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  • br Spinal metastases br Spine surgery br Neurosurgery br

    2020-03-17


    Spinal metastases
    Spine surgery
    Neurosurgery 
    Seventy percent of cancer patients will have metastatic bone disease, most commonly in the vertebra. Prognosis of metastatic lung cancer Calcipotriol poor and treatment is mostly palliative. To-date, there is no sys-tematic review on the ideal treatment for lung cancer with spinal metastases in regards to mortality. Literature searches were performed based on PRISMA guidelines for systematic review. Thirty-nine stud-ies comprising 1925 patients treated for spinal metastases of lung cancer met inclusion criteria. All anal-yses were performed using SAS and SPSS. Data were analyzed for meaningful comparisons of baseline patient characteristics, primary cancer type, metastatic lesion characteristics, treatment modality, and clinical and radiologic outcomes. Significantly greater mean survival length was seen in the non-surgical group (8.5 months, SD 6.6, SEM 0.17) compared to the surgical group (7.5 months, SD 4.5, SEM 0.25; p = 0.013). There was no statistically significant survival difference between different types of pri-mary lung cancer: NSCLC (8.3 months, SD 13.8, SEM 0.91) and SCLC (7.0 months, SD 4.6, SEM 0.46; p = 0.36). Number of vertebral levels involved per lesion also did not exhibit significant difference: single lesion (11.3 months, SD 6.8, SEM 2.2) and multiple lesions (13.8 months, SD 15.7, SEM 3.6; p = 0.64). For patients with symptomatic spinal metastases from lung cancer, non-operative approaches experience significantly better survival outcomes (p = 0.013). Future clinical studies are needed to determine the best treatment algorithm to help maximize outcomes and minimize mortality in metastatic lung cancer.
    2019 Elsevier Ltd. All rights reserved.
    1. Introduction
    Bone is the third most common site of metastatic disease fol-lowing the lung and liver, and bone metastase are a leading cause of chronic pain among cancer patients [46]. The spine is the most common location of bone metastases, as evidenced in seventy per-cent of terminal cancer patients [38]. Several pathophysiologic fac-tors, including vascular marrow and the anastomoses of the vertebral venous plexuses with deep thoracic and pelvic veins, make the spine the most common site of osseous metastatic dis-ease [4].
    Lung cancer is a highly aggressive cancer that often portends a poor prognosis as the worldwide leading cause of cancer-related deaths, with a case mortality rate of 1.4 million deaths each year, as well as the most common cancer, with an incidence of 1.6 mil-lion new diagnoses per year [8]. Forty to fifty percent of patients with lung cancer develop bone metastases [24]. Resulting deficits from bony destruction typically cause spinal pain, hypercalcemia,
    ⇑ Corresponding author at: Department of Neurological Surgery, University of Miami Miller School of Medicine, 1150 NW 14th St., Miami, FL 33136, USA.
    E-mail address: [email protected] (N. Schoen).
    and the progressive risk of mechanical instability, pathologic verte-bral compression fractures (VCF), and even paralysis from spinal cord compression [7]. Additionally, metastatic epidural spinal cord compression (MESCC) occurs in ten to twenty percent of spinal metastases, totaling more than twenty thousand cases per year in the United States. Posterior extension of the vertebral body tumor causes neural compromise [11,20]. These complications contribute to decreased quality of life and reduced survival. Esti-mates show that fourteen percent of patients with lung cancer have symptomatic, painful spinal metastases [11].
    The management of spinal metastases necessitates a variety of multidisciplinary interventions. Treatment options include medi-cal, minimally invasive, surgical, and radiation regimens. Determi-nation of intervention modality is a multifactorial process in consideration of neurologic deficits, systemic burden, and life expectancy, often with a cutoff of three months [11]. If greater than three months survival is predicted, surgery is considered and indi-cated in the presence of pain, mechanical instability, and neuro-logic deficit. Despite the poor prognosis of lung cancer spinal metastases, surgical intervention may provide some patients long-term benefit. Less invasive options include kyphoplasty, ver-tebroplasty, and radiotherapy. However, this decision may often