Clinical results of nonsurgical treatment for spinal metastases

Katagiri, Hirohisa; Takahashi, Mitsuru; Inagaki, Jiro; Kobayashi, Hidetoshi; Sugiura, Hideshi; Yamamura, S.; Iwata, Hiroji

doi:10.1016/s0360-3016(98)00288-0

Cited by 132 publications

(73 citation statements)

References 19 publications

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“…Radiosensitive solid tumor histologies include breast, prostate, ovarian, and neuroendocrine carcinomas. Renal, thyroid, hepatocellular, colon, and non-small cell lung carcinomas, sarcoma, and melanoma represent radioresistant tumors [7][8][9][10][11][12][13][14][15]. Solid tumors with radioresistant histologies generally require SRS to achieve durable local control, whereas radiosensitive solid tumors may be treated with cEBRT or SRS.…”

Section: Oncologic Assessmentmentioning

confidence: 99%

The NOMS Framework: Approach to the Treatment of Spinal Metastatic Tumors

et al. 2013

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Background. Spinal metastases frequently arise in patients with cancer. Modern oncology provides numerous treatment options that include effective systemic, radiation, and surgical options. We delineate and provide the evidence for the neurologic, oncologic, mechanical, and systemic (NOMS) decision framework, which is used at Memorial Sloan-Kettering Cancer Center to determine the optimal therapy for patients with spine metastases. Methods. We provide a literature review of the integral publications that serve as the basis for the NOMS framework and report the results of systematic implementation of the NOMSguided treatment. Results. The NOMS decision framework consists of the neurologic, oncologic, mechanical, and systemic considerations and incorporates the use of conventional external beam radiation, spinal stereotactic radiosurgery, and minimally invasive and open surgical interventions. Review of radiation oncology and surgical literature that examine the outcomes of treatment of spinal metastatic tumors provides support for the NOMS decision framework. Application of the NOMS paradigm integrates multimodality therapy to optimize local tumor control, pain relief, and restoration or preservation of neurologic function and minimizes morbidity in this often systemically ill patient population. Conclusion. NOMS paradigm provides a decision framework that incorporates sentinel decision points in the treatment of spinal metastases. Consideration of the tumor sensitivity to radiation in conjunction with the extent of epidural extension allows determination of the optimal radiation treatment and the need for surgical decompression. Mechanical stability of the spine and the systemic disease considerations further help determine the need and the feasibility of surgical intervention. The Oncologist 2013;18:744 -751 Implications for Practice: Treatment of spinal metastatic tumors requires a multidisciplinary approach which integrates radiation and medical oncology, surgery, and interventional radiology. The NOMS framework described in this manuscript incorporates the neurologic, oncologic, mechanical, and systemic considerations to facilitate decision making in the care of patients with spinal metastases. Furthermore, this framework allows dynamic integration of novel systemic and radiation options which is crucial in these rapidly evolving disciplines. The article summarizes the supporting literature for this framework and provides the results of implementation of the NOMS paradigm in the care of cancer patients. INTRODUCTIONSpinal metastases occur in 20% of all patients with cancer [1, 2], with 5%-10% of patients with cancer developing spinal cord compression [3,4]. The treatment of spinal metastases is palliative, with the goals of providing pain relief, maintenance or recovery of neurologic function, local durable tumor control, spinal stability, and improved quality of life. Over the past decade, treatment has evolved from simple decisions regarding the need for either surgery or conventional external beam...

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Section: Oncologic Assessmentmentioning

confidence: 99%

The NOMS Framework: Approach to the Treatment of Spinal Metastatic Tumors

et al. 2013

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“…However, only 6% to 67% percent of non-ambulatory patients' recovered ambulation, with reports in the higher range thought to be attributable to the large number of favorable histologies in those series 11,13 . Literature analysis reveals that all authors classify lymphoma, seminoma, and myeloma as radiosensitive histologies and supports the use of cEBRT to treat these tumors, regardless of the degree of ESCC or neurologic deficit 11,13,25,26,27 . On the other hand, solid tumors exhibit a wide range of radiosensitivity [25][26][27][28][29] .…”

Section: Radiosensitive Tumors: Conventional External Beam Radiationmentioning

confidence: 74%

“…Literature analysis reveals that all authors classify lymphoma, seminoma, and myeloma as radiosensitive histologies and supports the use of cEBRT to treat these tumors, regardless of the degree of ESCC or neurologic deficit 11,13,25,26,27 . On the other hand, solid tumors exhibit a wide range of radiosensitivity [25][26][27][28][29] . Radiosensitive solid tumor histologies include breast, prostate, ovarian, and neuroendocrine carcinomas.…”

Section: Radiosensitive Tumors: Conventional External Beam Radiationmentioning

confidence: 74%

An update in the management of spinal metastases

Joaquim

Powers

Laufer

et al. 2015

Arq. Neuro-Psiquiatr.

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Advances in cancer treatment over the past decade, such biologics and immunotherapy are improving patient outcomes and consequently life expectancy. The most common sites for metastases in the general population with cancer are the liver and lungs, followed by bone. Considering bone metastases, the majority will affect the spine 1 . Some studies estimate that up to 40% of all patients with cancer will have spinal metastases (SM) during the course of their disease 2,3 . The most frequent histologic types of cancer that give rise to bone metastases are breast, prostate and lung cancer 4 . Most of the spinal metastases are diagnosed following the diagnosis of the primary cancer. However, in about 10% of the patients, SM is the first manifestation of an unknown primary tumor 1 . Spinal cord compression is expected in up to 20% of the patients with SM. Approximately 95% of the patients with SM will demonstrate epidural metastases, mainly affecting the vertebral body and the pedicle regions, whereas 5% will present with intradural and less than 1% with intramedullary metastases 5,6 . Symptomatic spinal cord compression occurs more frequently in the thoracic spine, followed by cervical and then lumbar. The greater incidence of SM in the thoracic spine is attributed to the higher number of vertebrae and small canal diameter AbstrActThe best clinical treatment for spinal metastases requires an integrated approach with input from an interdisciplinary cancer team. The principle goals of treatment are maintenance or improvement in neurologic function and ambulation, spinal stability, durable tumor control, and pain relief. The past decade has witnessed an explosion of new technologies that have impacted our ability to reach these goals, such as separation surgery and minimally invasive spinal procedures. The biggest advance, however, has been the evolution of stereotactic radiosurgery that has demonstrated durable tumor control both when delivered as definitive therapy and as a postoperative adjuvant even for tumors considered markedly resistant to conventional external beam radiation. In this paper, we perform an update on the management of spinal metastases demonstrating the integration of these new technologies into a decision framework NOMS that assesses four basic aspects of a patient's spine disease: Neurologic, Oncologic, Mechanical Instability and Systemic disease.Keywords: spinal metastases, bone metastases, diagnosis, management, treatment, NOMS.resumo O tratamento dos pacientes com metástases na coluna requer uma abordagem multidisciplinar por equipe especializada em oncologia. Os objetivos básicos do tratamento são a manutenção/ melhora da função neurológica com preservação da deambulação, manutenção da estabilidade da coluna, controle tumoral e alívio da dor. A última década testemunhou uma explosão de novas tecnologias que auxiliaram a atingir os objetivos terapêuticos, como a cirurgia de separação e procedimentos minimamente cirúrgicos minimamente invasivos. Contudo, o maior avanço terapêutico constitui-se d...

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“…39 The median total radiation dose was 24 Gy (range, 18-35 Gy), in a mean of 3 fractions (range, 1-5). With a median follow-up for the cohort of 13 months (range, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18], local control based on imaging was achieved in 7 of the 10 patients treated.…”

Section: High-dose Spinal Rt In the Adjuvant Settingmentioning

confidence: 99%

“…[2][3][4][5] However, long-term control of symptoms, even for favorable histologies is, at best, approximately 60%, with a median duration of palliation of approximately 4 months. 6,7 The limited effectiveness of fractionated radiotherapy is inherent to the technological restrictions of this approach. A fundamental issue is the uncertainties in targeting deepseated tumors, conventionally guided by skin markings established during the simulation procedure.…”

Section: Introductionmentioning

confidence: 99%