Surgical Strategy for Spinal Metastases

Tomita, Katsuro; Kawahara, Norio; Kobayashi, Toshiji; Yoshida, Akira; Murakami, Hideki; Akamaru, Tomoyuki

doi:10.1097/00007632-200102010-00016

Cited by 1,220 publications

(1,146 citation statements)

References 23 publications

Supporting

Mentioning

1,017

Contrasting

Unclassified

Order By: Relevance

“…The authors of this study furthermore demonstrated median survival time after en bloc spondylectomy of more than 30 months and nearly 20% surviving more than 5 years. These findings underscore the results reported by Tomita et al who demonstrated median survival times in patients after en bloc resection of 38 months [33][34][35].…”

Section: Discussionsupporting

confidence: 88%

“…Tumors were equally distributed in the thoracic (n = 8) and lumbar (n = 7) spine. According to the surgical classification of vertebral tumors [32,34], the anatomic sites of eight tumors were considered as intra-and of seven tumors as extracompartmental. Five patients were treated with surgical treatment alone and another ten patients underwent neoadjuvant or adjuvant postoperative therapy, i.e., systemic polychemotherapy and/or radiation therapy (Table 1).…”

Section: Methodsmentioning

confidence: 99%

“…In addition, a technetium bone scintigraphy was performed in all patients for the assessment of secondary lesions. Furthermore, in patients displaying extracompartmental tumor location [32,34], an additional MRI scan of the affected spine levels was performed. All patients were evaluated using the revised scoring system of metastatic spine tumor prognosis, according to Tokuhashi et al [30].…”

Section: Methodsmentioning

confidence: 99%

“…Tumor extension was assessed as either intra-or extracompartmental according to the classification by Tomita et al [32,34]. The resection was classified as wide when the distance between tumor tissue and excision margin was oncologically sufficient and/or an intact anatomical barrier (e.g., compartmental cortical wall of the vertebra) was present.…”

Section: Histological Assessment and Surgical Classificationmentioning

confidence: 99%

“…In comparison to the extremities, where improved reconstruction of neurovascular and soft tissue structures with vascular grafts, neural transplants and pedicled or free flaps regularly allow wide resections and increased limb salvage, the resection of malignant tumors of the spine is incomparably more difficult [3,34]. The topographic vicinity of vital and central neurovascular structures, i.e., spinal cord, nerve roots, aorta, caval vein, etc., to the vertebral column profoundly complicate the achievement of wide resection margins for malignant vertebral tumors.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Primary malignant bone tumors and solitary metastases of the thoracolumbar spine: results by management with total en bloc spondylectomy

Melcher

Disch

Khodadadyan-Klostermann

et al. 2007

Eur Spine J

View full text Add to dashboard Cite

Primary malignant spinal tumors and solitary vertebral metastases of selected tumor entities in the thoracolumbar spine are indications for total en bloc spondylectomy (TES). This study aimed to describe our oncological and surgical management and to analyze the treatment results by management with TES for extra-and intracompartmental solitary spinal metastases and primary malignant vertebral bone tumors. In 15 patients (3 malignant bone tumors and 12 solitary metastases), tumors were distributed in the thoracic (n = 8) and lumbar (n = 7) spine. Tumors were classified as intra-(n = 8) and extracompartmental (n = 7). All patients underwent TES via a laterally extended posterior approach followed by dorsoventral reconstruction. Function and quality of life were assessed by Oswestry disability index (ODI) and SF-36 score. At follow-up (100%; mean: 33 ± 22 months), 11 patients had no evidence of disease. Two patients were alive with the disease and two were dead of the disease (no primary bone tumors). Histology revealed negative margins (R0) in all patients with wide (n = 11) and marginal (n = 4) resections. Two patients developed pulmonal metastases of which they died at 4 and 16 months of survival. No local recurrence was observed. Major complications did not occur. TES resulted in an acceptable outcome in the quality of life and function. TES is a demanding procedure reaching wide to marginal resections in a curative approach. In conjunction with multimodal therapies, local recurrences can effectively be prevented while control of distant disease needs to be improved. Proper selection of adequate patients combined with careful surgical planning are prerequisites for low complication rates, acceptable function and improved overall prognosis.

show abstract

Section: Discussionsupporting

confidence: 88%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Histological Assessment and Surgical Classificationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Primary malignant bone tumors and solitary metastases of the thoracolumbar spine: results by management with total en bloc spondylectomy

Melcher

Disch

Khodadadyan-Klostermann

et al. 2007

Eur Spine J

View full text Add to dashboard Cite

show abstract

Development of a Clinical Prediction Model for 1-Year Mortality in Patients With Advanced Cancer

et al. 2022

View full text Add to dashboard Cite

ImportanceTo optimize palliative care in patients with cancer who are in their last year of life, timely and accurate prognostication is needed. However, available instruments for prognostication, such as the surprise question (“Would I be surprised if this patient died in the next year?”) and various prediction models using clinical variables, are not well validated or lack discriminative ability.ObjectiveTo develop and validate a prediction model to calculate the 1-year risk of death among patients with advanced cancer.Design, Setting, and ParticipantsThis multicenter prospective prognostic study was performed in the general oncology inpatient and outpatient clinics of 6 hospitals in the Netherlands. A total of 867 patients were enrolled between June 2 and November 22, 2017, and followed up for 1 year. The primary analyses were performed from October 9 to 25, 2019, with the most recent analyses performed from June 19 to 22, 2022. Cox proportional hazards regression analysis was used to develop a prediction model including 3 categories of candidate predictors: clinician responses to the surprise question, patient clinical characteristics, and patient laboratory values. Data on race and ethnicity were not collected because most patients were expected to be of White race and Dutch ethnicity, and race and ethnicity were not considered as prognostic factors. The models’ discriminative ability was assessed using internal-external validation by study hospital and measured using the C statistic. Patients 18 years and older with locally advanced or metastatic cancer were eligible. Patients with hematologic cancer were excluded.Main Outcomes and MeasuresThe risk of death by 1 year.ResultsAmong 867 patients, the median age was 66 years (IQR, 56-72 years), and 411 individuals (47.4%) were male. The 1-year mortality rate was 41.6% (361 patients). Three prediction models with increasing complexity were developed: (1) a simple model including the surprise question, (2) a clinical model including the surprise question and clinical characteristics (age, cancer type prognosis, visceral metastases, brain metastases, Eastern Cooperative Oncology Group performance status, weight loss, pain, and dyspnea), and (3) an extended model including the surprise question, clinical characteristics, and laboratory values (hemoglobin, C-reactive protein, and serum albumin). The pooled C statistic was 0.69 (95% CI, 0.67-0.71) for the simple model, 0.76 (95% CI, 0.73-0.78) for the clinical model, and 0.78 (95% CI, 0.76-0.80) for the extended model. A nomogram and web-based calculator were developed to support clinicians in adequately caring for patients with advanced cancer.Conclusions and RelevanceIn this study, a prediction model including the surprise question, clinical characteristics, and laboratory values had better discriminative ability in predicting death among patients with advanced cancer than models including the surprise question, clinical characteristics, or laboratory values alone. The nomogram and web-based calculator developed for this study can be used by clinicians to identify patients who may benefit from palliative care and advance care planning. Further exploration of the feasibility and external validity of the model is needed.

show abstract

Interventions for the treatment of metastatic extradural spinal cord compression in adults

George

Jeba

Govindaraj

et al. 2008

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

Patients with stable spines retaining the ability to walk may be treated with radiotherapy. One trial indicates that short course radiotherapy suffices in patients with unfavourable histologies or predicted survival of less than six months. There is some evidence of benefit from decompressive surgery in ambulant patients with poor prognostic factors for radiotherapy; and in non-ambulant patients with a single area of compression, paraplegia < 48 hours, non-radiosensitive tumours and a predicted survival of more than three months. High dose corticosteroids carry a significant risk of serious adverse effects.

show abstract

Surgical Strategy for Spinal Metastases

Abstract: A new surgical strategy for spinal metastases based on the prognostic scoring system is proposed. This strategy provides appropriate guidelines for treatment in all patients with spinal metastases.

Cited by 1,220 publications

References 23 publications

Primary malignant bone tumors and solitary metastases of the thoracolumbar spine: results by management with total en bloc spondylectomy

Primary malignant bone tumors and solitary metastases of the thoracolumbar spine: results by management with total en bloc spondylectomy

Development of a Clinical Prediction Model for 1-Year Mortality in Patients With Advanced Cancer

Interventions for the treatment of metastatic extradural spinal cord compression in adults

Contact Info

Product

Resources

About