoma multiforme é a neoplasia de sistema nervoso central mais letal, com sobrevida media em torno de 13 meses e a de pior prognostico dentre todos os gliomas. A abordagem terapêutica do glioblastoma consiste em neurocirurgia com ressecção máxima possivel do volume tumoral, seguida de radioterapia e quimioterapia. A radioterapia reduz o risco de recidiva tumoral por meio de lesao direta e indireta ao acido desoxirribonucleico tumoral. Os efeitos em longo prazo da radioterapia incluem necrose tecidual, vasculopatia e neoplasia induzida pela radiação. Os tumores malignos intracranianos secundários mais reportados incluem meningiomas, gliomas e sarcomas. O período de latência entre a radioterapia de cranio e o surgimento de lesões radioinduzida varia na literatura entre seis meses a 47 anos, com media de 18,7 anos. Relato de caso: O presente relato descreve o surgimento de sarcoma fusocelular de alto grau radioinduzido apos dez meses em paciente que recebeu tratamento de glioblastoma no Hospital das Clinicas de Ribeirao Preto da Universidade de São Paulo. Conclusão: A raridade dessa associacao se deve provavelmente a baixa sobrevida dos pacientes com glioblastoma, limitando assim o tempo para desenvolvimento de neoplasias secundarias.

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