br Our study showed non operative treatments
Our study showed non-operative treatments offer a statistically significant survival advantage (p = 0.013). This finding may be true because patients presenting with spinal metastases have late-stage lung cancer and are less likely to tolerate aggressive treatments as well as a healthier population.
The Metastatic Spine Disease Multidisciplinary Working Group Algorithms provide insight in the recommended management of various metastatic spinal disease presentations . This study shows a nineteen percent reduction in the risk of development of spinal related events (SRE), including pain, vertebral compression, or MESCC, with the use of chemotherapeutic agents including bis-phosphonate and denosumab. Adjuvant radiation yields better results when patients have greater than three spinal metastases. Percutaneous tumor ablation is also considered when the tumor is unresponsive to chemoradiation or the spinal cord tolerance to radiation has been reached. In patients with a particularly good prognosis or long survival expectancy, fracture prophylaxis may be considered using vertebral augmentation, although results are variable. Observation is recommended when patients have a life expectancy of less than 6 months, have a low performance status, or have widespread visceral metastatic disease . The overall goal for the management of patients with asymptomatic spinal metastases is to prevent SRE, and in concordance with our findings, more conservative treatments show better outcomes in this population.
Uncomplicated painful spinal metastases include those that are not associated with pathologic vertebral T-5224 fractures or MESCC, but do cause the patient significant pain. First-line therapy involves the use of oral analgesics and chemotherapy including bis-phosphonates. If the previously described therapy is unsuccessful at
Primary cancer types outcomes are illustrated based on characteristics of primary cancer types, number of vertebral lesions, and treatments administered.
Details of cancer N Vertebral levels N Involvement of multiple Treatment/Therapy Average survival
SCLC 112 Cervical 31
Radiation, chemotherapy alone 1
Thoracic 44 1 Radiation, chemotherapy alone 4.1
Lumbar 44 1 Laminectomy, chemotherapy alone 4.3
Sacral 1 1
9 Adeno CA 363 Cervical 1 1 Radiation 11
Thoracic 28 18 Total en bloc spondylectomy, radiation 9.4
Lumbar 9 3 Vertebrectomy, decompression/reconstruction 12
Squamous cell CA 60 Cervical
Thoracic 6 5 Resection, radiation 40.2
Lumbar 1 1 Laminectomy
Large cell CA 10 Cervical
Lumbar 1 1 Laminectomy
Non-small cell 2 Cervical 19
Decompression, radiosurgery 13.7
Thoracic 69 2 Decompression, total en bloc spondylectomy, radiosurgery 14.4
Lumbar 28 2 Decompression, total en bloc spondylectomy, radiosurgery 13.7
Radiosurgery 16 Neuroendocrine
Thoracic 2 1 Chemotherapy alone
Summary of survival analyses A statistically significant difference is seen in treatment type between operative and non-operative groups. There was not a significant difference between lung cancer type nor lesion characteristics.
N Average survival (±SD/SEM) p-value
Lung cancer type
treating the pain, conventional external beam radiation therapy (cEBRT) is considered standard of care. For patients with greater than six-months life expectancy, stereotactic body radiation ther-apy is recommended. If these therapies are unsuccessful or cannot be administered, percutaneous tumor ablation is recommended . The treatment algorithm should be made on an individual basis given various patient-specific factors, and starting with less invasive regimens is recommended.