Team Approach: Metastatic Disease of the Spine

Abstract

* Symptomatic spinal metastasis is increasingly more common in patients with cancer as therapy for the primary disease advances and patients’ outcomes and life expectancy improve.* Treatment for this condition is almost always palliative, with the goals being prevention and treatment of spine-related events, such as pain, vertebral fracture, and spinal cord compression.* The main approaches for the management of spinal metastasis are chemotherapy with targeted agents for overall disease control and radiation therapy and surgical procedures to treat spine-related events and to improve local control.* Optimal management of patients with spinal metastasis is a challenge that requires a multidisciplinary approach. Treatment must be selected on an individual basis after careful evaluation of the tumor, the patient’s performance status, and the characteristics of the spinal lesion by the respective specialists.* Long-term palliation and local control are now feasible with newer techniques—a minimally invasive surgical procedure, a separation surgical procedure, stereotactic body radiation therapy, and radiosurgery—that have changed the treatment paradigms.

Current Overview of Treatment for Metastatic Bone Disease

“…For lesions with severe compression (grades 2 and 3), minimal surgical decompression of the epidural space may be considered unless the tumor is radiosensitive or the patient cannot tolerate surgery [ 86 ]. Breast and prostate cancer, lymphoma, seminoma, and myeloma are radiosensitive, while renal cell carcinoma, melanoma, and gastrointestinal tumors are radio-insensitive [ 87 ]. Surgery for spinal metastases due to radiation-sensitive tumors, such as multiple myeloma, malignant lymphoma, and leukemia should be avoided [ 88 , 89 , 90 ].…”