Published November 22, 2022 | Version v1
Journal article Open

Analysis and treatment results of spinal Metastases; ten years experience of Alexandria clinical oncology department

Authors/Creators

  • 1. Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.

Description

ABSTRACT

Background: This study attempted to review the medical records of all patients with spinal bone metastases presented to Alexandria Clinical Oncology and Nuclear Medicine Department (ACOD), Alexandria Main University Hospital during the period from January 2003 to December 2012.

Patients and Methods: A total of 350 patients were included in this study. Medical records were retrospectively reviewed and data were collected as regard demographic data, medical history, Clinical data, Investigations and diagnostic work up, treatment modalities and treatment outcomes.

Results: we observed that the origin of the tumor in the majority of cases was breast cancer (31.1%), followed by prostate cancer 17.7% then multiple myeloma 17.1%.The female patients presented with the highest percentage 60.9%.performance status according Eastern Cooperative Oncology Group ( ECOG) score was 0-2 in 58% of patients. The majority of patients were complaining of pain (98.6%). A considerable percentage of cases presented with symptoms of spinal cord compression (30%). Improvement regarding pain after treatment with radiotherapy was reported in (42.6%) of patients. Motor function improvement was (89.7%) at 8 weeks for patients presented with paresis and treated early. Type of primary tumor was the most significant prognostic factor (HR=6.873 and 4.431, P <0.001).

Conclusions: Breast cancer, prostate cancer and multiple myeloma constituted the most common primaries that develop spinal metastases. A higher incidence of spinal metastases in women compared with men. The predominant symptom in patients with spinal metastases was pain. Patients who developed spinal metastases were at risk of spinal cord compression. The goals of treatment were to relieve pain and prevent complications. External beam radiotherapy has been the mainstay for palliating pain resulting from spinal metastases. Early initiation of radiotherapy promote better functional outcome. Type of primary tumor was identified as the most powerful prognostic factor for patients with spinal metastases.

Key Words: Spinal metastases, clinical oncology, breast cancer, prostate cancer and multiple myeloma.

REFERENCES

 

  1. Helweg-Larsen S, Sorensen PS. Symptoms and signs in metastatic spinal cord compression: a study of progression from first symptom until diagnosis in 153 patients. Eur J Cancer 1994; 30A: 396-8.
  2. Ortiz Gomez JA. The incidence of vertebral body metastases. Int Orthop 1995; 19: 309-11.
  3. Nayyar T. Spinal metastates. In: Thamburaj VA (ed). Textbook of contemporary neurosurgery. Vol. 1 & 2. New Delhi, India: Jaypee Brothers, Medical Publishers Pvt. Limited; 2012. 1471-83.
  4. Van der Sande JJ, Boogerd W, Kroger R, Kapelle AC. Recurrent spinal epidural metastases: a pro-spective study with a complete follow up. J Neurol Neurosurg Psychiatry 1999; 66: 623-7.
  5. Sagban WJ, Ridha SMS, Hasan ZN. Comparison between metastatic spinal tumor of unknown primary tumor with a known primary. World J Neurosci 2015;6(01):18.
  6. Camins MB, Jenkins AL, Singhal A, Perrin RG. Tumors of the vertebral axis: benign, primary malignant, and metastatic tumors. In: Winn RH, Youmans JR (eds). Youmans neurological surgery. 5th ed. Philadelphia: W.B. Saunders Company; 2004. 4835-68.
  7. Bach F, Larsen BH, Rohde K, Børgesen SE, Gjerris F, Bøge-Rasmussen T, et al. Metastatic spinal cord compression. Occurrence, symptoms, clinical presentations and prognosis in 398 patients with spinal cord compression. Acta Neurochir (Wien) 1990; 107: 37-43.
  8. Jacobs WB, Perrin RG. Evaluation and treatment of spinal metastases: an overview. Neurosurg Focus 2001; 11: e10.
  9. Ruckdeschel JC. Early detection and treatment of spinal cord compression. Oncology (Williston Park) 2005; 19: 81-6.
  10. Costelloe CM, Rohren EM, Madewell JE, Hamaoka T, Theriault RL, Yu TK,
    et al. Imaging bone metastases in breast cancer: techniques and recommendations for diagnosis. Lancet Oncol 2009; 10: 606-14.
  11. Bünger C, Laursen M, Hansen E. A new algorithm for the surgical treatment of spinal metastases. Spine 1999; 24: 101-5.
  12. Tokuhashi Y, Matsuzaki H, Oda H, Oshima M, Ryu J. A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine 2005; 30: 2186-91.
  13. Cole JS, Patchell RA. Metastatic epidural spinal cord compression. Lancet Neurol 2008; 7: 459-66.
  14. Chow E, Harris K, Fan G, Tsao M, Sze WM. Palliative radiotherapy trials for bone metastases: a systematic review. J Clin Oncol 2007; 25: 1423-36.
  15. Landreneau FE, Landreneau RJ, Keenan RJ, Ferson PF. Diagnosis and management of spinal metastases frombreast cancer. J Neurooncol 1995; 23: 121-34.
  16. Costa L, Major PP. Effect of bisphosphonates on pain and quality of life in patients with bone metastases. Nat Clin Pract Oncol 2009; 6: 163-74.
  17. Jansson K, Bauer H. Survival complication and outcome in 282 patients operate neurological deficit due to thoracic or lumbar spinal metastases. Eur Spine J 2006; 15: 196-202.
  18. Zaikova O, Fosså SD, Bruland ØS, Giercksky KE, Sandstad B, Skjeldal S. Radiotherapy or surgery for spine metastases? A population-based study of 903 patients in the south-eastern region of Norway. Acta Orthopaedica 2011; 82: 365-71.
  19. Gasbarrini A, Li H, Cappuccio M, Mirabile L, Paderni S, Terzi S, et al. Efficacy evaluation of a new treatment algorithm for spinal metastases. Spine (Phila Pa 1976) 2010; 35: 1466-70.
  20. Harel R, Angelov L. Spine metastases: current treatments and future directions. Eur J Cancer 2010; 46: 2696-707.
  21. Rades D, Fehlauer F, Schulte R, Veninga T, Stalpers LJ, Basic H, et al. Prognostic factors for local control and survival after radiotherapy of metastatic spinal cord compression. J Clin Oncol 2006; 24: 3388-93.
  22. Porika Raju and Estari Mamidala (2015). Anti-diabetic activity of compound isolated from
    Physalis angulata fruit extracts in alloxan induced diabetic rats. The Ame J Sci & Med Res,
    2015,1(1); Pages 1 -6. doi:10.17812/ajsmr2015.11.1.  
  23. Papastefanou S, Alpantaki K, Akra G, Katonis P. Predictive value ofop Tokuhashi and Tomita scores in patients with metastatic spine disease. Acta Orthop Traumatol Turc 2012; 46: 50-6.
  24. Botterell EH, Fitzgerald GN. Spinal cord compression produced by extradural malignant tumors. Can Med Assoc J 1959; 80: 791-6.
  25. Georgy BA. Metastatic spinal lesions: state-of-the-art treatment options and future trends. AJNR Am J Neuroradiol 2008; 29: 1605-11.
  26. Yang Z, Yang Y, Zhang Y, Zhang Z, Chen Y, Shen Y, et al. Minimal access versus open spinal surgery in treating painful spine metastasis: A systematic review. World J Surg Oncol 2015; 13: 68.
  27. Paholpak P, Sirichativapee W, Wisanuyotin T, Kosuwon W, Jeeravipoolvarn P. Prevalence of Known and Unknown Primary Tumor Sites In Spinal Metastasis Patients. Open Orthop J 2012; 6: 440-4.
  28. Hartsell WF, Scott CB, Bruner DW, Scarantino CW, Ivker RA, Roach M 3rd, et al. Randomized trial of short- versus long-course radiotherapy for palliation of painful bone metastases. J Natl Cancer Inst 2005; 97: 798-804.
  29. Zaikova O, Fosså SD, Kongsgaard U, Kvaløy S, Giercksky KE, Skjeldal S. Pain after palliative radiotherapy for spine metastases. Clin Oncol 2010; 22: 828-36.
  30. Kataoka M, Kunisada T, Tanaka M, Takeda K, Itani S, Sugimoto Y, et al. Statistical analysis of prognostic factors for survival in patients with spinal metastasis. Acta Med Okayama 2012; 66: 213-9

Files

44.03n.pdf

Files (1.4 MB)

Name Size
md5:804ffbd52f6b99d95ada3a99aebf539a
1.4 MB Preview Download