The Metastatic Spine Disease Multidisciplinary Working Group Algorithms

Abstract

The Metastatic Spine Disease Multidisciplinary Working Group consists of medical and radiation oncologists, surgeons, and interventional radiologists from multiple comprehensive cancer centers who have developed evidence-and expert opinionbased algorithms for managing metastatic spine disease. The purpose of these algorithms is to facilitate interdisciplinary referrals by providing physicians with straightforward recommendations regarding the use of available treatment options, including emerging modalities such as stereotactic body radiation therapy and percutaneous tumor ablation. This consensus document details the evidence supporting the Working Group algorithms and includes illustrative cases to demonstrate how the algorithms may be applied. The Oncologist 2015;20:1205-1215Implications for Practice: The Metastatic Spine Disease Multidisciplinary Working Group algorithms can facilitate interdisciplinary referrals by providing physicians with straightforward recommendations regarding available treatment options, including emerging modalities such as stereotactic body radiation therapy and percutaneous tumor ablation.

Radiographic Local Control of Spinal Metastases with Percutaneous Radiofrequency Ablation and Vertebral Augmentation

“…These results suggest the possibility of a new, multidisciplinary paradigm for managing metastatic spine disease that incorporates RFA and vertebral augmentation for local tumor control. 18 Although radiation therapy is the standard of care for palliation and local control of osseous metastatic disease, RFA and vertebral augmentation may be an effective alternative for patients who cannot be offered or cannot tolerate radiation therapy or have radiation-resistant tumors (Fig 1). A prospective clinical trial is now needed to replicate these results.…”

Percutaneous Sacroplasty for Painful Bone Metastases: A Case Report

“…Wallace and colleagues provide algorithms for managing metastatic spine disease, which are evidence based and informed by expert opinion. These algorithms incorporate interdisciplinary referral pathways based on current and emerging therapies …”

Percutaneous Interventional Techniques for Treatment of Spinal Metastases

“…A multidisciplinary approach is recommended for the evaluation and treatment of patients with vertebral metastases, typically including radiation oncologists, medical oncologists, oncologic spine surgeons, and interventional radiologists to take into consideration and implement the most recent advances in each medical discipline for improved patient care. 15 While at present external beam radiation therapy is considered the reference standard for local control and pain palliation of spinal metastases, one should consider its limitations particularly efficacy in providing timely and adequate pain palliation. Incomplete pain response to radiation therapy has been reported in up to 75% of patients along with typically a 10-to 20-week delay to achieve maximum pain reduction following completion of radiation treatment, which is substantial considering diminished life expectancy of many patients with spinal metastases.…”