Intraoperative Radiotherapy Combined With Posterior Decompression and Stabilization for Non-Ambulant Paralytic Patients due to Spinal Metastasis

Kondo, Taiji; Hozumi, Takeshi; Goto, Takahiro; Seichi, Atsushi; Nakamura, Kozo

doi:10.1097/brs.0b013e31817c0410

Cited by 25 publications

(21 citation statements)

References 9 publications

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“…The majority of the current literature is based on retrospective data, which suggest that in well-selected patients, surgery can provide significant improvement in overall quality of life and function [15,17,[22][23][24][25][26][27][28][29][30][31]. However, patient selection for surgery is still controversial and depends on balancing the patient's estimated survival with the anticipated risks and benefits of surgery.…”

Section: Discussionmentioning

confidence: 99%

Surgery improves pain, function and quality of life in patients with spinal metastases: a prospective study on 118 patients

Quan

Vital²,

Aurouer³

et al. 2011

Eur Spine J

133

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Purpose There are few prospective studies on surgical outcomes and survival in patients with metastatic disease to the spine. The magnitude and duration of effect of surgery on pain relief and quality of life remains uncertain. Therefore, the aim of this clinical study was to prospectively evaluate clinical, functional, quality of life and survival outcomes after palliative surgery for vertebral metastases. Methods 118 consecutive patients who underwent spinal surgery for symptomatic vertebral metastases were prospectively followed up for 12 months or until death. Clinical data and data from the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire were obtained pre-and post-operatively and at regular follow-up intervals. Results Surgery was effective in achieving rapid improvement in axial and radicular pain, neurological deficit, sphincteric dysfunction and ambulatory status, with a complication rate of 26% and a 12 month mortality rate of 48%. Almost 50% of patients had complete resolution of back pain, radiculopathy and neurological deficit. Of the patients who were non-ambulant and incontinent, over 50% regained ambulatory ability and recovered urinary continence. The overall incidence of wound infection or breakdown was 6.8% and the local recurrence rate was 8.5%. There was a highly significant improvement in physical, role, cognitive and emotional functioning and global health status post-operatively. Greatest improvement in pain, function and overall quality of life occurred in the early post-operative period and was maintained until death or during the 12 month prospective follow-up period. Conclusion The potential for immediate and prolonged improvement in pain, function and quality of life in patients with symptomatic vertebral metastases should be considered during the decision-making process when selecting and counselling patients for surgery.

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Section: Discussionmentioning

confidence: 99%

Surgery improves pain, function and quality of life in patients with spinal metastases: a prospective study on 118 patients

Quan

Vital²,

Aurouer³

et al. 2011

Eur Spine J

133

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“…There was 1 RCT, 37 2 prospective cohort trials, 14,22 and 14 retrospective case series. 2,3,6,7,15,17,19,23,[25][26][27][28]31 As regards neurological outcomes for laminectomy alone without instrumentation for stabilization, Class II data are provided by Young et al 37 In their RCT of 29 patients, laminectomy followed by radiotherapy (RT) was compared with RT alone for the treatment of spinal metastases. Inclusion criteria were a neurological symptom, myelographic extradural block, and tissue diagnosis of metastasis.…”

Section: Posterior Laminectomy With and Without Instrumentationmentioning

confidence: 99%

“…The reported outcomes were WPO (88%) and I/M Frankel grades (89%). 19 Saito et al 28 (79 patients) evaluated the outcomes of PL and resection of an epidural metastatic tumor with intraoperative RT for the treatment of spinal metastasis. The reported outcomes were improvement by at least one Frankel grade (86%) and NAWPO (78%).…”

mentioning

confidence: 99%

“…In a follow-up study, these same authors 2 evaluated outcomes for lung carcinoma and revealed similar results, showing median survival times of 1.5 months after PL, 1 month after RT, and 3.5 months after PL+RT. The remaining studies reported overall median survival time (17 months, 19 10 months, 25 ), or overall survival of patients at the 3-month follow-up (87%, 7 63% 17 ). North et al reported an overall median survival of 10 months and also stratified survival based on tumor pathology, documenting a median survival of 1.7 years in breast cancer patients (HR 0.348, p = 0.02) and 3 months in lung cancer patients.…”

mentioning

confidence: 99%

“…2,3,6,7,14,15,17,19, 22,23, 25-28, 31, 36,37 Posterior approach laminectomy with instrumentation was used to stabilize the spine in 11 studies. 7,14,15,17,19,22,24,25,27,31 A PL was used with intraoperative RT to treat residual spinal metastatic tumor in 2 studies due to the severity of the spinal metastases. 19,28 …”

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confidence: 99%

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Posterior approaches for symptomatic metastatic spinal cord compression

Molina

Goodwin

Abu-Bonsrah

et al. 2016

FOC

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Surgical interventions for spinal metastasis are commonly performed for mechanical stabilization, pain relief, preservation of neurological function, and local tumor reduction. Although multiple surgical approaches can be used for the treatment of metastatic spinal lesions, posterior approaches are commonly performed. In this study, the role of posterior surgical procedures in the treatment of spinal metastases was reviewed, including posterior laminectomy with and without instrumentation for stabilization, transpedicular corpectomy, and costotransversectomy. A review of the literature from 1980 to 2015 was performed using Medline, as was a review of the bibliographies of articles meeting preset inclusion criteria, to identify studies on the role of these posterior approaches among adults with spinal metastasis. Thirty-four articles were ultimately analyzed, including 1 randomized controlled trial, 6 prospective cohort studies, and 27 retrospective case reports and/or series. Some of the reviewed articles had Level II evidence indicating that laminectomy with stabilization can be recommended for improvement in neurological outcome and reduction of pain in selected patients. However, the use of laminectomy alone should be carefully considered. Additionally, transpedicular corpectomy and costotransversectomy can be recommended with the expectation of improving neurological outcomes and reducing pain in properly selected patients with spinal metastases. With improvements in the treatment paradigms for patients with spinal metastasis, as well as survival, surgical therapy will continue to play an important role in the management of spinal metastasis. While this review presents a window into determining the utility of posterior approaches, future prospective studies will provide essential data to better define the roles of the various options now available to surgeons in treating spinal metastases.

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Intraoperative Radiation for Spinal Metastatic Disease

Imber

Folkert

Yamada

2020

Central Nervous System Metastases

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Intraoperative Radiotherapy Combined With Posterior Decompression and Stabilization for Non-Ambulant Paralytic Patients due to Spinal Metastasis

Abstract: The IORT procedure is a useful technique for the treatment of spinal cord compression because of spinal metastasis, offering significant neurologic recovery and a low rate of local recurrence.

Cited by 25 publications

References 9 publications

Surgery improves pain, function and quality of life in patients with spinal metastases: a prospective study on 118 patients

Surgery improves pain, function and quality of life in patients with spinal metastases: a prospective study on 118 patients

Posterior approaches for symptomatic metastatic spinal cord compression

Intraoperative Radiation for Spinal Metastatic Disease

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