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Diagnosis and management of spinal metastases from breast cancer

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Conclusions

Metastases to the spine is a common manifestation of breast cancer leading to considerable reduction in the patient's quality of life due to troublesome back pain and neurologic morbidity. It is not uncommon for spinal metastases to be an early and predominant manifestation of the patients systemic disease process. Although the breast cancer must be considered to be advanced, these patients will frequently have a reasonable functional status at the time of diagnosis of the spinal metastases. Accordingly, an aggressive approach of management should be considered in such patients so as to potentially achieve the most effective palliation. In the setting of breast cancer metastatic to the spine, radiation/systemic steroidal therapy remains the first line of management. The principle exception favoring primary surgical management is roentgenographic evidence of spinal instability related to the vertebral involvement by the metastatic process. The surgical team must also remain ready to intervene early with surgical decompression and spinal stabilization when any neurologic deterioration occurs during radiation therapy. When surgery is indicated, the anterior transthoracic approach to spinal metastases is an effective means of palliating these breast cancer patients.

A team approach involving the spinal surgeon, thoracic surgeon and anesthesiologist optimizes the care of the patient requiring thoracic spinal decompression of metastatic disease. Involvement of the thoracic surgeon in these patients care can result in expeditious thoracic exposure of the pathologic area of concern and valuable contribution to the post-operative care of these unfortunate patients.

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Landreneau, F.E., Landreneau, R.J., Keenan, R.J. et al. Diagnosis and management of spinal metastases from breast cancer. J Neuro-Oncol 23, 121–134 (1995). https://doi.org/10.1007/BF01053417

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