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Tang Q, Lu J, Zhu X, Song G, Wu H, Xu H, Wang A, Wang J. The efficacy and safety of short-course neoadjuvant denosumab for en bloc spondylectomy in spinal giant cell tumor of bone: a preliminary report. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:4297-4305. [PMID: 37318598 DOI: 10.1007/s00586-023-07770-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/25/2023] [Accepted: 05/05/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE This study aimed to investigate whether short course of neoadjuvant denosumab treatment for spinal GCTB could (1) Induce radiological and histological response? (2) Facilitate en bloc resection? (3) Achieve satisfactory oncological and functional outcomes? METHODS The clinical information of ten consecutive patients between 2018 and 2022 with spinal GCTB treated with short course of neoadjuvant denosumab (≤ 5 doses) and en bloc spondylectomy was retrospectively reviewed. The radiological and histological response, operative data, oncological and functional outcomes were analyzed. RESULTS The mean doses of neoadjuvant denosumab were 4.2 (range 3-5 doses). After neoadjuvant denosumab, there were 9 cases showing new ossification and 5 cases with reappearance of cortical integrity. The values of Hounsfield units (HU) of the soft tissue component were increased by > 50% in 7 cases. The signal intensity (SI) ratios of tumor/muscle in T2WI of plain MRI were decreased by > 10% in 60% of the cases. Shrinkage of soft tissue mass by > 10% was observed in 4 cases. The mean duration of operation was 575 ± 174 min, and the mean estimated blood loss (EBL) was 2790 ± 1934 ml. No obvious adhesion to dura mater or major vessels was encounter intraoperatively. There is no tumor collapse or breakage during surgery. Multinucleated giant cells were decreased in 6 cases (60%) with the remaining 4 cases showing absence of multinucleated giant cells. Mononuclear stromal cells existed in most of the cases (8 cases, 80%). New bone formation was noticed in 8 cases (80%). No patient had a worsening of neurologic function after surgery. No tumor recurrence was noticed within the mean follow-up of 24 ± 20 months. CONCLUSION Short-term neoadjuvant denosumab could yield radiological and histological responses and might facilitate en bloc spondylectomy by hardening the tumor and causing less adhesion to segmental vessels, major vessels and nerve roots, which was beneficial to achieve the optimal oncological and functional outcomes.
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Affiliation(s)
- Qinglian Tang
- Department of Musculoskeletal Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, China
| | - Jinchang Lu
- Department of Musculoskeletal Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, China
| | - Xiaojun Zhu
- Department of Musculoskeletal Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, China
| | - Guohui Song
- Department of Musculoskeletal Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, China
| | - Hao Wu
- Department of Musculoskeletal Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, China
| | - Huaiyuan Xu
- Department of Musculoskeletal Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, China
| | - Anqi Wang
- Department of Musculoskeletal Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, China
| | - Jin Wang
- Department of Musculoskeletal Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, 510060, Guangdong, China.
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Xu N, Chang S, Liu X, Jiang L, Yu M, Wu F, Dang L, Zhou H, Li Y, Wang Y, Liu X, Wu Y, Wei F, Liu Z. Medium to long term follow-up of survival and quality of life in patients with primary tumors of the cervical spine: Experience From a large single center. Front Surg 2023; 9:1011100. [PMID: 36684347 PMCID: PMC9852619 DOI: 10.3389/fsurg.2022.1011100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/28/2022] [Indexed: 01/07/2023] Open
Abstract
Objectives To evaluate the survival and medium to long term health-related quality of life (HRQoL) of patients with primary cervical spinal tumors in a cross-sectional study and to identify any significant associations with demographic or clinical characteristics. Methods Patients diagnosed with primary cervical spinal tumors were retrospectively enrolled and their clinical, radiologic, and follow-up data (specifically the EQ-5D questionnaire) were collected. Univariate and multivariate Cox time-dependent regression analyses were performed to examine the significance of certain variables on overall survival. Univariate and multivariate logistic regression analyses were conducted to identify variables significant for overall HRQoL and each dimension of the EQ-5D. Results A total of 341 patients were enrolled in the study with a mean follow-up of 70 months. The diagnosis was benign in 246 cases, malignant in 84, and unconfirmed in 11. The 5-year overall survival rate was 86% and the 10-year overall survival rate was 65%. Multivariate analysis suggested that surgical treatment (P = 0.002, hazard ratio [HR] = 0.431, 95% CI. [0.254, 0.729]), benign and malignant tumors [P < 0.001, HR = 2.788, 95% CI. (1.721, 4.516)], tumor and surrounding normal tissue boundary [P = 0.010, HR = 1.950, 95% CI. (1.171, 3.249)], and spinal instability [P = 0.031, HR = 1.731, 95% CI. (1.051, 2.851)] still had significant effects on survival. Conclusions In this cross-sectional study, we evaluated the survival period and medium and long-term health-related quality of life of patients with primary tumors of the cervical spine, and analyzed the significant related factors of tumor clinical characteristics. Surgery, myelopathy, malignancy, spinal pain relieved by lying down or supine position, and tumor infiltration on MRI were significant predictors for overall survival. Enneking stage and age were significant predictors for HRQoL.
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Affiliation(s)
- Nanfang Xu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
| | - Shuai Chang
- Department of Orthopedics, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
| | - Xiaoguang Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
| | - Liang Jiang
- Department of Orthopedics, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
| | - Miao Yu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
| | - Fengliang Wu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
| | - Lei Dang
- Department of Orthopedics, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
| | - Hua Zhou
- Department of Orthopedics, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
| | - Yan Li
- Department of Orthopedics, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
| | - Yongqiang Wang
- Department of Orthopedics, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
| | - Xiao Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
| | - Yunxia Wu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
| | - Feng Wei
- Department of Orthopedics, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China,Correspondence: Feng Wei Zhongjun Liu
| | - Zhongjun Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China,Correspondence: Feng Wei Zhongjun Liu
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Amadasu E, Panther E, Lucke-Wold B. Characterization and Treatment of Spinal Tumors. INTENSIVE CARE RESEARCH 2022; 2:76-95. [PMID: 36741203 PMCID: PMC9893847 DOI: 10.1007/s44231-022-00014-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/03/2022] [Indexed: 02/07/2023]
Abstract
The prevalence of spinal tumors is rare in comparison to brain tumors which encompass most central nervous system tumors. Tumors of the spine can be divided into primary and metastatic tumors with the latter being the most common presentation. Primary tumors are subdivided based on their location on the spinal column and in the spinal cord into intramedullary, intradural extramedullary, and primary bone tumors. Back pain is a common presentation in spine cancer patients; however, other radicular pain may be present. Magnetic resonance imaging (MRI) is the imaging modality of choice for intradural extramedullary and intramedullary tumors. Plain radiographs are used in the initial diagnosis of primary bone tumors while Computed tomography (CT) and MRI may often be necessary for further characterization. Complete surgical resection is the treatment of choice for spinal tumors and may be curative for well circumscribed lesions. However, intralesional resection along with adjuvant radiation and chemotherapy can be indicated for patients that would experience increased morbidity from damage to nearby neurological structures caused by resection with wide margins. Even with the current treatment options, the prognosis for aggressive spinal cancer remains poor. Advances in novel treatments including molecular targeting, immunotherapy and stem cell therapy provide the potential for greater control of malignant and metastatic tumors of the spine.
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Affiliation(s)
- Efosa Amadasu
- School of Medicine, University of South Florida, Tampa, USA
| | - Eric Panther
- Department of Neurosurgery, University of Florida, Gainesville, USA
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Abelleira-Lamela T, Vaquero-Cristóbal R, González-Gálvez N, Esparza-Ros F, Espeso-García A, Marcos-Pardo PJ. Sagittal spine disposition and pelvic tilt during outdoor fitness equipment use and their associations with kinanthropometry proportions in middle-aged and older adults. PeerJ 2021; 9:e12657. [PMID: 35036145 PMCID: PMC8697770 DOI: 10.7717/peerj.12657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/29/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Outdoor fitness training has become popular as a tool for improving the health, especially middle-aged and older adults. For this purpose, outdoor fitness equipment (OFE) have been installed in public areas. However, their safety and effectiveness are still unknown. The aim of the present research was to analyze the sagittal disposition of the spine and pelvic tilt during the use of OFE, and to determine the influence of anthropometric variables on these factors in middle-aged and older adults. METHODS Seventy healthy volunteers, 56 women and 14 men (age: 63.14 ± 8.19 years) participated in the study. Sagittal spine disposition and pelvic tilt were measured using a Spinal Mouse®, in the relaxed standing position, and during the use of the OFE. In addition, kinanthropometry variables were also measured according to the guidelines of the International Society for the Advancement of Kinanthropometry. RESULTS Regarding thoracic kyphosis, a significant decrease was found in thoracic kyphosis in the initial position (IP) in single bonny rider (SBR) (p = 0.006) and row (p = 0.046), and a significant increase in the final position (FP) in the row (p = 0.011), surfboard (p < 0.001) and air walker (p = 0.027) machines. In relation to the lumbar curvature and pelvic tilt, a significant decrease in lumbar lordosis and a decrease in pelvic anteversion were observed in the IP and FP in SBR and row; and in the bike (p < 0.001) machine. In the surfboard machine, a significant decrease in lumbar lordosis was found (p = 0.002), with no changes in pelvic tilt. According to the multiple linear regression analysis, the subjects with a higher cormic index and height were more at risk of increasing their thoracic kyphosis, decreasing lumbar lordosis and/or decreasing pelvic anteversion towards pelvic retroversion. CONCLUSIONS Middle-aged and older adults show spinal misalignments when using the OFE with respect to the standing position, showing a decrease in the thoracic kyphosis in IP of SBR and ROW, and a significant increase in the surfboard and air walker, and in the FP of Row, in the lumbar lordosis in all the OFE in sitting and some in standing, and in the pelvic anteversion in all the OFE in sitting. The variables height and the cormic index explained most of the changes in sagittal spine disposition.
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Affiliation(s)
- Tomás Abelleira-Lamela
- Injury Prevention in Sport Research Group. Faculty of Sport Science, Catholic University San Antonio of Murcia, Murcia, Spain
| | - Raquel Vaquero-Cristóbal
- Injury Prevention in Sport Research Group. Faculty of Sport Science, Catholic University San Antonio of Murcia, Murcia, Spain
- Injury Prevention in Sport Research Group. International Chair of Kinanthropometry, Catholic University San Antonio of Murcia, Murcia, Spain
- Active Aging, Exercise and Health/HEALTHY-AGE Network, Consejo Superior de Deportes (CSD), Ministry of Culture and Sport of Spain, Madrid, Spain
| | - Noelia González-Gálvez
- Injury Prevention in Sport Research Group. Faculty of Sport Science, Catholic University San Antonio of Murcia, Murcia, Spain
- Active Aging, Exercise and Health/HEALTHY-AGE Network, Consejo Superior de Deportes (CSD), Ministry of Culture and Sport of Spain, Madrid, Spain
| | - Francisco Esparza-Ros
- Injury Prevention in Sport Research Group. International Chair of Kinanthropometry, Catholic University San Antonio of Murcia, Murcia, Spain
- Active Aging, Exercise and Health/HEALTHY-AGE Network, Consejo Superior de Deportes (CSD), Ministry of Culture and Sport of Spain, Madrid, Spain
| | - Alejandro Espeso-García
- Injury Prevention in Sport Research Group. Faculty of Sport Science, Catholic University San Antonio of Murcia, Murcia, Spain
| | - Pablo Jorge Marcos-Pardo
- SPORT Research Group (CTS-1024). Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain
- Active Aging, Exercise and Health/HEALTHY-AGE Network, Consejo Superior de Deportes (CSD), Ministry of Culture and Sport of Spain, Madrid, Spain
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Cazzato RL, De Marini P, Leonard-Lorant I, Dalili D, Koch G, Autrusseau PA, Mayer T, Weiss J, Auloge P, Garnon J, Gangi A. Percutaneous thermal ablation of sacral metastases: Assessment of pain relief and local tumor control. Diagn Interv Imaging 2021; 102:355-361. [PMID: 33487588 DOI: 10.1016/j.diii.2020.12.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/21/2020] [Accepted: 12/29/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To retrospectively report on safety, pain relief and local tumor control achieved with percutaneous ablation of sacral bone metastases. MATERIALS AND METHODS From February 2009 to June 2020, 23 consecutive patients (12 women and 11 men; mean age, 60±8 [SD] years; median, 60; range: 48-80 years) with 23 sacral metastases underwent radiofrequency (RFA) or cryo-ablation (CA), with palliative or curative intent at our institution. Patients' demographics and data pertaining to treated metastases, procedure-related variables, safety, and clinical evolution following ablation were collected and analyzed. Pain was assessed with numerical pain rating scale (NPRS). RESULTS Sixteen (70%) patients were treated with palliative and 7 (30%) with curative intent. Mean tumor diameter was 38±19 (SD) mm (median, 36; range: 11-76). External radiation therapy had been performed on five metastases (5/23; 22%) prior to ablation. RFA was used in 9 (39%) metastases and CA in the remaining 14 (61%). Thermo-protective measures and adjuvant bone consolidation were used whilst treating 20 (87%) and 8 (35%) metastases, respectively. Five (22%) minor complications were recorded. At mean 31±21 (SD) (median, 32; range: 2-70) months follow-up mean NPRS was 2±2 (SD) (median, 1; range: 0-6) vs. 5±1 (median, 5; range: 4-8; P<0.001) at the baseline. Three metastases out of 7 (43%) undergoing curative ablation showed local progression at mean 4±4 (SD) (median, 2; range: 1-8) months follow-up. CONCLUSION Percutaneous ablation of sacral metastases is safe and results in significant long-lasting pain relief. Local tumor control seems sub-optimal; however, further investigations are needed to confirm these findings due to paucity of data.
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Affiliation(s)
- Roberto L Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France.
| | - Pierre De Marini
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Ian Leonard-Lorant
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Danoob Dalili
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, OX37LD Oxford, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, Strand, WC2R 2LS London, United Kingdom
| | - Guillaume Koch
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Pierre A Autrusseau
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Theo Mayer
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Julia Weiss
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Pierre Auloge
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Julien Garnon
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France; School of Biomedical Engineering and Imaging Sciences, King's College London, Strand, WC2R 2LS London, United Kingdom
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Ptashnikov D, Zaborovskii N, Kostrickii S, Mikaylov D, Masevnin S, Smekalenkov O, Kuparadze I. Metastasectomy and Targeted Therapy for Patients With Spinal Metastases of Renal Cell Carcinoma. Int J Spine Surg 2020; 14:982-988. [PMID: 33560258 DOI: 10.14444/7147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Renal cell carcinoma (RCC) is an aggressive malignant disease that frequently metastasizes to the spine. The main purpose of our study is to evaluate the influence of surgery as well as targeted therapy on the survival of patients with RCC metastases of the spine. METHODS Retrospective cohort study. We identified 100 patients with spinal RCC metastases who were retrospectively reviewed for preoperative conditions, treatment, and survival. Metastasectomy was performed in 39 cases, and 61 patients underwent decompression procedures with stabilization. Only 26 patients had adjuvant targeted therapy (7 with metastasectomy, 19 with palliative decompression). Pain, neurological status, survival time (from operation to death or last follow up), and local progression-free survival were evaluated. RESULTS Neurological function recovery and reported significant pain relief were observed. There was no significant difference in overall survival for the patients with metastasectomy and palliative decompression (P = .750). Metastasectomy provided better local control of disease compared with decompression (P = .043). There was a statistically significant difference in overall survival for the patients who received targeted therapy (P = .012). CONCLUSIONS Metastasectomy is effective for local control of tumors. Targeted therapy can potentially prolong overall survival for patients with spinal RCC metastases. LEVEL OF EVIDENCE 3. CLINICAL RELEVANCE Our findings suggest that spinal metastasectomy is useful for local control of tumor growth but not for live expectancy. Effective systemic therapy is key role in stopping of disease progression.
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Affiliation(s)
- Dmitrii Ptashnikov
- Spine Surgery and Oncology Service, R.R. Vreden Russian Research Institute of Traumatology and Orthopedics, Saint-Petersburg, Russia.,North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia
| | - Nikita Zaborovskii
- Spine Surgery and Oncology Service, R.R. Vreden Russian Research Institute of Traumatology and Orthopedics, Saint-Petersburg, Russia
| | | | - Dmitrii Mikaylov
- Spine Surgery and Oncology Service, R.R. Vreden Russian Research Institute of Traumatology and Orthopedics, Saint-Petersburg, Russia
| | - Sergei Masevnin
- Spine Surgery and Oncology Service, R.R. Vreden Russian Research Institute of Traumatology and Orthopedics, Saint-Petersburg, Russia
| | - Oleg Smekalenkov
- Spine Surgery and Oncology Service, R.R. Vreden Russian Research Institute of Traumatology and Orthopedics, Saint-Petersburg, Russia
| | - Irakli Kuparadze
- North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia
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Xing X, Zhang J, Chen Y, Zhao Q, Lang N, Yuan H. Application of monoexponential, biexponential, and stretched-exponential models of diffusion-weighted magnetic resonance imaging in the differential diagnosis of metastases and myeloma in the spine-Univariate and multivariate analysis of related parameters. Br J Radiol 2020; 93:20190891. [PMID: 32462885 DOI: 10.1259/bjr.20190891] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To explore the value of related parameters in monoexponential, biexponential, and stretched-exponential models of diffusion-weighted imaging (DWI) in differentiating metastases and myeloma in the spine. METHODS 53 metastases and 16 myeloma patients underwent MRI with 10 b-values (0-1500 s/mm2). Parameters of apparent diffusion coefficient (ADC), true diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (f), the distribution diffusion coefficient (DDC), and intravoxel water diffusion heterogeneity (α) from DWI were calculated. The independent sample t test and the Mann-Whiney U test were used to compare the statistical difference of the parameter values between the two. Receiver operating characteristics (ROC) curve analysis was used to identify the diagnostic efficacy. Then substituted each parameter into the decision tree model and logistic regression model, identified meaningful parameters, and evaluated their joint diagnostic performance. RESULTS The ADC, D, and α values of metastases were higher than those of myeloma, whereas the D* value was lower than that of myeloma, and the difference was significant (p < 0.05); the area under the ROC curve for the above parameters was 0.661, 0.710, 0.781, and 0.743, respectively. There was no significant difference in the f and DDC values (p > 0.05). D and α were found to conform to the decision tree model, and the accuracy of model diagnosis was 84.1%. ADC and α were found to conform to the logistic regression model, and the accuracy was 87.0%. CONCLUSION The 3 models of DWI have certain values indifferentiating metastases and myeloma in spine, and the diagnostic performance of ADC, D, α and D*was better. Combining ADC with α may markedly aid in the differential diagnosis of the two. ADVANCES IN KNOWLEDGE Monoexponential, biexponential, and stretched-exponential models can offer additional information in the differential diagnosis of metastases and myeloma in the spine. Decision tree model and logistic regression model are effective methods to help further distinguish the two.
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Affiliation(s)
- Xiaoying Xing
- Department of Radiology, Peking University Third Hospital, Beijing, PR China
| | - Jiahui Zhang
- Department of Radiology, Peking University Third Hospital, Beijing, PR China
| | - Yongye Chen
- Department of Radiology, Peking University Third Hospital, Beijing, PR China
| | - Qiang Zhao
- Department of Radiology, Peking University Third Hospital, Beijing, PR China
| | - Ning Lang
- Department of Radiology, Peking University Third Hospital, Beijing, PR China
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, Beijing, PR China
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Charest-Morin R, Fisher CG, Versteeg AL, Sahgal A, Varga PP, Sciubba DM, Schuster JM, Weber MH, Clarke MJ, Rhines LD, Boriani S, Bettegowda C, Fehlings MG, Arnold PM, Gokaslan ZL, Dea N. Clinical presentation, management and outcomes of sacral metastases: a multicenter, retrospective cohort study. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:214. [PMID: 31297379 DOI: 10.21037/atm.2019.04.88] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Sacral metastases are rare and literature regarding their management is sparse. This multicenter, prospective, observational study aimed to determine health related-quality of life (HRQOL) and pain in patients treated for sacral metastases with surgery and/or radiation therapy (RT). The secondary objectives were to describe the adverse event (AE) profile and change in neurologic function in this population. Methods Twenty-three patients presenting with symptomatic sacral metastases were identified from the Epidemiology, Process and Outcomes of Spine Oncology (EPOSO) dataset, a prospective multicenter study on spinal metastases. Patients requiring surgery and/or RT between August 2013 and February 2017 were prospectively enrolled. HRQOL, assessed by the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQv2.0), the Short Form-36 version 2 (SF-36v2), and the EuroQol-5Dimension (EQ-5D) was documented at baseline, 6 weeks, 3 and 6 months post-treatment. Pain numeric rating scale (NRS), AEs, lower extremities motor score (ASIA), and bowel and bladder function were also recorded. Results Eight patients underwent surgery ± RT and 15 patients underwent RT alone. Mean age was 59.3 (SD 11.7) years and 13 patients were female. At 6 months, 3 (37.5%) surgical patients and 2 (13.3%) RT patients were deceased. There was a trend showing that surgical patients had worse baseline HRQOL and pain. Pain NRS, EQ-5D, SOSGOQv2.0, and the mental component of the SF-36v2 showed improvement, irrespective of treatment (P>0.05). Ten AEs occurred in the surgical cohort, dominated by wound complications (n=3). Bowel and bladder function improved at 6 weeks in both groups. Conclusions Surgical treatment and RT are both valid treatment options for symptomatic sacral metastases. Improvement in HRQOL can be expected with an acceptable AE rate.
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Affiliation(s)
- Raphaële Charest-Morin
- Department of Orthopaedics, Division of Spine, University of British Columbia and Vancouver General Hospital, Vancouver, BC, Canada
| | - Charles G Fisher
- Department of Orthopaedics, Division of Spine, University of British Columbia and Vancouver General Hospital, Vancouver, BC, Canada
| | - Ann L Versteeg
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Arjun Sahgal
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Peter Pal Varga
- National Center for Spinal Disorders and Buda Health Center, Budapest, Hungary
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James M Schuster
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Michael H Weber
- Department of Orthopaedic Surgery, McGill University, Montreal, Qc, Canada
| | | | - Laurence D Rhines
- Department of Neurosurgery, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | | | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael G Fehlings
- Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
| | - Paul M Arnold
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Nicolas Dea
- Department of Orthopaedics, Division of Spine, University of British Columbia and Vancouver General Hospital, Vancouver, BC, Canada
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Wang SX, Wang HL, Lin KY, Bian C, Sun C, Dong J. Surgical Outcomes and Prognostic Factors for Metastatic Spine Hepatocellular Carcinoma. World Neurosurg 2019; 122:e1052-e1058. [DOI: 10.1016/j.wneu.2018.10.226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/28/2018] [Accepted: 10/29/2018] [Indexed: 11/24/2022]
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Spondylolisthesis and tumors: a treatment algorithm. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:206-212. [PMID: 29654368 DOI: 10.1007/s00586-018-5589-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 04/07/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Pars defect and spondylolisthesis are frequent conditions, while bone tumors-particularly the primaries-are rare. The contemporary occurrence can delay the diagnosis of the tumor, if symptoms are considered related to spondylolisthesis, or can make reconstruction more demanding. To our knowledge, only two case reports of this contemporary occurrence have been published in the literature. Being such rare, guidelines on surgical treatment have not been proposed yet. MATERIALS AND METHODS A retrospective review of patients treated for spine bone tumors by the senior author from 1990 to 2017 was performed to find cases of contemporary occurrence of spondylolisthesis and/or pars defect and spine bone tumors. General health data, radiological imaging, histological tumor diagnosis, treatment, and follow-up were analyzed and discussed. RESULTS Among the 1870 patients treated for spinal tumors between 1990 and 2017 by the senior author, 14 cases of association between tumors and spondylolysis/spondylolisthesis were observed. The cohort includes five males (35.7%) and nine females (64.3%), aged 14-72. Mean age of patients at surgery time was 47. CONCLUSIONS Interactions between spondylolisthesis and bone tumors of the spine are episodic. These two conditions rarely occur in the same patient. No treatment strategy has been described until now. The target of this paper is to propose an algorithm to surgically treat patients with concomitant bone tumor and spondylolisthesis. This classification identifies a treatment-oriented algorithm based on two major categories: type A, bone tumor arising on the same vertebra or to an adjacent level; type B, bone tumor arising at least one unit far from the spondylolisthesis. This algorithm can help the surgeon facing this rare combination of diseases in the appropriate preoperative planning. These slides can be retrieved under Electronic Supplementary Material.
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Abstract
STUDY DESIGN A case report. OBJECTIVE To report a case of the lumbar giant cell tumor (GCT) utilizing a new clinical treatment modality (denosumab therapy), which showed a massive tumor reduction combined with the L4 spondylectomy. SUMMARY OF BACKGROUND DATA There are some controversies about spinal GCT treatments. Denosumab has provided good clinical results in terms of tumor shrinkage, and local control in a short-time follow-up clinical study phase 2, although for spinal lesions, it has not been described. Nonetheless, "en bloc" spondylectomy has been accepted as being the best treatments modalities in terms of oncological control. METHODS A case study with follow-up examination and series radiological assessments 6 months after therapy started, followed by a complex spine surgery. RESULTS The denosumab therapy showed on the lumbar computed tomography scans follow-up 6 months later, a marked tumor regression around 90% associated to vertebral body calcification, facilitating a successful L4 spondylectomy with an anterior and posterior reconstruction. The patient recovered without neurological deficits. CONCLUSION A new therapeutic modality for spinal GCT is available and showing striking clinical results; however, it is necessary for well-designed studies to answer the real role of denosumab therapy avoiding or facilitating complex spine surgeries as spondylectomies for spinal GCT. LEVEL OF EVIDENCE 5.
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Ma X, Wei S, Yang C, Hua Y, Shen J, Cai Z. Gelfoam embolization or 125I seed implantation may be a more effective treatment than surgical treatment for giant benign sacral neurogenic tumors. World J Surg Oncol 2015; 13:247. [PMID: 26271355 PMCID: PMC4536730 DOI: 10.1186/s12957-015-0662-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 07/28/2015] [Indexed: 11/15/2022] Open
Abstract
Background The goal of the present study was to assess the effects of computed tomography (CT)-guided iodine-125 (125I) seed implantation or gelatin sponge particle (GSP) embolization on patients with giant benign sacral neurogenic tumors. Methods A total of 24 cases with giant sacral neurogenic tumor were performed in a retrospective study between 2000 and 2012. Nineteen cases received surgical resection, and five cases received non-surgical treatment. In surgical group, patients with type III sacral tumor had received a combined anterior-posterior approach and patients with type IV were treated with simple anterior approach. In non-surgical group, CT-guided 125I seed implantation or GSP embolization was applied to occlude vessels. Besides, CT scanning or magnetic resonance imaging was used to assess the size and development of tumors. Results Two of the five patients were treated three times with GSP embolization, one had received GSP embolization combined with CT-guided 125I seed implantation, one case did not receive any treatment, and one patient was lost to follow-up. Patients in non-surgical group were followed up for 2–8 years. Conclusions Our study suggested that CT-guided 125I seed implantation or GSP embolization treatment is very useful to slow down the development of giant benign sacral neurogenic tumors.
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Affiliation(s)
- Xiaojun Ma
- Department of Orthopedics, Tongji University, Shanghai Tenth People's Hospital, 301 Yanchang Rd, Shanghai, 200072, China. .,Department of Orthopedics, Shanghai Jiao Tong University, Shanghai First People's Hospital, No.100 Haining road, Hongkou district, Shanghai, 200080, China.
| | - Sun Wei
- Department of Orthopedics, Shanghai Jiao Tong University, Shanghai First People's Hospital, No.100 Haining road, Hongkou district, Shanghai, 200080, China.
| | - Chunxi Yang
- Department of Orthopedics, Tongji University, Shanghai Tenth People's Hospital, 301 Yanchang Rd, Shanghai, 200072, China.
| | - Yingqi Hua
- Department of Orthopedics, Shanghai Jiao Tong University, Shanghai First People's Hospital, No.100 Haining road, Hongkou district, Shanghai, 200080, China.
| | - Jiakang Shen
- Department of Orthopedics, Shanghai Jiao Tong University, Shanghai First People's Hospital, No.100 Haining road, Hongkou district, Shanghai, 200080, China.
| | - Zhengdong Cai
- Department of Orthopedics, Shanghai Jiao Tong University, Shanghai First People's Hospital, No.100 Haining road, Hongkou district, Shanghai, 200080, China.
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Eap C, Tardieux E, Goasgen O, Bennis S, Mireau E, Delalande B, Cvitkovik F, Baussart B, Aldea S, Jovenin N, Gaillard S. Tokuhashi score and other prognostic factors in 260 patients with surgery for vertebral metastases. Orthop Traumatol Surg Res 2015; 101:483-8. [PMID: 25910701 DOI: 10.1016/j.otsr.2015.03.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 02/08/2015] [Accepted: 03/11/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Metastatic disease of the spine is an increasingly common public health problem. Surgery should be an integral component of the overall cancer treatment plan and, importantly, must neither delay not jeopardize any of the other components. The prognosis governs the choice of the surgical strategy. Tokuhashi et al. developed a prognostic score in 1990, then revised it in 2000 and 2005. Here, our objective was to evaluate the performance of the Tokuhashi score in a cohort of 260 patients and to look for other variables that might improve preoperative outcome prediction. MATERIAL AND METHOD We retrospectively established a single-centre cohort of 260 patients who underwent spinal metastasis surgery between 1998 and 2008. For each patient, the following data were collected prospectively: socio-demographic features, history of the malignancy, variables needed to determine the Tokuhashi score, and treatments used. SAS 9.0 software was chosen for the statistical analysis. Variables were described as mean ± SD, overall survival was estimated using the Kaplan-Meier method, and survivals in subgroups were compared by the log-rank test. To assess agreement between survival predicted by the Tokuhashi score and observed survival, we computed Cohen's kappa and interpreted the results according to Landis and Koch. RESULTS There were 143 females and 117 males with a mean age of 59 years and overall median survival of 10 months. Median observed survivals in the three Tokuhashi score categories (< 6, 6-12, and > 12 months predicted survival) were 5, 10, and 36 months, respectively. These survival times differed significantly (P < 0.0001). Cohen's kappa indicated moderate agreement between predicted and observed survivals. Other factors associated with significant survival differences were time from cancer diagnosis to metastasis diagnosis (synchronous, < 2 years, 2-5 years, or > 5 years; P < 0.0001) and age (< 70 years or ≥ 70 years, P = 0.0053). CONCLUSION Our cohort study supports the validity and reproducibility of the Tokuhashi score. Our finding that shorter time to metastasis diagnosis and age ≥ 70 years were also significantly associated with survival in our population invites further efforts to improve and update the Tokuhashi score.
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Affiliation(s)
- C Eap
- Service de neurochirurgie, hôpital Foch, 40, rue Worth, 92151 Suresnes, France.
| | - E Tardieux
- Service de neurochirurgie, hôpital Foch, 40, rue Worth, 92151 Suresnes, France
| | - O Goasgen
- Service de neurochirurgie, hôpital Foch, 40, rue Worth, 92151 Suresnes, France
| | - S Bennis
- Service de neurochirurgie, hôpital Foch, 40, rue Worth, 92151 Suresnes, France
| | - E Mireau
- Service de neurochirurgie, hôpital Foch, 40, rue Worth, 92151 Suresnes, France
| | - B Delalande
- Service de neurochirurgie, hôpital Foch, 40, rue Worth, 92151 Suresnes, France
| | - F Cvitkovik
- Service de neurochirurgie, hôpital Foch, 40, rue Worth, 92151 Suresnes, France
| | - B Baussart
- Service de neurochirurgie, hôpital Foch, 40, rue Worth, 92151 Suresnes, France
| | - S Aldea
- Service de neurochirurgie, hôpital Foch, 40, rue Worth, 92151 Suresnes, France
| | - N Jovenin
- Service de neurochirurgie, hôpital Foch, 40, rue Worth, 92151 Suresnes, France
| | - S Gaillard
- Service de neurochirurgie, hôpital Foch, 40, rue Worth, 92151 Suresnes, France
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Goldschlager T, Dea N, Boyd M, Reynolds J, Patel S, Rhines LD, Mendel E, Pacheco M, Ramos E, Mattei TA, Fisher CG. Giant cell tumors of the spine: has denosumab changed the treatment paradigm? J Neurosurg Spine 2015; 22:526-33. [PMID: 25700239 DOI: 10.3171/2014.10.spine13937] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECT Giant cell tumors (GCTs) of the spine are rare and complex to treat. They have a propensity for local recurrence and the potential to metastasize. Treatment is currently surgical and presents unique challenges due to the proximity of neural structures and the need for reconstruction. Denosumab has been shown in clinical trials to be an effective treatment for GCT, but has not yet been studied specifically in GCT of the spine or as a surgical adjunct. To the authors' knowledge this is the first such reported series. METHODS A multicenter, prospective series of 5 patients with GCT of the spine treated with denosumab were included. Patient demographic data, oncological history, neurological status, tumor staging, treatment details and adverse events, surgical procedure, complications, radiological and histological responses, and patient outcome were analyzed. RESULTS All patients were women, with a mean age of 38 years, and presented with pain; 2 patients had additional neurological signs and symptoms. The mean duration of symptoms was 62 weeks. No patient had a prior tumor or metastatic disease at presentation. All patients had Enneking Stage III tumors and were treated with monthly cycles of 120 mg of denosumab, with initial additional loading doses on Days 8 and 15. Patients were given daily supplements of calcium (500 mg) and vitamin D (400 IU). There were no denosumab-related adverse events. All patients had a radiological response to denosumab. One patient failed to have a histological response to denosumab, with > 90% of tumor cells found to be viable on histological investigation. CONCLUSIONS This study reports the early experience of using denosumab in the treatment of spinal GCT. The results demonstrate a clinically beneficial radiological response and an impressive histological response in most but not all patients. Further experience with denosumab and longer patient follow-up is required. Denosumab has the potential to change the treatment paradigm for spinal GCT.
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Fisher CG, Goldschlager T, Boriani S, Varga PP, Rhines LD, Fehlings MG, Luzzati A, Dekutoski MB, Reynolds JJ, Chou D, Berven SH, Williams RP, Quraishi NA, Bettegowda C, Gokaslan ZL. An evidence-based medicine model for rare and often neglected neoplastic conditions. J Neurosurg Spine 2014; 21:704-10. [DOI: 10.3171/2014.7.spine13954] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The National Institutes of Health recommends strategies to obtain evidence for the treatment of rare conditions such as primary tumors of the spine (PTSs). These tumors have a low incidence and are pathologically heterogeneous, and treatment approaches are diverse. Appropriate evidence-based care is imperative. Failure to follow validated oncological principles may lead to unnecessary mortality and profound morbidity. This paper outlines a scientific model that provides significant evidence guiding the treatment of PTSs.
Methods
A four-stage approach was used: 1) planning: data from large-volume centers were reviewed to provide insight; 2) recruitment: centers were enrolled and provided the necessary infrastructure; 3) retrospective stage: existing medical records were reviewed and completed with survival data; and 4) prospective stage: prospective data collection has been implemented. The AOSpine Knowledge Forum Tumor designed six modules: demographic, clinical, diagnostic, therapeutic, local recurrence, survival, and perioperative morbidity data fields and provided funding.
Results
It took 18 months to implement Stages 1–3, while Stage 4 is ongoing. A total of 1495 tumor cases were captured and diagnosed as one of 18 PTS histotypes. In addition, a PTS biobank network has been created to link clinical data with tumor pathology and molecular analysis.
Conclusions
This scientific model has not only aggregated a large amount of PTS data, but has also established an international collaborative network of spine oncology centers. Access to large volumes of data will generate further research to guide and enhance PTS clinical management. This model could be applied to other rare neoplastic conditions. Clinical trial registration no.: NCT01643174 (ClinicalTrials.gov).
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Affiliation(s)
- Charles G. Fisher
- 1Division of Spine, Department of Orthopaedics, University of British Columbia and Vancouver CoastalHealth, Vancouver, British Columbia
| | - Tony Goldschlager
- 1Division of Spine, Department of Orthopaedics, University of British Columbia and Vancouver CoastalHealth, Vancouver, British Columbia
- 14Monash Institute of Medical Research, Monash University, Clayton, Victoria, Australia; and
| | - Stefano Boriani
- 2Unit of Oncologic and Degenerative Spine Surgery, Rizzoli Institute, Bologna
| | - Peter Paul Varga
- 3National Center for Spinal Disorders and Buda Health Center, Budapest, Hungary
| | - Laurence D. Rhines
- 4Department of Neurosurgery, MD Anderson Cancer Center, The University of Texas, Houston, Texas
| | - Michael G. Fehlings
- 5Division of Neurosurgery, Department of Surgery, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada
| | - Alessandro Luzzati
- 6Oncologia Ortopedica e Ricostruttiva del Rachide, Istituto Ortopedico Galeazzi, Milano, Italy
| | | | | | - Dean Chou
- Departments of 9Neurological Surgery and
| | - Sigurd H. Berven
- 10Orthopaedic Surgery, University of California, San Francisco, California
| | - Richard P. Williams
- 11Department of Orthopaedics, Princess Alexandra Hospital, Brisbane, Queensland
| | - Nasir A. Quraishi
- 12Center for Spine Studies and Surgery, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom;
| | - Chetan Bettegowda
- 13Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ziya L. Gokaslan
- 13Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Szövérfi Z, Lazary A, Bozsódi Á, Klemencsics I, Éltes PE, Varga PP. Primary Spinal Tumor Mortality Score (PSTMS): a novel scoring system for predicting poor survival. Spine J 2014; 14:2691-700. [PMID: 24650850 DOI: 10.1016/j.spinee.2014.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 01/04/2014] [Accepted: 03/08/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although the surgical and oncological therapies of primary spinal tumors (PSTs) have changed significantly over the last few decades, the prognosis of this rare disease is still poor. The decision-making process in the multidisciplinary management is handicapped by the lack of large-scale population-based prognostic studies. PURPOSE The objective of the present study was to investigate preoperative factors associated with PST mortality and to develop a predictive scoring system of poor survival. STUDY DESIGN This is a large-scale ambispective cohort study. PATIENT SAMPLE The study included 323 consecutive patients with PSTs, treated surgically over an 18-year period at a tertiary care spine referral center for a population of 10 million. OUTCOME MEASURE Survival was the outcome measure. METHODS Patients were randomly divided into a training cohort (n=273) and a validation cohort (n=50). In the training cohort, 12 preoperative factors were investigated using Cox proportional hazard models. Based on the mortality-related variables, a simple scoring system of mortality was created, and three groups of patients were identified. Kaplan-Meier and log-rank analyses were used to compare the survival in the three groups. The model performance was assessed by measuring the discriminative ability (c-index) of the model and by applying a pseudo-R(2) goodness-of-fit test (Nagelkerke R(2), RN(2)). Internal validation was performed using bootstrapping in the training cohort and assessing the discrimination and explained variation of the model in the validation cohort. RESULTS Patient age, spinal region, tumor grade, spinal pain, motor deficit, and myelopathy/cauda equina syndrome were significantly associated with poor survival in the multivariate analysis (p<.001, RN(2)=0.799). Based on these variables, we developed the Primary Spinal Tumor Mortality Score (PSTMS), where an eight-point scale was divided into three categories (low, medium, and high mortality). The three PSTMS categories were significantly associated with the overall survival (p<.001, RN(2)=0.811, c=0.82). The model performance remained similarly high in the validation cohort (RN(2)=0.831, c=0.81). CONCLUSIONS The present study identifies six predictive variables for mortality in PSTs. Using these six variables, an easy-to-use scoring system was developed that can be applied to the estimation of postoperative survival in all types of PST patients.
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Affiliation(s)
- Zsolt Szövérfi
- National Center for Spinal Disorders, Kiralyhagó St 1-3, Budapest 1126, Hungary
| | - Aron Lazary
- National Center for Spinal Disorders, Kiralyhagó St 1-3, Budapest 1126, Hungary
| | - Árpád Bozsódi
- National Center for Spinal Disorders, Kiralyhagó St 1-3, Budapest 1126, Hungary
| | - István Klemencsics
- National Center for Spinal Disorders, Kiralyhagó St 1-3, Budapest 1126, Hungary
| | - Péter E Éltes
- National Center for Spinal Disorders, Kiralyhagó St 1-3, Budapest 1126, Hungary
| | - Péter Pál Varga
- National Center for Spinal Disorders, Kiralyhagó St 1-3, Budapest 1126, Hungary.
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Szövérfi Z, Lazáry A, Varga PP. [Primary Spinal Tumor Registry at the National Centre for Spinal Disorders]. Orv Hetil 2014; 155:745-9. [PMID: 24796780 DOI: 10.1556/oh.2014.29920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Primary spinal tumors are rare diseases. Primary spinal tumor registry would be useful to help decision making in this complex field of spine surgery. In this article the authors present the latest findings from the Primary Spinal Tumor Registry at the National Centre for Spinal Disorders, Hungary. The registry is based on a novel database management software, the REDCap electronic data capture system. It contains data of 323 patients treated surgically during an 18-year period. Among the 126 malignant tumors, the most frequent was chordoma (61 cases). In the case of benign tumors schwannoma showed the largest prevalence (45 cases). The authors conclude that due to the rarity of the disease and the complexity of the management, multicenter, prospective registries are required to provide high level of evidence. The structure of the Primary Spinal Tumor Registry in the National Centre for Spinal Disorders in Hungary is optimal for user-friendly, fast and secure data collection providing a prospective database for scientific researches and clinical follow-up.
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Affiliation(s)
- Zsolt Szövérfi
- Országos Gerincgyógyászati Központ Budapest Királyhágó u. 1-3. 1126
| | - Aron Lazáry
- Országos Gerincgyógyászati Központ Budapest Királyhágó u. 1-3. 1126
| | - Péter Pál Varga
- Országos Gerincgyógyászati Központ Budapest Királyhágó u. 1-3. 1126
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Abstract
OBJECTIVES The objective of the authors was to provide an up-to-date review about the epidemiology, diagnosis, and surgical management of the malignant primary sacral tumors. METHODS A PubMed search was conducted using a combination of the following items: (('Spinal Neoplasms'[Mesh]) AND 'Sacrum'[Mesh]) NOT ('Metastasis' OR 'Metastases' OR 'Benign'). The literature review and the author's own surgical experiences were used to assess the current treatment strategies of the malignant sacral tumors. RESULTS Twenty case series were identified, which studies discuss in detail the surgical strategies, the postoperative complications, the functional and oncologic outcome, and the recurrence-free and disease-specific survival of this rare patient category. DISCUSSION Sacral tumors are rare pathologies. Their management generates a complex medical problem, as they usually are diagnosed in advanced stages with extended dimensions involving the sacral nerves and surrounding organs. The evaluation and complex treatment of these rare tumors require a multidisciplinary approach, optimally at institutions with comprehensive care and experience. Although conventional oncologic therapeutic methods should be used as neoadjuvant or adjuvant therapies in certain histological types, en bloc resection with wide surgical margins is essential for long-term local oncologic control. This is often technically difficult to achieve, as just a few centers in the world perform sacral tumor surgeries on a regular basis, and have enough wide experience. Therefore international cooperation and organization of multicenter tumor registries are essential to develop evidence based treatment protocols.
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Varga PP. Expert's comment concerning Grand Rounds case entitled "Surgical management of recurrent thoracolumbar spinal sarcoma with 4-level total en bloc spondylectomy: description of technique and report of two cases" (by Claudia Druschel; Alexander C. Disch; Ingo Melcher; Tilmann Engelhardt; Alessandro Luzzati; Norbert P. Haas; Klaus-Dieter Schaser). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 21:10-2. [PMID: 21912830 DOI: 10.1007/s00586-011-1998-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/15/2011] [Indexed: 11/30/2022]
Affiliation(s)
- Peter Paul Varga
- National Center for Spinal Disorders, Királyhágó Street 1-3, 1126, Budapest, Hungary.
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Current World Literature. Curr Opin Support Palliat Care 2010; 4:207-27. [DOI: 10.1097/spc.0b013e32833e8160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Quraishi NA, Gokaslan ZL, Boriani S. The surgical management of metastatic epidural compression of the spinal cord. ACTA ACUST UNITED AC 2010; 92:1054-60. [PMID: 20675746 DOI: 10.1302/0301-620x.92b8.22296] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Metastatic epidural compression of the spinal cord is a significant source of morbidity in patients with systemic cancer. With improved oncological treatment, survival in these patients is improving and metastatic cord compression is encountered increasingly often. The treatment is mostly palliative. Surgical management involves early circumferential decompression of the cord with concomitant stabilisation of the spine. Patients with radiosensitive tumours without cord compression benefit from radiotherapy. Spinal stereotactic radiosurgery and minimally invasive techniques, such as vertebroplasty and kyphoplasty, with or without radiofrequency ablation, are promising options for treatment and are beginning to be used in selected patients with spinal metastases. In this paper we review the surgical management of patients with metastatic epidural spinal cord compression.
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Affiliation(s)
- N A Quraishi
- Centre for Spine Studies and Surgery, Queens Medical Centre, Derby Road, Nottingham NG7 2UH, UK.
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