Spinal Metastatic Disease: Analysis of Factors Determining Functional Prognosis and the Choice of Treatment

Barcena, Alejandro; Lobato, R.D.; Rivas, Juán J.; Cordobés, F.; Castro, S.; Cabrera, Antonio G.; Lamas, Eduardo

doi:10.1227/00006123-198412000-00009

Cited by 42 publications

(7 citation statements)

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“…12,20 The management option chosen in patients with metastatic spinal disease is dependent on the histological classification of the primary cancer, because this has significant implications for treatment and prognosis. 2,3,15,16,18,20,23,38,39 However, few series in the literature deal specifically with management of spinal metastases from specific cancers. 5 In our study, we sought to characterize the clinical presentation, surgical management, and outcomes in a large series of patients undergoing spinal surgery for symptomatic prostate cancer metastases to identify patient characteristics that may contribute to better survival and functional outcome.…”

Section: Discussionmentioning

confidence: 99%

Surgical management of prostate cancer metastatic to the spine

Williams¹,

Fox²,

Sciubba

et al. 2009

SPI

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Object Significant improvements in neurological function and pain relief are the benefits of aggressive surgical management of spinal metastatic disease. However, there is limited literature regarding the management of tumors with specific histological features. In this study, a series of patients undergoing spinal surgery for metastatic prostate cancer were reviewed to identify predictors of survival and functional outcome. Methods The authors retrospectively reviewed the records of all patients who were treated with surgery for prostate cancer metastases to the spine between 1993 and 2005 at a single institution. Particular attention was given to initial presentation, operative management, clinical and neurological outcomes, and factors associated with complications and overall survival. Results Forty-four patients underwent a total of 47 procedures. The median age at spinal metastasis was 66 years (range 50–84 years). Twenty-four patients had received previous external-beam radiation to the site of spinal involvement, with a median dose of 70 Gy (range 30–74 Gy). Frankel scores on discharge were significantly improved when compared with preoperative scores (p = 0.001). Preoperatively, 32 patients (73%) were walking and 33 (75%) were continent. On discharge, 36 (86%) of 42 patients were walking, and 37 (88%) of 42 were continent. Preoperatively, 40 patients (91%) were taking narcotics, with a median morphine equivalent dose of 21.5 mg/day, and 28 patients (64%) were taking steroids, with a median dose of 16 mg/day. At discharge, the median postoperative morphine equivalent dose was 12 mg/day, and the median steroid dose was 0 mg/day (p < 0.001). Complications occurred in 15 (32%) of 47 procedures, with 9 (19%) considered major, and there were 4 deaths within 30 days of surgery. The median overall survival was 5.4 months. Gleason score (p = 0.002), total number of metastases (p = 0.001), and the degree of spinal canal compression (p = 0.001) were independent predictors of survival. Age ≥ 65 years at the time of surgery was an independent predictor of a postoperative complication (p = 0.005). Conclusions In selected patients with prostate cancer metastases to the spine, aggressive surgical decompression and spinal reconstruction is a useful treatment option. The results show that on average, neurological outcome is improved and use of analgesics is reduced. Gleason score, metastatic burden, and degree of spinal canal compression may be associated with survival following surgery, and thus should be considered carefully prior to opting for surgical management.

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Section: Discussionmentioning

confidence: 99%

Surgical management of prostate cancer metastatic to the spine

Williams¹,

Fox²,

Sciubba

et al. 2009

SPI

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“…In fact, 62 % of nonambulatory patients regained the ability to walk after surgery compared to 19 % with radiation alone. Although this study did not include patients with paraplegia persisting longer than 48 h, older series suggest that immediate surgery is also advantageous in this group (Barcena et al 1984). Unfortunately, only a minority of paraplegic patients (<30%) can expect to regain ambulation with such treatment.…”

Section: Treatmentmentioning

confidence: 97%

Oncologic Emergencies

Jacobsen¹,

Beck²,

Foster³

2007

Emergencies in Urology

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“…The lack of a significant effect of visceral metastasis on survival of BCSM patients in many reported series 33,35,39 differs from the Tokuhashi score, 9,19 Tomita score, 10 and other reports concerning metastatic spinal tumor from varied pathology. [65][66][67][68][69][70] Tan et al 35 reported that patients with visceral metastasis were divided into 3 groups: removable visceral metastasis, unremovable visceral metastasis, and no visceral metastasis, with the nonsignificant differences between the 3. Tan et al 35 estimated that 86.5% of patients in this study had visceral metastases.…”

Section: Visceral Metastasismentioning

confidence: 99%

Prognostic Factors for Bone Survival and Functional Outcomes in Patients With Breast Cancer Spine Metastases

Qiao

Zhang

et al. 2022

Technol Cancer Res Treat

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According to the Global Cancer Statistics 2020 report, breast cancer is the most commonly diagnosed cancer worldwide. Patients with mammary cancer live longer due to the continuous optimization of chemotherapy, targeted drugs, and hormone therapy, which will inevitably lead to an increase in the prevalence of metastatic bone tumors. Bone metastasis affects approximately 8% of patients with mammary cancer, with the spine being the most common site. Metastatic neoplasms can invade the centrum and its attachments, leading to local pain, spinal instability, vertebral pathological fractures, spinal cord compression, impaired neurological function, and paralysis, ultimately reducing the quality of life. Multidisciplinary and personalized management using analgesic drugs, endocrine therapy, corticosteroid therapy, chemotherapy, bisphosphonates, immunotherapy, targeted drugs, radiotherapy, and surgery has been advocated for the treatment of spinal metastases. Multiple paradigms and systems have been proposed to determine suitable treatments. In the early stages, the occurrence of metastasis indicates a terminal stage of the tumor process in patients with malignant tumors, implying that their lifespan is limited. As a result, the choice of treatment is heavily influenced by longevity. However, with the development of treatment methods, the lifespan of patients with tumors has considerably increased in recent years. This leads to the choice of patient’s treatment, which depends not only on the patient’s survival, but also on the radiotherapy or postoperative functional outcomes. Nevertheless, they fall short of determining the variables that affect survival and functional outcomes in histology-specific subgroups of breast cancer. To accurately predict the bone survival and functional outcomes of patients with breast cancer spine metastases a review of prognostic factors was performed.

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Spinal Metastatic Disease: Analysis of Factors Determining Functional Prognosis and the Choice of Treatment

Cited by 42 publications

References 0 publications

Surgical management of prostate cancer metastatic to the spine

Surgical management of prostate cancer metastatic to the spine

Oncologic Emergencies

Prognostic Factors for Bone Survival and Functional Outcomes in Patients With Breast Cancer Spine Metastases

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