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Mazurek MH, Abruzzo AR, King AH, Koranteng E, Rigney G, Lie W, Razak S, Gupta R, Mehan WA, Lev MH, Hirsch JA, Buch K, Succi MD. Implementation of a Survey Spine MR Imaging Protocol for Cord Compression in the Emergency Department: Experience at a Level 1 Trauma Center. AJNR Am J Neuroradiol 2024; 45:1378-1384. [PMID: 38702066 PMCID: PMC11392377 DOI: 10.3174/ajnr.a8326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 04/22/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND AND PURPOSE Imaging stewardship in the emergency department (ED) is vital in ensuring patients receive optimized care. While suspected cord compression (CC) is a frequent indication for total spine MR imaging in the ED, the incidence of CC is low. Recently, our level 1 trauma center introduced a survey spine MR imaging protocol to evaluate for suspected CC while reducing examination time to avoid imaging overutilization. This study aims to evaluate the time savings, frequency of ordering patterns of the survey, and the symptoms and outcomes of patients undergoing the survey. MATERIALS AND METHODS This retrospective study examined patients who received a survey spine MR imaging in the ED at our institution between 2018 and 2022. All examinations were performed on a 1.5T GE Healthcare scanner by using our institutional CC survey protocol, which includes sagittal T2WI and STIR sequences through the cervical, thoracic, and lumbar spine. Examinations were read by a blinded, board-certified neuroradiologist. RESULTS A total of 2002 patients received a survey spine MR imaging protocol during the study period. Of these patients, 845 (42.2%, mean age 57 ± 19 years, 45% women) received survey spine MR imaging examinations for the suspicion of CC, and 120 patients (14.2% positivity rate) had radiographic CC. The survey spine MR imaging averaged 5 minutes and 50 seconds (79% faster than routine MR imaging). On multivariate analysis, trauma, back pain, lower extremity weakness, urinary or bowel incontinence, numbness, ataxia, and hyperreflexia were each independently associated with CC. Of the 120 patients with CC, 71 underwent emergent surgery, 20 underwent nonemergent surgery, and 29 were managed medically. CONCLUSIONS The survey spine protocol was positive for CC in 14% of patients in our cohort and acquired at a 79% faster rate compared with routine total spine. Understanding the positivity rate of CC, the clinical symptoms that are most associated with CC, and the subsequent care management for patients presenting with suspected cord compression who received the survey spine MR imaging may better inform the broad adoption and subsequent utilization of survey imaging protocols in emergency settings to increase throughput, improve allocation of resources, and provide efficient care for patients with suspected CC.
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Affiliation(s)
- Mercy H Mazurek
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - Annie R Abruzzo
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - Alexander H King
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - Erica Koranteng
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - Grant Rigney
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - Winston Lie
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - Shahaan Razak
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - Rajiv Gupta
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
- Department of Radiology (R.G., W.A.M., M.H.L., J.A.H., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - William A Mehan
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
- Department of Radiology (R.G., W.A.M., M.H.L., J.A.H., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - Michael H Lev
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
- Department of Radiology (R.G., W.A.M., M.H.L., J.A.H., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - Joshua A Hirsch
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
- Department of Radiology (R.G., W.A.M., M.H.L., J.A.H., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - Karen Buch
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
| | - Marc D Succi
- From the Harvard Medical School (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Boston, Massachusetts
- Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO) (M.H.M., A.R.A., A.H.K., E.K., G.R., W.L., S.R., R.G., W.A.M., M.H.L., J.A.H., K.B., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
- Department of Radiology (R.G., W.A.M., M.H.L., J.A.H., M.D.S.), Massachusetts General Hospital, Boston, Massachusetts
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Suh YJ, Li AT, Pandey M, Nordmann CS, Huang YL, Wu M. Decoding physical principles of cell migration under controlled environment using microfluidics. BIOPHYSICS REVIEWS 2024; 5:031302. [PMID: 39091432 PMCID: PMC11290890 DOI: 10.1063/5.0199161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 06/26/2024] [Indexed: 08/04/2024]
Abstract
Living cells can perform incredible tasks that man-made micro/nano-sized robots have not yet been able to accomplish. One example is that white blood cells can sense and move to the site of pathogen attack within minutes. The robustness and precision of cellular functions have been perfected through billions of years of evolution. In this context, we ask the question whether cells follow a set of physical principles to sense, adapt, and migrate. Microfluidics has emerged as an enabling technology for recreating well-defined cellular environment for cell migration studies, and its ability to follow single cell dynamics allows for the results to be amenable for theoretical modeling. In this review, we focus on the development of microfluidic platforms for recreating cellular biophysical (e.g., mechanical stress) and biochemical (e.g., nutrients and cytokines) environments for cell migration studies in 3D. We summarize the basic principles that cells (including bacteria, algal, and mammalian cells) use to respond to chemical gradients learned from microfluidic systems. We also discuss about novel biological insights gained from studies of cell migration under biophysical cues and the need for further quantitative studies of cell function under well-controlled biophysical environments in the future.
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Affiliation(s)
- Young Joon Suh
- Department of Biological and Environmental Engineering, Cornell University, Ithaca, New York 14853, USA
| | - Alan T. Li
- Department of Biological and Environmental Engineering, Cornell University, Ithaca, New York 14853, USA
| | - Mrinal Pandey
- Department of Biological and Environmental Engineering, Cornell University, Ithaca, New York 14853, USA
| | - Cassidy S. Nordmann
- Department of Biomedical Engineering, Cornell University, Ithaca, New York 14853, USA
| | - Yu Ling Huang
- Department of Biological and Environmental Engineering, Cornell University, Ithaca, New York 14853, USA
| | - Mingming Wu
- Department of Biological and Environmental Engineering, Cornell University, Ithaca, New York 14853, USA
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Shea GKH, Kwan KYH. Management of Metastatic Spinal Disease - A Practical Approach. Global Spine J 2024:21925682231173646. [PMID: 39069670 DOI: 10.1177/21925682231173646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVE This review presents a comprehensive approach to the management of spinal metastases. METHODS N/A. RESULTS The wide spectrum of clinical presentation in spinal metastases necessitates a personalized approach to treatment planning. This includes a comprehensive diagnostic workup, oncological management, palliation of symptoms, and surgical intervention if appropriate. A systematic and multidisciplinary approach allows optimal shared decision making to reach an evidence-informed and value-congruent treatment plan for the patient. We highlight how advances in stereotactic body radiotherapy (SBRT) and separation surgery may be incorporated into clinical management from a spine surgeon's perspective. CONCLUSION This review summarizes the approach and management of spinal metastases, its outcomes and complications.
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Affiliation(s)
- Graham Ka Hon Shea
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, The University of Hong Kong, Hong Kong
| | - Kenny Yat Hong Kwan
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, The University of Hong Kong, Hong Kong
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Liu DTF, Misra R, Moore T. Palliative Radiotherapy in Non-small Cell Lung Cancer: Patterns of Use and Predictors of 30-Day Mortality in End-of-Life Care. Cureus 2024; 16:e65238. [PMID: 39184714 PMCID: PMC11343330 DOI: 10.7759/cureus.65238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2024] [Indexed: 08/27/2024] Open
Abstract
Introduction Lung cancer is the leading cause of cancer-related deaths worldwide, with non-small cell lung cancer (NSCLC) being the most common type. More than half of patients require radiotherapy throughout their treatment. Palliative radiotherapy (PRT) is an important tool for symptom control and quality of life improvement in advanced NSCLC patients. However, the benefits of PRT must be balanced against possible disadvantages, especially in end-of-life (EOL) care. This study aims to describe the profile of PRT-treated deceased NSCLC patients, quantify the proportion of PRT recipients in the last 30 days of life and identify short-term survival prognostic factors in this group. Materials and methods This retrospective analysis was performed at two radiotherapy facilities within the Kent Oncology Centre, UK, for two years, running from January 1, 2022, to January 1, 2024. Data were collected from 857 deceased NSCLC patients who received PRT. Demographics, cancer diagnosis, histology, tumour, node, metastasis (TNM) staging, radiotherapy details, recent treatments, performance status (PS) and comorbidities were analysed. Patients have been stratified as long-term survivors (more than 30 days after PRT initiation, LTS group) along with short-term survivors (STS) (died within 30 days, STS group). Descriptive statistics, chi-squared tests, t-tests and multivariable logistic regression have been used in the data analysis. Results Out of 857 patients, 148 (17.3%) died within 30 days of PRT initiation. PS was considerably worse (p = 0.027), Adult Comorbidity Evaluation 27 (ACE-27) scores were higher (p = 0.018), and metastatic disease was more prevalent (60.1% vs. 47.5%, p = 0.02) in STS group patients. Fewer patients in the STS group completed their treatment compared to the LTS group (63.5% vs. 82.8%, p < 0.001). The STS group also received lower mean radiation dose (17.7 Gy vs. 19.6 Gy, p = 0.022) and fewer fractions (4.4 vs. 5.2, p = 0.019). The most common RT regimen in both cohorts was 20 Gy in five fractions, used in 55.4% of STS and 49.8% of LTS patients, with no significant difference in single fraction RT use between groups (33.1% in STS vs. 36.8% in LTS, p = 0.401). Multivariate logistic regression identified significant predictors of 30-day mortality: poorer PS (adjusted OR: 1.981, 95% CI: 1.33-3.12, p = 0.001), metastatic disease (adjusted OR: 2.02, 95% CI: 1.246-3.571, p = 0.002), incomplete PRT (adjusted OR: 0.337, 95% CI: 0.21-0.514, p < 0.001) and no recent chemotherapy (adjusted OR: 0.542, 95% CI: 0.342-0.941, p = 0.044). Conclusion This study demonstrated that compared with previous reports, a higher proportion of NSCLC patients who received PRT died within 30 days of treatment initiation, and low treatment adherence rates highlight challenges in EOL settings. Identification of poor PS and metastatic disease as predictors of short-term mortality would help inform PRT decision-making. The underutilisation of single-fraction radiotherapy and the link between recent chemotherapy and lower 30-day mortality warrant further study. These results highlight the need for better prognostic tools and more selective use of PRT, including increased consideration of single-fraction radiotherapy, in NSCLC patients approaching end of life and emphasise the importance of balancing benefit against treatment burden in this vulnerable population.
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Ziegler J, El-Shakankery KH, Hyare H, Flynn M. Synchronous skull base and spinal metastases in a patient with treatment-resistant, high-grade serous adenocarcinoma of tubo-ovarian origin. BMJ Case Rep 2024; 17:e259144. [PMID: 38772871 DOI: 10.1136/bcr-2023-259144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2024] Open
Abstract
Brain metastases (BMs) arising from ovarian cancer remain rare. Spinal cord metastases are even rarer, accounting for just 0.4% of total metastatic spinal cord compressions. In this report, we describe a case of a woman in her 70s who developed sequential brain and spinal cord metastases during her treatment for high-grade serous ovarian cancer, without a germline or somatic BRCA mutation. Following completion of neoadjuvant chemotherapy, interval debulking surgery and adjuvant chemotherapy, relapsed disease was ultimately identified as a single BM, curiously mimicking an acoustic neuroma. Subsequently, spinal cord metastases rapidly developed. Throughout, multidisciplinary team meetings guided decisions on patient management. In this report, we highlight the rarity of such a presentation and discuss the possible role of disease pathophysiology, associated systemic anticancer therapy resistance, and treatment possibilities for both cerebral and spinal metastases.
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Affiliation(s)
- Joseph Ziegler
- Department of Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Harpreet Hyare
- Imaging Department, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - Michael Flynn
- Department of Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
- Clinical Research Facility, NIHR University College London Hospitals Biomedical Research Centre, London, UK
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Zhang M, Zhang M, Yu M, Song Y, Wang Y. A study on short-term efficacy and safety of Iodine-125 brachytherapy coupled with preoperative arterial chemoembolization for hypervascular spinal metastasis. Brachytherapy 2024; 23:207-213. [PMID: 38044181 DOI: 10.1016/j.brachy.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/05/2023] [Accepted: 10/05/2023] [Indexed: 12/05/2023]
Abstract
PURPOSE Hypervascular spinal metastatic malignancies can cause severe pain and intraoperative bleeding and selection of appropriate treatment can be challenging. This study aimed to observe the short-term efficacy and safety of Iodine-125 brachytherapy (125I BT) combined with preoperative transcatheter arterial chemoembolization (TACE) for hypervascular spinal metastasis. METHODS This study included a total of 33 patients (39 lesions) with hypervascular spinal metastasis. All of them carried out a regimen of TACE followed by 125I BT under CT guidance. A brachytherapy planning system has been utilized for the purpose of designing treatment plans and optimizing dose distribution. Pain relief was evaluated using a numeric rating scale (NRS) and intraoperative bleeding was recorded. Follow-up was conducted for 6 months to observe the local control rate and clinical complications. RESULTS All patients tolerated combined treatment well and intraoperative blood loss of every patient was not more than 10 ml. The 2- and 6- month local disease control rates were 92.3% and 83.8%. The NRS scores for thirty-three tumor patients before surgery and after one week, two, and six months of surgery were recorded as 7.33 ± 1.80, 7.39 ± 1.89, 3.15 ± 2.35, and 4.16 ± 2.15, respectively. The NRS score 2 months after treatment was found considerably lower in comparison to the NRS score before operation (p < 0.05). CONCLUSIONS According to our findings, 125I BT as well as preoperative TACE leads to perioperative hemostasis, pain alleviation, and reduced tumor burden, indicating that this combined treatment could be effective and promising for hypervascular spinal metastases.
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Affiliation(s)
- Menglong Zhang
- Department of Minimally Invasive Intervention, Ganzhou People's Hospital, Zhanggong District, Ganzhou, Jiangxi, China.
| | - Menglin Zhang
- Chengyang District People's Hospital of Qingdao, Shandong, China
| | - Miaoshen Yu
- Department of Minimally Invasive Intervention, Ganzhou People's Hospital, Zhanggong District, Ganzhou, Jiangxi, China
| | - Yusheng Song
- Department of Minimally Invasive Intervention, Ganzhou People's Hospital, Zhanggong District, Ganzhou, Jiangxi, China
| | - Yan Wang
- Department of Minimally Invasive Intervention, Ganzhou People's Hospital, Zhanggong District, Ganzhou, Jiangxi, China
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Yavorkovsky LL. Aggressive B-Cell Lymphoma with Metastatic Spinal Cord Compression: Treat the Patient, Not the Disease. Oncol Res Treat 2024; 47:287-295. [PMID: 38432228 DOI: 10.1159/000538104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION The management of metastatic spinal cord compression (mSCC) is a demanding task. The main challenges of mSCC include various manifestations and unpredictable outcomes with indiscriminate treatment recommendations. Because of attendant urgency with potentially devastating health consequences, the SCC is an emotionally disturbing experience whose management could take an impulsive rather than rational approach. The treatment strategy is particularly problematic when mSCC is caused by a malignant lymphoma with its protean attributes. CASE REPORT A 68-year-old female presented with generalized body pain and weight loss. Imaging studies revealed a vast bulk of the disease involving lymph nodes, spleen, visceral organs, musculature, marrow, and bones including vertebrae with extension into the spinal canal. A biopsy of the chest wall mass showed high-grade diffuse large B-cell lymphoma. A magnetic resonance imaging (MRI) of the spine demonstrated diffuse marrow replacement by the tumor of the thoracic and lumbar spine with compression of the cord. The prompt treatment with corticosteroids and immunochemotherapy (ICT) was recommended, but the patient elected to seek a second opinion. After two doses of radiation therapy, the patient's general condition rapidly deteriorated and she was hospitalized for systemic ICT. Despite the treatment, her condition continued to deteriorate, and she died 3 weeks after the presentation. CONCLUSION The presented case demonstrates some hitherto unaddressed challenges in evaluation and treatment of mSCC caused by aggressive non-Hodgkin lymphoma (LSSC). The case scrutinizes the role of MRI in uncommon clinical situations. The case has also exposed some ethical issues associated with the proper management of LSCC.
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Affiliation(s)
- Leonid L Yavorkovsky
- Oncology Division, Kaiser Permanente San Jose Medical Center, San Jose, California, USA
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Yaouanq M, Gibson N, Boudoussier A, Edouard L, Pouvreau P, Taleb I, Bouleftour W, Sargos P, Magné N, Benziane-Ouaritini N. Emergency radiation therapy in modern-day practice: Now or never, or never again ? Support Care Cancer 2024; 32:114. [PMID: 38240886 DOI: 10.1007/s00520-024-08322-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/11/2024] [Indexed: 01/23/2024]
Abstract
Radiation therapy plays a fundamental role in oncological emergencies such as superior vena cava syndrome (SVCS) and metastatic epidural spinal cord compression (MESCC). These are two examples of critical complications of metastatic cancer in terms of pain and functional impact (respiratory and/or neurological). The aim of this review is to explore the current indications, treatment options and outcomes for emergency radiotherapy regarding to these complications.Regarding SVCS, studies are mostly retrospective and unanimously demonstrated a beneficial effect of radiotherapy on symptom relief. Spinal cord compression remains an indication for urgent radiotherapy, and should be combined with surgery when possible. The innovative stereotactic body radiotherapy (SBRT) showed promising results, however this technique requires small volumes and more time preparation and therefore is often unsuitable for SVCS and MESCC emergencies.This review concluded that radiotherapy has a central role to play within a multimodal approach for SVCS and MESCC treatment. Further prospective studies are needed to confirm the effectiveness of radiation and establish the criteria for selecting patients to benefit from this treatment option.
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Affiliation(s)
- Margaux Yaouanq
- Department of Radiation Oncology, Institut Bergonié, Bordeaux, France
| | - Nyere Gibson
- Department of Radiation Oncology, Institut Bergonié, Bordeaux, France
| | | | - Lucas Edouard
- Department of Radiation Oncology, Institut Bergonié, Bordeaux, France
| | - Pierre Pouvreau
- Department of Radiation Oncology, Institut Bergonié, Bordeaux, France
| | - Imed Taleb
- Department of Radiation Oncology, Institut Bergonié, Bordeaux, France
| | - Wafa Bouleftour
- Cancerology and Hematology Institute, Department of Medical Oncology, Saint-Etienne University Hospital, 42055, Saint-Etienne, France.
| | - Paul Sargos
- Department of Radiation Oncology, Institut Bergonié, Bordeaux, France
| | - Nicolas Magné
- Department of Radiation Oncology, Institut Bergonié, Bordeaux, France
- Cellular and Molecular Radiobiology Laboratory, Lyon-Sud Medical School, Unité Mixte de Recherche CNRS5822/IP2I, University of Lyon, Lyon, France
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Gojsevic M, Shariati S, Chan AW, Bonomo P, Zhang E, Kennedy SKF, Rajeswaran T, Rades D, Vassiliou V, Soliman H, Lee SF, Wong HCY, Rembielak A, Oldenburger E, Akkila S, Azevedo L, Chow E. Quality of life in patients with malignant spinal cord compression: a systematic review. Support Care Cancer 2023; 31:736. [PMID: 38055061 DOI: 10.1007/s00520-023-08186-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/13/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION Malignant spinal cord compression (MSCC) is an oncological emergency that may result in a devastating combination of malignancy and disability. Existing quality of life (QoL) questionnaires commonly used in MSCC literature (EORTC QLQ-C30, BM-22, Brief Pain Inventory, and Spine Oncology Study Group Outcomes) may not capture all the commonly reported symptoms and lack specificity to MSCC. The primary objective of this systematic review is to determine unmet patient needs and underreported QoL issues and compile a comprehensive list of QoL issues. The secondary objective of this review is to compile all existing QoL tools and questionnaires and determine whether any QoL issues are not addressed in the existing tools currently used in the literature. METHODS A literature search was conducted on Ovid MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases between 1946 and February 6, 2023, to compile all QoL issues and existing questionnaires used to assess QoL in patients with MSCC. All study designs were included given that they discussed QoL issues specific to patients with MSCC. RESULTS The results of this systematic review identified the most frequently discussed QoL issues in the literature studying MSCC. This included direct symptoms of MSCC such as back pain, paralysis, limb weakness/numbness, and urinary/bowel incontinence. Indirect symptoms coming from radiotherapy treatment such as dysphagia, painful swallowing, mouth pain, dry mouth, diarrhea, fatigue, and nausea/vomiting were also noted. Other symptoms resulting from corticosteroid treatment included difficulty sleeping, blurring of vision, weight gain, and mood disturbance. Patients also experienced psychosocial issues such as anxiety, depression, emotional distress, low self-esteem, concerns about dependence on others, concerns about getting home, and fear about their prognosis and future. CONCLUSION This review highlights the QoL issues specific to patients with MSCC and QoL tools capturing these issues. Relevance of QoL issues identified in this systematic review must be prospectively validated by patients and healthcare professionals with experience in treating MSCC.
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Affiliation(s)
- Milena Gojsevic
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Saba Shariati
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Adrian Wai Chan
- Department of Clinical Oncology, Tuen Mun Hospital, Hospital Authority, Hong Kong, Hong Kong
| | - Pierluigi Bonomo
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Elwyn Zhang
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Samantha K F Kennedy
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Thenugaa Rajeswaran
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Vassilios Vassiliou
- Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Nicosia, Cyprus
| | - Hany Soliman
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Shing-Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hospital Authority, Hong Kong, Hong Kong
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
| | - Henry C Y Wong
- Department of Oncology, Princess Margaret Hospital, Hong Kong, Hong Kong
| | - Agata Rembielak
- The University of Manchester, Manchester, UK
- Department of Clinical Oncology, The Christie NHS Foundation Trust and the University of Manchester, Manchester, UK
| | - Eva Oldenburger
- Department of Radiation Oncology, University Hospitals Leuven, Louvain, Belgium
| | - Shereen Akkila
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | | | - Edward Chow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
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10
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Hawkins JE, Dworzynski K, Haden N. Spinal metastases and metastatic spinal cord compression: summary of updated NICE guidance. BMJ 2023; 383:1973. [PMID: 37852656 DOI: 10.1136/bmj.p1973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Affiliation(s)
- James E Hawkins
- National Institute for Health and Care Excellence, City Tower, Manchester M1 4BT, UK
| | - Katharina Dworzynski
- National Institute for Health and Care Excellence, City Tower, Manchester M1 4BT, UK
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11
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Vassiliou A, Osunronbi T, Enyioma S, Rago G, Karathanasi A, Ghose A, Sheriff M, Mikropoulos C, Sanchez E, Moschetta M, Chargari C, Rassy E, Boussios S. Prognostic Factors in Patients with Metastatic Spinal Cord Compression Secondary to Lung Cancer-A Retrospective UK Single-Centre Study. Cancers (Basel) 2023; 15:4432. [PMID: 37760402 PMCID: PMC10527546 DOI: 10.3390/cancers15184432] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/30/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
PURPOSE Metastatic spinal cord compression (MSCC) is a severe complication of cancer that can lead to irreversible neurological impairment, necessitating prompt recognition and intervention. This retrospective, single-centre study aimed to determine the prognostic factors and survival rates among patients presenting with MSCC secondary to lung cancer. METHODS AND MATERIALS We identified 74 patients with epidural metastases-related spinal cord compression and a history of lung cancer through the electronic database of Medway Maritime Hospital in the United Kingdom (UK), spanning the period from April 2016 to September 2021. Among them, 39 were below 55 years old, while 35 were aged 55 years or older; 24 patients were diagnosed with small cell lung cancer (SCLC), and 50 patients had non-small cell lung cancer (NSCLC). RESULTS The median overall survival (OS) was 5.5 months, with 52 out of 74 patients dying within 6 months of diagnosis with MSCC. For the entire cohort, the statistically significant variables on multi-variate analysis were cancer type (NSCLC had improved OS), the number of involved vertebrae (one to two vertebrae involvement had improved OS), and the time taken to develop motor deficits (≤10 days to develop motor deficits had worsened OS). For the NSCLC cohort, the statistically significant variables on multivariate analysis were molecular alterations (patients with epidermal growth factor receptor (EGFR) mutation), pre-treatment ambulatory status, Eastern Cooperative Oncology Group (ECOG) performance status, and the time taken to develop motor deficits. CONCLUSIONS Within the entire cohort, patients diagnosed with NSCLC and spinal metastases affecting one to two vertebrae exhibited enhanced OS. Within the NSCLC subgroup, those with EGFR mutations who were ambulatory and possessed an ECOG performance status of 1-2 demonstrated improved OS. In both the entire cohort and the NSCLC subgroup, the development of motor deficits within a period of ≤10 days was associated with poor OS.
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Affiliation(s)
- Anna Vassiliou
- Department of Medical Oncology, Medway NHS Foundation Trust, Gillingham ME7 5NY, UK (E.S.)
| | - Temidayo Osunronbi
- Hull University Teaching Hospital NHS Foundation Trust, Hull HU1 3SA, UK
| | - Synthia Enyioma
- Department of Medical Oncology, Medway NHS Foundation Trust, Gillingham ME7 5NY, UK (E.S.)
| | - Gerardo Rago
- Department of Medical Oncology, Medway NHS Foundation Trust, Gillingham ME7 5NY, UK (E.S.)
| | - Afroditi Karathanasi
- Department of Medical Oncology, Medway NHS Foundation Trust, Gillingham ME7 5NY, UK (E.S.)
| | - Aruni Ghose
- Department of Medical Oncology, Medway NHS Foundation Trust, Gillingham ME7 5NY, UK (E.S.)
- Department of Medical Oncology, Barts Cancer Centre, St. Bartholomew’s Hospital, Barts Health NHS Trust, London EC1A 7BE, UK
- Department of Medical Oncology, Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, London HA6 2RN, UK
| | - Matin Sheriff
- Department of Urology, Medway NHS Foundation Trust, Gillingham ME7 5NY, UK
| | - Christos Mikropoulos
- Department of Medical Oncology, St Luke’s Cancer Centre, Royal Surrey Hospital, Guildford GU1 1EB, UK
| | - Elisabet Sanchez
- Department of Medical Oncology, Medway NHS Foundation Trust, Gillingham ME7 5NY, UK (E.S.)
| | - Michele Moschetta
- Novartis Institutes for BioMedical Research, CH-4056 Basel, Switzerland;
| | - Cyrus Chargari
- Department of Radiation Oncology, Pitié Salpêtrière University Hospital, 75013 Paris, France;
| | - Elie Rassy
- Department of Medical Oncology, Gustave Roussy Institut, 94805 Villejuif, France;
| | - Stergios Boussios
- Department of Medical Oncology, Medway NHS Foundation Trust, Gillingham ME7 5NY, UK (E.S.)
- Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK
- Kent Medway Medical School, University of Kent, Canterbury CT2 7LX, UK
- AELIA Organization, 9th Km Thessaloniki–Thermi, 57001 Thessaloniki, Greece
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12
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Zijlstra H, Striano BM, Crawford AM, Groot OQ, Raje N, Tobert DG, Patel CG, Wolterbeek N, Delawi D, Kempen DHR, Verlaan JJ, Schwab JH. Neurologic Outcomes After Radiation Therapy for Severe Spinal Cord Compression in Multiple Myeloma: A Study of 162 Patients. J Bone Joint Surg Am 2023; 105:1261-1269. [PMID: 37262176 DOI: 10.2106/jbjs.22.01335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Bone destruction is the most frequent disease-defining clinical feature of multiple myeloma (MM), resulting in skeletal-related events such as back pain, pathological fractures, or neurologic compromise including epidural spinal cord compression (ESCC). Up to 24% of patients with MM will be affected by ESCC. Radiation therapy has been proven to be highly effective in pain relief in patients with MM. However, a critical knowledge gap remains with regard to neurologic outcomes in patients with high-grade ESCC treated with radiation. METHODS We retrospectively included 162 patients with MM and high-grade ESCC (grade 2 or 3) who underwent radiation therapy of the spine between January 2010 and July 2021. The primary outcome was the American Spinal Injury Association (ASIA) score after 12 to 24 months, or the last known ASIA score if the patient had had a repeat treatment or died. Multivariable logistic regression was used to assess factors associated with poor neurologic outcomes after radiation, defined as neurologic deterioration or lack of improvement. RESULTS After radiation therapy, 34 patients (21%) had no improvement in their impaired neurologic function and 27 (17%) deteriorated neurologically. Thirty-six patients (22%) underwent either surgery or repeat irradiation after the initial radiation therapy. There were 100 patients who were neurologically intact at baseline (ASIA score of E), of whom 16 (16%) had neurologic deterioration. Four variables were independently associated with poor neurologic outcomes: baseline ASIA (odds ratio [OR] = 6.50; 95% confidence interval [CI] = 2.70 to 17.38; p < 0.001), Eastern Cooperative Oncology Group (ECOG) performance status (OR = 6.19; 95% CI = 1.49 to 29.49; p = 0.015), number of levels affected by ESCC (OR = 4.02; 95% CI = 1.19 to 14.18; p = 0.026), and receiving steroids prior to radiation (OR = 4.42; 95% CI = 1.41 to 16.10; p = 0.015). CONCLUSIONS Our study showed that 38% of patients deteriorated or did not improve neurologically after radiation therapy for high-grade ESCC. The results highlight the need for multidisciplinary input and efforts in the treatment of high-grade ESCC in patients with MM. Future studies will help to improve patient selection for specific and standardized treatments and to clearly delineate which patients are likely to benefit from radiation therapy. LEVEL OF EVIDENCE Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- H Zijlstra
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - B M Striano
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts
| | - A M Crawford
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts
| | - O Q Groot
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - N Raje
- Department of Hematology/Oncology-Center for Multiple Myeloma, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts
| | - D G Tobert
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts
| | - C G Patel
- Department of Radiation Oncology, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts
| | - N Wolterbeek
- Department of Orthopedic Surgery, St. Antonius Hospital, Utrecht, The Netherlands
| | - D Delawi
- Department of Orthopedic Surgery, St. Antonius Hospital, Utrecht, The Netherlands
| | - D H R Kempen
- Department of Orthopedic Surgery, OLVG, Amsterdam, Amsterdam, The Netherlands
| | - J J Verlaan
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J H Schwab
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts
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13
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Zijlstra H, Crawford AM, Striano BM, Pierik RJ, Tobert DG, Wolterbeek N, Delawi D, Terpstra WE, Kempen DHR, Verlaan JJ, Schwab JH. Neurological Outcomes and the Need for Retreatments Among Multiple Myeloma Patients With High-Grade Spinal Cord Compression: Radiotherapy vs Surgery. Global Spine J 2023:21925682231188816. [PMID: 37452005 DOI: 10.1177/21925682231188816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES Up to 30% of Multiple Myeloma (MM) patients are expected to experience Epidural Spinal Cord Compression (ESCC) during the course of their disease. To prevent irreversible neurological damage, timely diagnosis and treatment are important. However, debate remains regarding the optimal treatment regimen. The aim of this study was to investigate the neurological outcomes and frequency of retreatments for MM patients undergoing isolated radiotherapy and surgical interventions for high-grade (grade 2-3) ESCC. METHODS This study included patients with MM and high-grade ESCC treated with isolated radiotherapy or surgery. Pre- and post-treatment American Spinal Injury Association (ASIA) impairment scale and retreatment rate were compared between the 2 groups. Adjusted multivariable logistic regression was utilized to examine differences in neurologic compromise, pain, and retreatments. RESULTS A total of 247 patients were included (Radiotherapy: n = 154; Surgery: n = 93). After radiotherapy, 82 patients (53%) achieved full neurologic function (ASIA E) at the end of follow-up. Of the surgically treated patients, 67 (64%) achieved full neurologic function. In adjusted analyses, patients treated with surgery were less likely to experience neurologic deterioration within 2 years (OR = .15; 95%CI .05-.44; P = .001) and had less pain (OR = .29; 95%CI .11-.74; P = .010). Surgical treatment was not associated with an increased risk of retreatments (OR = .64; 95%CI .28-1.47; P = .29) or death (HR = .62, 95%CI .28-1.38; P = .24). CONCLUSIONS After adjusting for baseline differences, surgically treated patients with high-grade ESCC showed better neurologic outcomes compared to patients treated with radiotherapy. There were no differences in risk of retreatment or death.
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Affiliation(s)
- Hester Zijlstra
- Department of Orthopedic Surgery, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alexander M Crawford
- Department of Orthopedic Surgery, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
| | - Brendan M Striano
- Department of Orthopedic Surgery, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
| | - Robert-Jan Pierik
- Department of Orthopedic Surgery, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
| | - Daniel G Tobert
- Department of Orthopedic Surgery, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
| | - Nienke Wolterbeek
- Department of Orthopedic Surgery, St. Antonius Hospital, Utrecht, The Netherlands
| | - Diyar Delawi
- Department of Orthopedic Surgery, St. Antonius Hospital, Utrecht, The Netherlands
| | - Wim E Terpstra
- Department of Hematology/Oncology, OLVG, Amsterdam, The Netherlands
| | | | - Jorrit-Jan Verlaan
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joseph H Schwab
- Department of Orthopedic Surgery, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
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14
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Youssef E, Santos E, Moussa AM, Lis E, Vaynrub M, Barzilai O, Bilsky M, Cornelis FH. Preoperative Embolization of Metastatic Spinal Cord Compression with n-Butyl Cyanoacrylate: Safety and Effectiveness in Limiting Blood Loss. J Vasc Interv Radiol 2023; 34:613-618. [PMID: 36649805 PMCID: PMC10065907 DOI: 10.1016/j.jvir.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To evaluate the safety and effectiveness of preoperative embolization with n-butyl cyanoacrylate (nBCA) performed for metastatic spinal cord compression (MSCC) in limiting blood loss (BL). MATERIALS AND METHODS In this institutional review board-approved retrospective study, clinical records from 2017 to 2022 were reviewed. Twenty consecutive patients (11 men and 9 women; mean age, 65.8 years ± 10.0; range, 45-82 years) underwent 21 preoperative spine tumor embolizations with nBCA. Angiograms were used to calculate the percentage reduction in tumor vascularity, and relevant clinical data (levels studied and embolized, fluoroscopy time [FT], reference dose [RD], and Kerma area product [KAP]) and operative data (BL and operative time [OT]) were analyzed. Adverse events and outcomes were recorded. RESULTS A median of 2 levels were embolized per procedure (range, 1-5) but 4.9 were studied (range, 1-10). After embolization, tumor blush was reduced by a median of 87.3% (range, 50%-90%). The mean FT was 41 minutes ± 15.4 (range, 16-67 minutes), the mean RD was 1,977.1 mGy ± 1,794.3 (range, 450.2-6,319 mGy), and the mean KAP was 180.5 Gy·cm2 ± 166.2 (range, 30.4-504 Gy·cm2). The adverse event rate was 1 (4.7%) of the 21 embolizations because a weakness of lower extremities related to swelling was observed. Surgery was performed at a mean of 1.4 days ± 1 (range, 1-5 days) after embolization. The mean surgical estimated BL was 432.5 mL ± 328.5 (range, 25-1,100 mL), and the mean OT was 210.1 minutes ± 97.4 (range, 57-489 minutes). CONCLUSIONS Preoperative embolization of tumors resected for MSCC with nBCA is a safe procedure allowing for performance of surgery with acceptable BL.
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Affiliation(s)
- Eslam Youssef
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ernesto Santos
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Amgad M Moussa
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Eric Lis
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Maksim Vaynrub
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ori Barzilai
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mark Bilsky
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Francois H Cornelis
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
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15
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Hallinan JTPD, Zhu L, Zhang W, Ge S, Muhamat Nor FE, Ong HY, Eide SE, Cheng AJL, Kuah T, Lim DSW, Low XZ, Yeong KY, AlMuhaish MI, Alsooreti A, Kumarakulasinghe NB, Teo EC, Yap QV, Chan YH, Lin S, Tan JH, Kumar N, Vellayappan BA, Ooi BC, Quek ST, Makmur A. Deep learning assessment compared to radiologist reporting for metastatic spinal cord compression on CT. Front Oncol 2023; 13:1151073. [PMID: 37213273 PMCID: PMC10193838 DOI: 10.3389/fonc.2023.1151073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/16/2023] [Indexed: 05/23/2023] Open
Abstract
Introduction Metastatic spinal cord compression (MSCC) is a disastrous complication of advanced malignancy. A deep learning (DL) algorithm for MSCC classification on CT could expedite timely diagnosis. In this study, we externally test a DL algorithm for MSCC classification on CT and compare with radiologist assessment. Methods Retrospective collection of CT and corresponding MRI from patients with suspected MSCC was conducted from September 2007 to September 2020. Exclusion criteria were scans with instrumentation, no intravenous contrast, motion artefacts and non-thoracic coverage. Internal CT dataset split was 84% for training/validation and 16% for testing. An external test set was also utilised. Internal training/validation sets were labelled by radiologists with spine imaging specialization (6 and 11-years post-board certification) and were used to further develop a DL algorithm for MSCC classification. The spine imaging specialist (11-years expertise) labelled the test sets (reference standard). For evaluation of DL algorithm performance, internal and external test data were independently reviewed by four radiologists: two spine specialists (Rad1 and Rad2, 7 and 5-years post-board certification, respectively) and two oncological imaging specialists (Rad3 and Rad4, 3 and 5-years post-board certification, respectively). DL model performance was also compared against the CT report issued by the radiologist in a real clinical setting. Inter-rater agreement (Gwet's kappa) and sensitivity/specificity/AUCs were calculated. Results Overall, 420 CT scans were evaluated (225 patients, mean age=60 ± 11.9[SD]); 354(84%) CTs for training/validation and 66(16%) CTs for internal testing. The DL algorithm showed high inter-rater agreement for three-class MSCC grading with kappas of 0.872 (p<0.001) and 0.844 (p<0.001) on internal and external testing, respectively. On internal testing DL algorithm inter-rater agreement (κ=0.872) was superior to Rad 2 (κ=0.795) and Rad 3 (κ=0.724) (both p<0.001). DL algorithm kappa of 0.844 on external testing was superior to Rad 3 (κ=0.721) (p<0.001). CT report classification of high-grade MSCC disease was poor with only slight inter-rater agreement (κ=0.027) and low sensitivity (44.0), relative to the DL algorithm with almost-perfect inter-rater agreement (κ=0.813) and high sensitivity (94.0) (p<0.001). Conclusion Deep learning algorithm for metastatic spinal cord compression on CT showed superior performance to the CT report issued by experienced radiologists and could aid earlier diagnosis.
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Affiliation(s)
- James Thomas Patrick Decourcy Hallinan
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- *Correspondence: James Thomas Patrick Decourcy Hallinan,
| | - Lei Zhu
- Department of Computer Science, School of Computing, National University of Singapore, Singapore, Singapore
| | - Wenqiao Zhang
- Department of Computer Science, School of Computing, National University of Singapore, Singapore, Singapore
| | - Shuliang Ge
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | - Faimee Erwan Muhamat Nor
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Han Yang Ong
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sterling Ellis Eide
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Amanda J. L. Cheng
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tricia Kuah
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | - Desmond Shi Wei Lim
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | - Xi Zhen Low
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | - Kuan Yuen Yeong
- Department of Radiology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Mona I. AlMuhaish
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
- Department of Radiology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ahmed Mohamed Alsooreti
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
- Department of Diagnostic Imaging, Salmaniya Medical Complex, Manama, Bahrain
| | | | - Ee Chin Teo
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | - Qai Ven Yap
- Biostatistics Unit, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Shuxun Lin
- Division of Spine Surgery, Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Jiong Hao Tan
- University Spine Centre, Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
| | - Naresh Kumar
- University Spine Centre, Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
| | - Balamurugan A. Vellayappan
- Department of Radiation Oncology, National University Cancer Institute Singapore, National University Hospital, Singapore, Singapore
| | - Beng Chin Ooi
- Department of Computer Science, School of Computing, National University of Singapore, Singapore, Singapore
| | - Swee Tian Quek
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Andrew Makmur
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Muacevic A, Adler JR, Sandhu M, Agrawal K, Caicedo Murillo M, Heritage C, Ramovic M, Akhtar K. A Rare Case of Aggressive Atypical Cervical Cancer With Multi-Organ Involvement. Cureus 2022; 14:e32968. [PMID: 36578845 PMCID: PMC9792719 DOI: 10.7759/cureus.32968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2022] [Indexed: 12/27/2022] Open
Abstract
Squamous cell carcinoma (SCC) of cervical origin with metastasis to the brain is rare. Our patient was a 30-year-old Caucasian female with squamous cell carcinoma, initially with unknown primary, with metastases to the brain, kidney, cervix, lung, adrenal glands, vulva, pelvic wall, and scalp. She initially presented to her outpatient gynecologist for a vulvar mass. A biopsy of the vulvar mass was consistent with SCC. The patient continued to have fatigue along with thoracic rib pain. An initial work-up was performed, including imaging which showed diffuse metastatic disease involving the lungs, kidneys and adrenal glands, as well as a pathological compression fracture of the seventh thoracic vertebra with cord compression. Brain magnetic resonance imaging (MRI) showed multiple metastatic lesions and she underwent craniotomy for brain lesion resection. Given the aggressive nature of the patient's disease and her symptomatic burden, she was started on chemotherapy in the hospital with Carboplatin, Paclitaxel, and Pembrolizumab.
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Hallinan JTPD, Ge S, Zhu L, Zhang W, Lim YT, Thian YL, Jagmohan P, Kuah T, Lim DSW, Low XZ, Teo EC, Barr Kumarakulasinghe N, Yap QV, Chan YH, Tan JH, Kumar N, Vellayappan BA, Ooi BC, Quek ST, Makmur A. Diagnostic Accuracy of CT for Metastatic Epidural Spinal Cord Compression. Cancers (Basel) 2022; 14:cancers14174231. [PMID: 36077767 PMCID: PMC9454807 DOI: 10.3390/cancers14174231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Early diagnosis of metastatic epidural spinal cord compression (MESCC) is vital to expedite therapy and prevent paralysis. Staging CT is performed routinely in cancer patients and presents an opportunity for earlier diagnosis. Methods: This retrospective study included 123 CT scans from 101 patients who underwent spine MRI within 30 days, excluding 549 CT scans from 216 patients due to CT performed post-MRI, non-contrast CT, or a gap greater than 30 days between modalities. Reference standard MESCC gradings on CT were provided in consensus via two spine radiologists (11 and 7 years of experience) analyzing the MRI scans. CT scans were labeled using the original reports and by three radiologists (3, 13, and 14 years of experience) using dedicated CT windowing. Results: For normal/none versus low/high-grade MESCC per CT scan, all radiologists demonstrated almost perfect agreement with kappa values ranging from 0.866 (95% CI 0.787–0.945) to 0.947 (95% CI 0.899–0.995), compared to slight agreement for the reports (kappa = 0.095, 95%CI −0.098–0.287). Radiologists also showed high sensitivities ranging from 91.51 (95% CI 84.49–96.04) to 98.11 (95% CI 93.35–99.77), compared to 44.34 (95% CI 34.69–54.31) for the reports. Conclusion: Dedicated radiologist review for MESCC on CT showed high interobserver agreement and sensitivity compared to the current standard of care.
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Affiliation(s)
- James Thomas Patrick Decourcy Hallinan
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
- Correspondence:
| | - Shuliang Ge
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Lei Zhu
- Department of Computer Science, School of Computing, National University of Singapore, 13 Computing Drive, Singapore 117417, Singapore
| | - Wenqiao Zhang
- Department of Computer Science, School of Computing, National University of Singapore, 13 Computing Drive, Singapore 117417, Singapore
| | - Yi Ting Lim
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Yee Liang Thian
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Pooja Jagmohan
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Tricia Kuah
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Desmond Shi Wei Lim
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Xi Zhen Low
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Ee Chin Teo
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Nesaretnam Barr Kumarakulasinghe
- National University Cancer Institute, NUH Medical Centre (NUHMC), Levels 8–10, 5 Lower Kent Ridge Road, Singapore 119074, Singapore
| | - Qai Ven Yap
- Biostatistics Unit, Yong Loo Lin School of Medicine, 10 Medical Drive, Singapore 117597, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, 10 Medical Drive, Singapore 117597, Singapore
| | - Jiong Hao Tan
- University Spine Centre, Department of Orthopaedic Surgery, National University Health System, 1E, Lower Kent Ridge Road, Singapore 119228, Singapore
| | - Naresh Kumar
- University Spine Centre, Department of Orthopaedic Surgery, National University Health System, 1E, Lower Kent Ridge Road, Singapore 119228, Singapore
| | - Balamurugan A. Vellayappan
- Department of Radiation Oncology, National University Cancer Institute Singapore, National University Hospital, Singapore 119074, Singapore
| | - Beng Chin Ooi
- Department of Computer Science, School of Computing, National University of Singapore, 13 Computing Drive, Singapore 117417, Singapore
| | - Swee Tian Quek
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Andrew Makmur
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
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18
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Ong W, Zhu L, Zhang W, Kuah T, Lim DSW, Low XZ, Thian YL, Teo EC, Tan JH, Kumar N, Vellayappan BA, Ooi BC, Quek ST, Makmur A, Hallinan JTPD. Application of Artificial Intelligence Methods for Imaging of Spinal Metastasis. Cancers (Basel) 2022; 14:4025. [PMID: 36011018 PMCID: PMC9406500 DOI: 10.3390/cancers14164025] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/10/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
Spinal metastasis is the most common malignant disease of the spine. Recently, major advances in machine learning and artificial intelligence technology have led to their increased use in oncological imaging. The purpose of this study is to review and summarise the present evidence for artificial intelligence applications in the detection, classification and management of spinal metastasis, along with their potential integration into clinical practice. A systematic, detailed search of the main electronic medical databases was undertaken in concordance with the PRISMA guidelines. A total of 30 articles were retrieved from the database and reviewed. Key findings of current AI applications were compiled and summarised. The main clinical applications of AI techniques include image processing, diagnosis, decision support, treatment assistance and prognostic outcomes. In the realm of spinal oncology, artificial intelligence technologies have achieved relatively good performance and hold immense potential to aid clinicians, including enhancing work efficiency and reducing adverse events. Further research is required to validate the clinical performance of the AI tools and facilitate their integration into routine clinical practice.
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Affiliation(s)
- Wilson Ong
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd., Singapore 119074, Singapore
| | - Lei Zhu
- Department of Computer Science, School of Computing, National University of Singapore, 13 Computing Drive, Singapore 117417, Singapore
| | - Wenqiao Zhang
- Department of Computer Science, School of Computing, National University of Singapore, 13 Computing Drive, Singapore 117417, Singapore
| | - Tricia Kuah
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd., Singapore 119074, Singapore
| | - Desmond Shi Wei Lim
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd., Singapore 119074, Singapore
| | - Xi Zhen Low
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd., Singapore 119074, Singapore
| | - Yee Liang Thian
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd., Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Ee Chin Teo
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd., Singapore 119074, Singapore
| | - Jiong Hao Tan
- University Spine Centre, Department of Orthopaedic Surgery, National University Health System, 1E, Lower Kent Ridge Road, Singapore 119228, Singapore
| | - Naresh Kumar
- University Spine Centre, Department of Orthopaedic Surgery, National University Health System, 1E, Lower Kent Ridge Road, Singapore 119228, Singapore
| | - Balamurugan A. Vellayappan
- Department of Radiation Oncology, National University Cancer Institute Singapore, National University Hospital, Singapore 119074, Singapore
| | - Beng Chin Ooi
- Department of Computer Science, School of Computing, National University of Singapore, 13 Computing Drive, Singapore 117417, Singapore
| | - Swee Tian Quek
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd., Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Andrew Makmur
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd., Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - James Thomas Patrick Decourcy Hallinan
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd., Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
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19
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Kuah T, Vellayappan BA, Makmur A, Nair S, Song J, Tan JH, Kumar N, Quek ST, Hallinan JTPD. State-of-the-Art Imaging Techniques in Metastatic Spinal Cord Compression. Cancers (Basel) 2022; 14:3289. [PMID: 35805059 PMCID: PMC9265325 DOI: 10.3390/cancers14133289] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 12/23/2022] Open
Abstract
Metastatic Spinal Cord Compression (MSCC) is a debilitating complication in oncology patients. This narrative review discusses the strengths and limitations of various imaging modalities in diagnosing MSCC, the role of imaging in stereotactic body radiotherapy (SBRT) for MSCC treatment, and recent advances in deep learning (DL) tools for MSCC diagnosis. PubMed and Google Scholar databases were searched using targeted keywords. Studies were reviewed in consensus among the co-authors for their suitability before inclusion. MRI is the gold standard of imaging to diagnose MSCC with reported sensitivity and specificity of 93% and 97% respectively. CT Myelogram appears to have comparable sensitivity and specificity to contrast-enhanced MRI. Conventional CT has a lower diagnostic accuracy than MRI in MSCC diagnosis, but is helpful in emergent situations with limited access to MRI. Metal artifact reduction techniques for MRI and CT are continually being researched for patients with spinal implants. Imaging is crucial for SBRT treatment planning and three-dimensional positional verification of the treatment isocentre prior to SBRT delivery. Structural and functional MRI may be helpful in post-treatment surveillance. DL tools may improve detection of vertebral metastasis and reduce time to MSCC diagnosis. This enables earlier institution of definitive therapy for better outcomes.
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Affiliation(s)
- Tricia Kuah
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore; (A.M.); (S.N.); (J.S.); (S.T.Q.); (J.T.P.D.H.)
| | - Balamurugan A. Vellayappan
- Department of Radiation Oncology, National University Cancer Institute Singapore, National University Hospital, Singapore 119074, Singapore;
| | - Andrew Makmur
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore; (A.M.); (S.N.); (J.S.); (S.T.Q.); (J.T.P.D.H.)
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Shalini Nair
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore; (A.M.); (S.N.); (J.S.); (S.T.Q.); (J.T.P.D.H.)
| | - Junda Song
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore; (A.M.); (S.N.); (J.S.); (S.T.Q.); (J.T.P.D.H.)
| | - Jiong Hao Tan
- University Spine Centre, Department of Orthopaedic Surgery, National University Health System, 1E Lower Kent Ridge Road, Singapore 119228, Singapore; (J.H.T.); (N.K.)
| | - Naresh Kumar
- University Spine Centre, Department of Orthopaedic Surgery, National University Health System, 1E Lower Kent Ridge Road, Singapore 119228, Singapore; (J.H.T.); (N.K.)
| | - Swee Tian Quek
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore; (A.M.); (S.N.); (J.S.); (S.T.Q.); (J.T.P.D.H.)
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - James Thomas Patrick Decourcy Hallinan
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore; (A.M.); (S.N.); (J.S.); (S.T.Q.); (J.T.P.D.H.)
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
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20
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Rail B, Ogwumike E, Adeyemo E, Badejo O, Barrie U, Kenfack YJ, El Ahmadieh TY, Kafka B, Hall K, Bagley CA, Aoun SG. Pancreatic Cancer Metastasis to the Spine: A Systematic Review of Management Strategies and Outcomes with Case Illustration. World Neurosurg 2022; 160:94-101.e4. [PMID: 35026458 DOI: 10.1016/j.wneu.2022.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE We aim to provide a thorough review of the literature regarding patient characteristics, treatment options, and outcomes of pancreatic cancer metastasis to the spine. We also provide an illustrative case from our institution of a patients with pancreatic adenocarcinoma presenting initially as cervical radiculopathy with an isolated cervical spine lesion. METHODS Using the PRISMA guidelines, the literature in PubMed, Google Scholar, and Web of Science databases was searched. We excluded systematic reviews and meta-analyses that did not provide novel cases, as well as reports of metastatic disease from other nonpancreatic primary cancers. RESULTS Thirty-two patients across 21 studies met the inclusion criteria. The patients were predominantly male (58%), with a mean age of 59 years. Of patients, 64% presented with back pain, 39% with motor deficits, and 15% with bladder or bowel dysfunction. For treatment, chemotherapy was used in 55% of cases and radiotherapy in 42%. Surgical treatment was performed in 42% of cases, with complete tumor resection achieved in 24% of cases. The mean patient survival after treatment was 28 weeks (range, 1-83 weeks), with patients undergoing treatment involving surgery having increased survival (44 weeks) compared with noninvasive treatment alone (18 weeks). CONCLUSIONS Spinal metastasis of pancreatic cancer is rare and typically portends a poor prognosis. It is vital to recognize the presence of spinal involvement early in the disease course and initiate treatment.
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Affiliation(s)
- Benjamin Rail
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Erica Ogwumike
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Emmanuel Adeyemo
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Olatunde Badejo
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Umaru Barrie
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Yves J Kenfack
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Tarek Y El Ahmadieh
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Benjamin Kafka
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kristen Hall
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Carlos A Bagley
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA; Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA; Spine Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Salah G Aoun
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA; Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA; Spine Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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21
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Murali N, Turmezei T, Bhatti S, Patel P, Marshall T, Smith T. What is the effectiveness of radiofrequency ablation in the management of patients with spinal metastases? A systematic review and meta-analysis. J Orthop Surg Res 2021; 16:659. [PMID: 34742319 PMCID: PMC8571892 DOI: 10.1186/s13018-021-02775-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/05/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Spinal metastases are indicative of progressive cancer which can lead to vertebral body fractures and spinal cord compression. Radiofrequency ablation (RFA) treatment is infrequently used in patients with refractory pain. The aim of this systematic review is to determine the clinical efficacy of RFA, with the scope of using it as front-line management of spinal metastases. METHODS Electronic databases were searched (to July 2020) for studies evaluating RFA treatment for spinal metastases in adults. Measured outcomes were pain (primary), disability, health-related quality of life (HRQOL), complications, tumour control and mortality. Study inclusion, data extraction and risk of bias using the ROBIN-I tool were assessed. Meta-analysis was conducted for pooled results with homogeneity, and narrative synthesis was conducted otherwise. RESULTS 15 studies were included. RFA reduces pain scores at 3-5 weeks [standardised mean difference (SMD 2.24, 95% confidence intervals (CI) 1.55-2.93], 3-4 months (SMD 3.00, 95% CI 1.11-4.90) and 5-6 months (SMD 3.54, 95% CI 1.96-5.11). RFA is effective in reducing disability/improving HRQOL in the short-term but longer-term efficacy remains unclear. 13.2% cases reported local tumour control failure (2.5 months-5 year follow-up) whereas mortality was 23.6% (follow-up of up to 1 year). CONCLUSION Low quality evidence has proven RFA to be safe and effective in reducing pain and disability, especially in the short-term. RFA may be routinely implemented in all cases involving refractory pain or radiotherapy-resistant tumours but controlled trials are required to compare the efficacy of RFA to current frontline treatments. PROSPERO protocol registration number: CRD42020202377.
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Affiliation(s)
- Navanith Murali
- Norwich Medical School, University of East Anglia, Norwich, UK.
| | - Thomas Turmezei
- Norwich Medical School, University of East Anglia, Norwich, UK
- Department of Radiology, Norfolk & Norwich University Hospital, Norwich, UK
| | - Sumbal Bhatti
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Puja Patel
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Thomas Marshall
- Department of Radiology, Norfolk & Norwich University Hospital, Norwich, UK
| | - Toby Smith
- Norwich Medical School, University of East Anglia, Norwich, UK
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22
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The Role of a Navigational Radiofrequency Ablation Device and Concurrent Vertebral Augmentation for Treatment of Difficult-to-Reach Spinal Metastases. Curr Oncol 2021; 28:4004-4015. [PMID: 34677258 PMCID: PMC8534768 DOI: 10.3390/curroncol28050340] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/03/2021] [Accepted: 10/05/2021] [Indexed: 02/05/2023] Open
Abstract
Aims: The purpose of this study was to assess the effectiveness of a navigational radiofrequency ablation device with concurrent vertebral augmentation in the treatment of posterior vertebral body metastatic lesions, which are technically difficult to access. Primary outcomes of the study were evaluation of pain palliation and radiologic assessment of local tumor control. Materials and Methods: Thirty-five patients with 41 vertebral spinal metastases involving the posterior vertebral body underwent computed tomography-guided percutaneous targeted radiofrequency ablation, with a navigational radiofrequency ablation device, associated with vertebral augmentation. Twenty-one patients (60%) had 1 or 2 metastatic lesions (Group A) and fourteen (40%) patients had multiple (>2) vertebral lesions (Group B). Changes in pain severity were evaluated by visual analog scale (VAS). Metastatic lesions were evaluated in terms of radiological local control. Results: The procedure was technically successful in all the treated vertebrae. Among the symptomatic patients, the mean VAS score dropped from 5.7 (95% CI 4.9–6.5) before tRFA and to 0.9 (95% CI 0.4–1.3) after tRFA (p < 0.001). The mean decrease in VAS score between baseline and one week follow up was 4.8 (95% CI 4.2–5.4). VAS decrease over time between one week and one year following radiofrequency ablation was similar, suggesting that pain relief was immediate and durable. Neither patients with 1–2 vertebral metastases, nor those with multiple lesions, showed radiological signs of local progression or recurrence of the tumor in the index vertebrae during a median follow up of 19 months (4–46 months) and 10 months (4–37 months), respectively. Conclusion: Treatment of spinal metastases with a navigational radiofrequency ablation device and vertebral augmentation can be used to obtain local tumor control with immediate and durable pain relief, providing effective treatment in the multimodality management of difficult-to-reach spinal metastases.
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23
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Furtado ARR, Moris LM, Esmieu S, Cherubini GB, Mantis P. Low-field magnetic resonance imaging characteristics of multifocal vertebral lesions in dogs. Vet Rec 2021; 189:e78. [PMID: 34505679 DOI: 10.1002/vetr.78] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/10/2020] [Accepted: 12/26/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND There is a lack of information regarding magnetic resonance imaging (MRI) features of polyostotic vertebral lesions in dogs. The aim of this retrospective study was to identify and differenciate low-field MRI features of aggressive versus benign multifocal vertebral diseases in dogs. METHODS MRI examinations from 49 dogs with polyostotic vertebral lesions were reviewed. Images were evaluated for vertebral intensity changes, expansile lesions, new bone formation, cortical bone interruption, paravertebral musculature changes, lymphadenomegaly, spinal cord compression and spinal cord signal changes. RESULTS Twenty-nine dogs with non-aggressive bone lesions and 20 dogs with aggressive vertebral lesions were included. Non-aggressive lesions had variable T2-weighted fast spin-echo (T2W) signal intensity and the majority displayed low signal intensity on short tau inversion recovery (STIR). Aggressive lesions predominantly had high T2W and STIR signal intensity, with variable signal intensity on T1-weighted spin-echo and contrast enhancement. Aggressive lesions were associated with spinal pain (p < 0.01), new bone formation (p = 0.02), spinal cord compression (p < 0.01) and lymphadenomegaly (p < 0.01). Cortical interruption (p < 0.01) and paravertebral musculature changes (p < 0.01) were the strongest indicative imaging features for aggressive lesions. CONCLUSION Spinal pain, spinal cord compression, new bone formation, lymphadenomegaly and especially cortical interruption and paravertebral musculature signal intensity changes were the best discriminators for differentiating malignant from benign vertebral lesions.
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Hurley P, Azzopardi C, Botchu R, Grainger M, Gardner A. Can MRI be used as a safe and expedient option for calculating Spinal Instability Neoplastic Score for patients with metastatic spinal cord compression? Bone Joint J 2021; 103-B:971-975. [PMID: 33934648 DOI: 10.1302/0301-620x.103b5.bjj-2020-1823.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to assess the reliability of using MRI scans to calculate the Spinal Instability Neoplastic Score (SINS) in patients with metastatic spinal cord compression (MSCC). METHODS A total of 100 patients were retrospectively included in the study. The SINS score was calculated from each patient's MRI and CT scans by two consultant musculoskeletal radiologists (reviewers 1 and 2) and one consultant spinal surgeon (reviewer 3). In order to avoid potential bias in the assessment, MRI scans were reviewed first. Bland-Altman analysis was used to identify the limits of agreement between the SINS scores from the MRI and CT scans for the three reviewers. RESULTS The limit of agreement between the SINS score from the MRI and CT scans for the reviewers was -0.11 for reviewer 1 (95% CI 0.82 to -1.04), -0.12 for reviewer 2 (95% CI 1.24 to -1.48), and -0.37 for reviewer 3 (95% CI 2.35 to -3.09). The use of MRI tended to increase the score when compared with that using the CT scan. No patient having their score calculated from MRI scans would have been classified as stable rather than intermediate or unstable when calculated from CT scans, potentially leading to suboptimal care. CONCLUSION We found that MRI scans can be used to calculate the SINS score reliably, compared with the score from CT scans. The main difference between the scores derived from MRI and CT was in defining the type of bony lesion. This could be made easier by knowing the site of the primary tumour when calculating the score, or by using inverted T1-volumetric interpolated breath-hold examination MRI to assess the bone more reliably, similar to using CT. Cite this article: Bone Joint J 2021;103-B(5):971-975.
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25
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Alektoroff K, Moulopoulos LA, Papanagiotou P. [Spinal tumors]. Radiologe 2021; 61:267-274. [PMID: 33570679 DOI: 10.1007/s00117-021-00815-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 11/26/2022]
Abstract
Spinal tumors are often classified into three anatomical compartments on the basis of their relationship to the dural space and myelon. The most common primary spinal neoplasms are glial tumors (ependymoma, astrocytoma), nerve sheath tumors (schwannoma, neurofibroma) and meningioma. Metastases represent another common tumor entity and can occur in every spinal compartment. Magnetic resonance imaging (MRI) is the most important noninvasive method for spinal tumor imaging.
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Affiliation(s)
- K Alektoroff
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Klinikum Bremen-Mitte/Bremen-Ost, 28205, Bremen, Deutschland.
| | - L A Moulopoulos
- Zentrum für Radiologie, Nationale und Kapodistrias-Universität Athen, Aretaieion Klinikum, Athen, Griechenland
| | - P Papanagiotou
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Klinikum Bremen-Mitte/Bremen-Ost, 28205, Bremen, Deutschland
- Zentrum für Radiologie, Nationale und Kapodistrias-Universität Athen, Aretaieion Klinikum, Athen, Griechenland
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Van Nieuwenhove S, Van Damme J, Padhani AR, Vandecaveye V, Tombal B, Wuts J, Pasoglou V, Lecouvet FE. Whole-body magnetic resonance imaging for prostate cancer assessment: Current status and future directions. J Magn Reson Imaging 2020; 55:653-680. [PMID: 33382151 DOI: 10.1002/jmri.27485] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/08/2020] [Accepted: 12/08/2020] [Indexed: 12/20/2022] Open
Abstract
Over the past decade, updated definitions for the different stages of prostate cancer and risk for distant disease, along with the advent of new therapies, have remarkably changed the management of patients. The two expectations from imaging are accurate staging and appropriate assessment of disease response to therapies. Modern, next-generation imaging (NGI) modalities, including whole-body magnetic resonance imaging (WB-MRI) and nuclear medicine (most often prostate-specific membrane antigen [PSMA] positron emission tomography [PET]/computed tomography [CT]) bring added value to these imaging tasks. WB-MRI has proven its superiority over bone scintigraphy (BS) and CT for the detection of distant metastasis, also providing reliable evaluations of disease response to treatment. Comparison of the effectiveness of WB-MRI and molecular nuclear imaging techniques with regard to indications and the definition of their respective/complementary roles in clinical practice is ongoing. This paper illustrates the evolution of WB-MRI imaging protocols, defines the current state-of-the art, and highlights the latest developments and future challenges. The paper presents and discusses WB-MRI indications in the care pathway of men with prostate cancer in specific key situations: response assessment of metastatic disease, "all in one" cancer staging, and oligometastatic disease.
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Affiliation(s)
- Sandy Van Nieuwenhove
- Department of Radiology and Medical Imaging, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Julien Van Damme
- Department of Urology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Anwar R Padhani
- Mount Vernon Cancer Centre, Mount Vernon Hospital, London, UK
| | - Vincent Vandecaveye
- Department of Radiology and Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Bertrand Tombal
- Department of Urology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Joris Wuts
- Department of Radiology and Medical Imaging, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel, Brussels, Belgium
| | - Vassiliki Pasoglou
- Department of Radiology and Medical Imaging, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Frederic E Lecouvet
- Department of Radiology and Medical Imaging, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
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Lang N, Zhang Y, Zhang E, Zhang J, Chow D, Chang P, Yu HJ, Yuan H, Su MY. Differentiation of spinal metastases originated from lung and other cancers using radiomics and deep learning based on DCE-MRI. Magn Reson Imaging 2019; 64:4-12. [PMID: 30826448 DOI: 10.1016/j.mri.2019.02.013] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/06/2019] [Accepted: 02/28/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE To differentiate metastatic lesions in the spine originated from primary lung cancer and other cancers using radiomics and deep learning, compared to traditional hot-spot ROI analysis. METHODS In a retrospective review of clinical spinal MRI database with a dynamic contrast enhanced (DCE) sequence, a total of 61 patients without prior cancer diagnosis and later confirmed to have metastases (30 lung; 31 non-lung cancers) were identified. For hot-spot analysis, a manual ROI was placed to calculate three heuristic parameters from the wash-in, maximum, and wash-out phases in the DCE kinetics. For each case, the 3D tumor mask was generated by using the normalized-cut algorithm. Radiomics analysis was performed to extract histogram and texture features from three DCE parametric maps. Deep learning was performed using these maps as inputs into a conventional convolutional neural network (CNN), as well as using all 12 sets of DCE images into a convolutional long short term memory (CLSTM) network. RESULTS For hot-spot ROI analysis, mean wash-out slope was 0.25 ± 10% for lung metastases and -9.8 ± 12.9% for other tumors. CHAID classification using a wash-out slope of -6.6% followed by wash-in enhancement ratio of 98% achieved a diagnostic accuracy of 0.79. Radiomics analysis using features representing tumor heterogeneity only reached the highest accuracy of 0.71. Classification using CNN achieved a mean accuracy of 0.71 ± 0.043, whereas a CLSTM improved accuracy to 0.81 ± 0.034. CONCLUSIONS DCE-MRI machine-learning analysis methods have potential to predict lung cancer metastases in the spine, which may be used to guide subsequent workup for confirmed diagnosis.
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Affiliation(s)
- Ning Lang
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Yang Zhang
- Department of Radiological Sciences, University of California, Irvine, CA, USA
| | - Enlong Zhang
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Jiahui Zhang
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Daniel Chow
- Department of Radiological Sciences, University of California, Irvine, CA, USA
| | - Peter Chang
- Department of Radiological Sciences, University of California, Irvine, CA, USA
| | - Hon J Yu
- Department of Radiological Sciences, University of California, Irvine, CA, USA
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, Beijing, China.
| | - Min-Ying Su
- Department of Radiological Sciences, University of California, Irvine, CA, USA.
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Lei M, Yu J, Yan S, An X, Liu Y. Clinical outcomes and risk factors in patients with cervical metastatic spinal cord compression after posterior decompressive and spinal stabilization surgery. Ther Clin Risk Manag 2019; 15:119-127. [PMID: 30666122 PMCID: PMC6333387 DOI: 10.2147/tcrm.s184497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose The aim of this study was to investigate the clinical results of surgery for cervical spine metastasis and identify clinical risk factors affecting postoperative survival and neurological outcome. Patients and methods A retrospective analysis of medical records was performed on 19 patients who had undergone decompressive surgery and spine stabilization due to metastatic spinal cord compression in the cervical spine. All patients had severe pain before surgery. Worst pain, average pain, and pain interference were evaluated using the visual analog scale (range, 0–10) for each patient at baseline and following surgery. Neurological recovery was assessed using the Japanese Orthopaedic Association Score (JOAS). In addition, associations between ten characteristics and postoperative survival and neurological outcomes were analyzed in the study. Results The mean worst pain score in a 24-hour period was 8.6 before the operation. At 1 day, 1, 3, 6, and 12 months after the operation, the mean worst pain scores decreased to 5.6, 4.5, 3.8, 2.6, and 2.4 (all P<0.001 vs baseline), respectively. Similar decreases in average pain and pain interference were also observed. The median JOAS in a 24-hour period was 11.0 before the operation. At 1 day, 1, 3, 6, and 12 months after the operation, the median JOAS increased to 12.0 (P=0.469), 13.0 (P=0.010), 14.0 (P<0.001), 15.0 (P<0.001), and 14.0 (P<0.001), respectively. According to the multivariate analysis, postoperative survival was significantly associated with the type of primary tumor (P=0.033), preoperative ambulatory status (P=0.004), extra-spinal bone metastasis (P=0.021), 125I seed brachytherapy (P=0.014), and complication status (P=0.009). Better neurological outcome was found to be correlated with higher JOAS (P=0.013). Surgery-related complications occurred in 26.3% of patients. Conclusion Posterior decompression and spine stabilization for painful cervical spine metastasis resulting from spinal cord compression were found to be effective for neurological recovery and pain control with a tolerable rate of complications.
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Affiliation(s)
- Mingxing Lei
- Department of Orthopedic Surgery, Hainan Hospital of the PLA General Hospital, Sanya, People's Republic of China,
| | - Jun Yu
- Department of Anesthesiology, The Fourth Medical Center of PLA General Hospital, Beijing, People's Republic of China
| | - Shiju Yan
- Department of Orthopedic Surgery, Hainan Hospital of the PLA General Hospital, Sanya, People's Republic of China,
| | - Xiao An
- Department of Orthopedic Surgery, Hainan Hospital of the PLA General Hospital, Sanya, People's Republic of China,
| | - Yaosheng Liu
- Department of Orthopedic Surgery, The 307th Hospital, Beijing, People's Republic of China,
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da Silva GT, Bergmann A, Thuler LCS. Impact of Symptomatic Metastatic Spinal Cord Compression on Survival of Patients with Non-Small-Cell Lung Cancer. World Neurosurg 2017; 108:698-704. [DOI: 10.1016/j.wneu.2017.09.079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 09/11/2017] [Accepted: 09/13/2017] [Indexed: 01/05/2023]
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Lei M, Liu Y, Liu S, Wang L, Zhou S, Zhou J. Individual strategy for lung cancer patients with metastatic spinal cord compression. Eur J Surg Oncol 2016; 42:728-34. [DOI: 10.1016/j.ejso.2016.01.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 01/02/2016] [Accepted: 01/20/2016] [Indexed: 01/10/2023] Open
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Wei D, Ma XL, Zhang SQ, Bi XY. Atypical Guillain-Barre Syndrome Caused by Primary Diffuse Large B-cell Lymphoma Originating from Dorsal Root Ganglion. CNS Neurosci Ther 2015; 21:674-6. [PMID: 26179114 DOI: 10.1111/cns.12432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 06/08/2015] [Indexed: 11/27/2022] Open
Affiliation(s)
- Dong Wei
- Department 5 of Surgery, PLA 150 Hospital, Luoyang, China
| | - Xiao-Long Ma
- Department of Neuroradiology, Changhai Hospital, Shanghai, China
| | - She-Qing Zhang
- Department of Neurology, Changhai Hospital, Shanghai, China
| | - Xiao-Ying Bi
- Department of Neurology, Changhai Hospital, Shanghai, China
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