Spinal Extradural Metastasis: Review of Current Treatment Options

Bartels, Ronald H. M. A.; Linden, Yvette M. van der; Graaf, Winette T.A. van der

doi:10.3322/ca.2007.0016

Cited by 197 publications

(155 citation statements)

References 162 publications

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“…In stratified analysis, adjusted for age, gender, N stage, KPS, spine involvement, and more than three or three or fewer metastatic sites, we found that combined CRT may [31][32][33], this preliminary finding suggested that a considerable proportion of patients with single bone metastasis receiving combined CRT could be cured. Future match-paired or even prospective studies are warranted to validate this finding.…”

Section: Cmementioning

confidence: 70%

M1 Stage Subdivision and Treatment Outcome of Patients With Bone-Only Metastasis of Nasopharyngeal Carcinoma

et al. 2015

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Background. The current M1 stage in nasopharyngeal carcinoma (NPC) does not differentiate patients based on metastatic site and number of metastases. This study aims to subdivide the M1 stage of NPC patients with bone-only metastases and to identify the patients who may benefit from combined chemoradiotherapy (CRT). Methods. Between 1998 and 2007, 312 patients diagnosed with bone-only metastasis at Sun Yat-sen University Cancer Center were enrolled.Various possible subdivisions of M1 stage were considered, including by the time order of metastasis (synchronous vs. metachronous), involvement of specific bone metastatic site, the number of metastatic sites, and the number of metastases. The correlation of the subdivisions of M1 stage with overall survival (OS) was determined by Cox regression. Results. The median OS was 23.4 months. Patients with more than three metastatic sites had significantly poorer OS than patients with three or fewer metastatic sites (16.2 vs. 32.4

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Section: Cmementioning

confidence: 70%

M1 Stage Subdivision and Treatment Outcome of Patients With Bone-Only Metastasis of Nasopharyngeal Carcinoma

et al. 2015

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“…The prediction for survival is, for example, important to choose between long-or short-course radiotherapy [14]. The predicted survival apart from other factors also determines whether a patient will be a surgical candidate [1].…”

Section: Discussionmentioning

confidence: 99%

“…New insights contributed to this development. To be a surgical candidate, an expected survival of at least 3 months apart from other factors is mandatory [1].…”

Section: Introductionmentioning

confidence: 99%

External validation of a model to predict the survival of patients presenting with a spinal epidural metastasis

Bartels

Feuth

Rades

et al. 2011

Cancer Metastasis Rev

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The surgical treatment of spinal metastases is evolving. The major problem is the selection of patients who may benefit from surgical treatment. One of the criteria is an expected survival of at least 3 months. A prediction model has been previously developed. The present study has been performed in order to validate externally the model and to demonstrate that this model can be generalized to other institutions and other countries than the Netherlands. Data of 356 patients from five centers in Germany, Spain, Sweden, and the Netherlands who were treated for metastatic epidural spinal cord compression were collected. Hazard ratios in the test population corresponded with those of the developmental population. However, the observed and the expected survival were different. Analysis revealed that the baseline hazard function was significantly different. This tempted us to combine the data and develop a new prediction model. Estimating iteratively, a baseline hazard was composed. An adapted prediction model is presented. External validation of a prediction model revealed a difference in expected survival, although the relative contribution of the specific hazard ratios was the same as in the developmental population. This study emphasized the need to check the baseline hazard function in external validation. A new model has been developed using an estimated baseline hazard.

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“…96 Common treatment options for patients with metastatic skin malignancies include surgical excision, radiotherapy, chemotherapy, immunotherapies, small molecule inhibitors, steroids, and analgesics. 12,50 The majority of patients diagnosed with a metastasis from skin malignancy often receive palliative treatment, given the poor prognoses at this stage of disease. For patients with spinal metastases, surgical intervention is considered in cases of mechanical instability, tumor progression during radiation therapy or failed radiation, medically intractable pain, and/or functionally significant or progressive neurological dysfunction.…”

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confidence: 99%

A systematic review of clinical outcomes for patients diagnosed with skin cancer spinal metastases

Goodwin

Sankey

Liu

et al. 2016

SPI

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OBJECT Surgical procedures and/or adjuvant therapies are effective modalities for the treatment of symptomatic spinal metastases. However, clinical results specific to the skin cancer spinal metastasis cohort are generally lacking. The purpose of this study was to systematically review the literature for treatments, clinical outcomes, and survival following the diagnosis of a skin cancer spinal metastasis and evaluate prognostic factors in the context of spinal skin cancer metastases stratified by tumor subtype. METHODS The authors performed a literature review using PubMed, Embase, CINAHL, and Web of Science to identify articles since 1950 that reported survival, clinical outcomes, and/or prognostic factors for the skin cancer patient population with spinal metastases. The methodological quality of reviews was assessed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) tool. RESULTS Sixty-five studies met the preset criteria and were included in the analysis. Of these studies, a total of 25, 40, 25, and 12 studies included patients who underwent some form of surgery, radiotherapy, chemotherapy, or observation alone, respectively. Sixty-three of the 65 included studies were retrospective in nature (Class of Evidence [CoE] IV), and the 2 prospective studies were CoE II. Based on the studies analyzed, the median overall survival for a patient with a spinal metastasis from a primary skin malignancy is 4.0 months; survival by tumor subtype is 12.5 months for patients with basal cell carcinoma (BCC), 4.0 months for those with melanoma, 4.0 months for those with squamous cell carcinoma, 3.0 months for those with pilomatrix carcinoma, and 1.5 months for those with Merkel cell carcinoma (p < 0.0001). The overall percentage of known continued disease progression after spine metastasis diagnosis was 40.1% (n = 244/608, range 25.0%–88.9%), the rate of known recurrence of the primary skin cancer lesion was 3.5% (n = 21/608, range 0.2%–100.0%), and the rate of known spine metastasis recurrence despite treatment for all skin malignancies was 2.8% (n = 17/608, range 0.0%–33.3%). Age greater than 65 years, sacral spinal involvement, presence of a neurological deficit, and nonambulatory status were associated with decreased survival in patients diagnosed with a primary skin cancer spinal metastasis. All other clinical or prognostic parameters were of low or insufficient strength. CONCLUSIONS Patients diagnosed with a primary skin cancer metastasis to the spine have poor overall survival with the exception of those with BCC. The median duration of survival for patients who received surgical intervention alone, medical management (chemotherapy and/or radiation) alone, or the combination of therapies was similar across interventions. Age, spinal region, and neurological status may be associated with poor survival following surgery.

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Spinal Extradural Metastasis: Review of Current Treatment Options

Cited by 197 publications

References 162 publications

M1 Stage Subdivision and Treatment Outcome of Patients With Bone-Only Metastasis of Nasopharyngeal Carcinoma

M1 Stage Subdivision and Treatment Outcome of Patients With Bone-Only Metastasis of Nasopharyngeal Carcinoma

External validation of a model to predict the survival of patients presenting with a spinal epidural metastasis

A systematic review of clinical outcomes for patients diagnosed with skin cancer spinal metastases

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