Advertisement

Metastatic Spine Disease: Critical Evaluation of the Current Literature

  • Adedayo O. Ashana
  • Andrew B. Kay
  • Justin Earl Bird
Chapter

Abstract

The treatment of metastatic disease to the spine has evolved substantially over time. Steroids and radiation therapy were initially seen as the primary treatment modalities, as surgery was viewed as ineffective. Surgical treatment became more common after the 2005 Patchell study, and several treatment algorithms were instituted based on its finding. However recent advances in nonsurgical modalities have made nonoperative care the treatment of choice for many patients with metastatic spine disease. In this chapter, critical review of the literature is performed, and available treatment options are summarized.

Keywords

Spine Metastases Literature review Steroids Radiotherapy Chemotherapy Stereotactic radiosurgery 

References

  1. 1.
    Aaron AD. The management of cancer metastatic to bone. JAMA. 1994;272(15):1206–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Jacobs WB, Perrin RG. Evaluation and treatment of spinal metastases: an overview. Neurosurg Focus. 2001;11(6):1–1.CrossRefGoogle Scholar
  3. 3.
    Posner JB. Spinal metastases. In:Neurologic complications of cancer. Philadelphia, PA: FA Davis Co.; 1995. p. 111–42.Google Scholar
  4. 4.
    Young RF, Post EM, King GA. Treatment of spinal epidural metastases: randomized prospective comparison of laminectomy and radiotherapy. J Neurosurg. 1980;53(6):741–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, Mohiuddin M, Young B. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet. 2005;366(9486):643–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Sørensen PS, Helweg-Larsen S, Mouridsen H, Hansen HH. Effect of high-dose dexamethasone in carcinomatous metastatic spinal cord compression treated with radiotherapy: a randomised trial. Eur J Cancer. 1994;30(1):22–7.CrossRefGoogle Scholar
  7. 7.
    George R, Jeba J, Ramkumar G, Chacko AG, Leng M, Tharyan P. Interventions for the treatment of metastatic extradural spinal cord compression in adults. Cochrane Database Syst Rev. 2015;9:CD006716.Google Scholar
  8. 8.
    Kumar A, Weber MH, Gokaslan Z, Wolinsky JP, Schmidt M, Rhines L, Fehlings MG, Laufer I, Sciubba DM, Clarke MJ, Sundaresan N. Metastatic spinal cord compression and steroid treatment: a systematic review. Clin Spine Surg. 2017;30(4):156–63.CrossRefPubMedGoogle Scholar
  9. 9.
    Heimdal K, Hirschberg H, Slettebø H, Watne K, Nome O. High incidence of serious side effects of high-dose dexamethasone treatment in patients with epidural spinal cord compression. J Neuro-Oncol. 1992;12(2):141–4.CrossRefGoogle Scholar
  10. 10.
    Weissman DE, Dufer D, Vogel V, Abeloff MD. Corticosteroid toxicity in neuro-oncology patients. J Neuro-Oncol. 1987;5(2):125–8.CrossRefGoogle Scholar
  11. 11.
    Maranzano E, Latini P. Effectiveness of radiation therapy without surgery in metastatic spinal cord compression: final results from a prospective trial. Int J Radiat Oncol Biol Phys. 1995;32(4):959–67.CrossRefPubMedGoogle Scholar
  12. 12.
    Aabo K, Walbon-Jørgensen S. Central nervous system complications by malignant lymphomas: radiation schedule and treatment results. Int J Radiat Oncol Biol Phys. 1986;12(2):197–202.CrossRefPubMedGoogle Scholar
  13. 13.
    Gilbert RW, Kim JH, Posner JB. Epidural spinal cord compression from metastatic tumor: diagnosis and treatment. Ann Neurol. 1978;3(1):40–51.CrossRefPubMedGoogle Scholar
  14. 14.
    Greenberg HS, Kim JH, Posner JB. Epidural spinal cord compression from metastatic tumor: results with a new treatment protocol. Ann Neurol. 1980;8(4):361–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Posner JB. Back pain and epidural spinal cord compression. Med Clin North Am. 1987;71(2):185.CrossRefPubMedGoogle Scholar
  16. 16.
    Siegal T, Siegal T. Current considerations in the management of neoplastic spinal cord compression. Spine. 1989;14(2):223–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Yamada Y, Bilsky MH, Lovelock DM, Venkatraman ES, Toner S, Johnson J, Zatcky J, Zelefsky MJ, Fuks Z. High-dose, single-fraction image-guided intensity-modulated radiotherapy for metastatic spinal lesions. Int J Radiat Oncol Biol Phys. 2008;71(2):484–90.CrossRefPubMedGoogle Scholar
  18. 18.
    Gerszten PC, Mendel E, Yamada Y. Radiotherapy and radiosurgery for metastatic spine disease: what are the options, indications, and outcomes? Spine. 2009;34(22S):S78–92.CrossRefPubMedGoogle Scholar
  19. 19.
    Gerszten PC, Burton SA, Ozhasoglu C, Welch WC. Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution. Spine. 2007;32(2):193–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Ryu S, Fang Yin F, Rock J, Zhu J, Chu A, Kagan E, Rogers L, Ajlouni M, Rosenblum M, Kim JH. Image-guided and intensity-modulated radiosurgery for patients with spinal metastasis. Cancer. 2003;97(8):2013–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Ryu S, Rock J, Rosenblum M, Kim JH. Patterns of failure after single-dose radiosurgery for spinal metastasis. J Neurosurg. 2004;101:402–5.CrossRefPubMedGoogle Scholar
  22. 22.
    Gerszten PC, Burton SA, Ozhasoglu C, Vogel WJ, Welch WC, Baar J, Friedland DF. Stereotactic radiosurgery for spinal metastases from renal cell carcinoma. J Neurosurg Spine. 2005;3(4):288–95.CrossRefPubMedGoogle Scholar
  23. 23.
    Moussazadeh N, Lis E, Katsoulakis E, Kahn S, Svoboda M, DiStefano NM, McLaughlin L, Bilsky MH, Yamada Y, Laufer I. Five-year outcomes of high-dose single-fraction spinal stereotactic radiosurgery. Int J Radiat Oncol Biol Phys. 2015;93(2):361–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Katsoulakis E, Laufer I, Bilsky M, Agaram NP, Lovelock M, Yamada Y. Pathological characteristics of spine metastases treated with high-dose single-fraction stereotactic radiosurgery. Neurosurg Focus. 2017;42(1):E7.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Huo M, Sahgal A, Pryor D, Redmond K, Lo S, Foote M. Stereotactic spine radiosurgery: review of safety and efficacy with respect to dose and fractionation. Surg Neurol Int. 2017;8:30.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Folkert MR, Bilsky MH, Tom AK, Oh JH, Alektiar KM, Laufer I, Tap WD, Yamada Y. Outcomes and toxicity for hypofractionated and single-fraction image-guided stereotactic radiosurgery for sarcomas metastasizing to the spine. Int J Radiat Oncol Biol Phys. 2014;88(5):1085–91.CrossRefPubMedGoogle Scholar
  27. 27.
    Ghia AJ, Chang EL, Bishop AJ, Pan HY, Boehling NS, Amini B, Allen PK, Li J, Rhines LD, Tannir NM, Tatsui CE. Single-fraction versus multifraction spinal stereotactic radiosurgery for spinal metastases from renal cell carcinoma: secondary analysis of phase I/II trials. J Neurosurg Spine. 2016;24(5):829–36.CrossRefPubMedGoogle Scholar
  28. 28.
    Lo SS, Sahgal A, Chang EL, Mayr NA, Teh BS, Huang Z, Schefter TE, Yao M, Machtay M, Slotman BJ, Timmerman RD. Serious complications associated with stereotactic ablative radiotherapy and strategies to mitigate the risk. Clin Oncol. 2013;25(6):378–87.CrossRefGoogle Scholar
  29. 29.
    Rose PS, Laufer I, Boland PJ, Hanover A, Bilsky MH, Yamada J, Lis E. Risk of fracture after single fraction image-guided intensity-modulated radiation therapy to spinal metastases. J Clin Oncol. 2009;27(30):5075–9.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Boehling NS, Grosshans DR, Allen PK, McAleer MF, Burton AW, Azeem S, Rhines LD, Chang EL. Vertebral compression fracture risk after stereotactic body radiotherapy for spinal metastases. J Neurosurg Spine. 2012;16(4):379–86.CrossRefPubMedGoogle Scholar
  31. 31.
    Sahgal A, Atenafu EG, Chao S, Al-Omair A, Boehling N, Balagamwala EH, Cunha M, Thibault I, Angelov L, Brown P, Suh J. Vertebral compression fracture after spine stereotactic body radiotherapy: a multi-institutional analysis with a focus on radiation dose and the spinal instability neoplastic score. J Clin Oncol. 2013;31(27):3426–31.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Guckenberger M, Mantel F, Gerszten PC, Flickinger JC, Sahgal A, Létourneau D, Grills IS, Jawad M, Fahim DK, Shin JH, Winey B. Safety and efficacy of stereotactic body radiotherapy as primary treatment for vertebral metastases: a multi-institutional analysis. Radiat Oncol. 2014;9(1):226.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Hall WA, Stapleford LJ, Hadjipanayis CG, Curran WJ, Crocker I, Shu HK. Stereotactic body radiosurgery for spinal metastatic disease: an evidence-based review. Int J Surg Oncol. 2011;2011:979214.PubMedCentralPubMedGoogle Scholar
  34. 34.
    Khan L, Chiang A, Zhang L, Thibault I, Bedard G, Wong E, Loblaw A, Soliman H, Fehlings MG, Chow E, Sahgal A. Prophylactic dexamethasone effectively reduces the incidence of pain flare following spine stereotactic body radiotherapy (SBRT): a prospective observational study. Support Care Cancer. 2015;23(10):2937–43.CrossRefPubMedGoogle Scholar
  35. 35.
    Gomez DR, Hunt MA, Jackson A, O’Meara WP, Bukanova EN, Zelefsky MJ, Yamada Y, Rosenzweig KE. Low rate of thoracic toxicity in palliative paraspinal single-fraction stereotactic body radiation therapy. Radiother Oncol. 2009;93(3):414–8.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Xue J, Kubicek G, Patel A, Goldsmith B, Asbell SO, LaCouture TA. Validity of current stereotactic body radiation therapy dose constraints for aorta and major vessels. Semin Radiat Oncol. 2016;26(2):135–9.CrossRefPubMedGoogle Scholar
  37. 37.
    Fourney DR, Frangou EM, Ryken TC, DiPaola CP, Shaffrey CI, Berven SH, Bilsky MH, Harrop JS, Fehlings MG, Boriani S, Chou D. Spinal instability neoplastic score: an analysis of reliability and validity from the spine oncology study group. J Clin Oncol. 2011;29(22):3072–7.CrossRefPubMedGoogle Scholar
  38. 38.
    Hentschel SJ, Rhines LD, Shah HN, Burton AW, Mendel E. Percutaneous vertebroplasty in vertebra plana secondary to metastasis. Clin Spine Surg. 2004;17(6):554–7.Google Scholar
  39. 39.
    Cassady JR, Sagerman RH, Chang CH. Radiation therapy for lymphoma of the spinal canal 1. Radiology. 1967;89(2):313–5.CrossRefGoogle Scholar
  40. 40.
    Friedman M, Kim TH, Panahon AM. Spinal cord compression in malignant lymphoma—treatment and results. Cancer. 1976;37(3):1485–91.CrossRefPubMedGoogle Scholar
  41. 41.
    Khan FR, Glicksman AS, Chu FC, Nickson JJ. Treatment by radiotherapy of spinal cord compression due to extradural metastases 1. Radiology. 1967;89(3):495–500.CrossRefPubMedGoogle Scholar
  42. 42.
    Martin WE, Heller P. Radiation therapy for paraplegia due to multiple myeloma. JAMA. 1965;191(3):247–9.CrossRefPubMedGoogle Scholar
  43. 43.
    Mones RJ, Dozier D, Berrett A. Analysis of medical treatment of malignant extradural spinal cord tumors. Cancer. 1966;19(12):1842–53.CrossRefPubMedGoogle Scholar
  44. 44.
    Murphy WT, Bilge N. Compression of the spinal cord in patients with malignant lymphoma 1. Radiology. 1964;82(3):495–501.CrossRefPubMedGoogle Scholar
  45. 45.
    Raichle ME, Posner JB. The treatment of extradural spinal cord compression. Neurology. 1970;20(4):391.CrossRefPubMedGoogle Scholar
  46. 46.
    Rubin P, Miller G. Extradural spinal cord compression by tumor: part I: experimental production and treatment trials 1. Radiology. 1969;93(6):1243–8.CrossRefPubMedGoogle Scholar
  47. 47.
    Rubin P, Mayer E, Poulter C. Part II: High daily dose experience without laminectomy 1. Radiology. 1969;93(6):1248–60.CrossRefPubMedGoogle Scholar
  48. 48.
    Chi JH, Gokaslan Z, McCormick P, Tibbs PA, Kryscio RJ, Patchell RA. Selecting treatment for patients with malignant epidural spinal cord compression—does age matter?: results from a randomized clinical trial. Spine. 2009;34(5):431–5.CrossRefPubMedGoogle Scholar
  49. 49.
    Laufer I, Rubin DG, Lis E, Cox BW, Stubblefield MD, Yamada Y, Bilsky MH. The NOMS framework: approach to the treatment of spinal metastatic tumors. Oncologist. 2013;18(6):744–51.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Bilsky MH, Laufer I, Fourney DR, Groff M, Schmidt MH, Varga PP, Vrionis FD, Yamada Y, Gerszten PC, Kuklo TR. Reliability analysis of the epidural spinal cord compression scale: clinical article. J Neurosurg Spine. 2010;13(3):324–8.CrossRefPubMedGoogle Scholar
  51. 51.
    Lim ZD, Mahajan A, Weinberg J, Tannir NM. Outcome of patients with renal cell carcinoma metastatic to the brain treated with sunitinib without local therapy. Am J Clin Oncol. 2013;36(3):258–60.CrossRefPubMedGoogle Scholar
  52. 52.
    Rousseau B, Kempf E, Desamericq G, Boissier E, Chaubet-Houdu M, Joly C, Saldana C, Boussion H, Neuzillet C, Macquin-Mavier I, Oudard S. First-line antiangiogenics for metastatic renal cell carcinoma: a systematic review and network meta-analysis. Crit Rev Oncol Hematol. 2016;107:44–53.CrossRefPubMedGoogle Scholar
  53. 53.
    Berenson J, Pflugmacher R, Jarzem P, Zonder J, Schechtman K, Tillman JB, Bastian L, Ashraf T, Vrionis F, Cancer Patient Fracture Evaluation (CAFE) Investigators. Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: a multicentre, randomised controlled trial. Lancet Oncol. 2011;12(3):225–35.CrossRefPubMedGoogle Scholar
  54. 54.
    Fourney DR, Schomer DF, Nader R, Chlan-Fourney J, Suki D, Ahrar K, Rhines LD, Gokaslan ZL. Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients. J Neurosurg Spine. 2003;98(1):21–30.CrossRefGoogle Scholar
  55. 55.
    Mendel E, Bourekas E, Gerszten P, Golan JD. Percutaneous techniques in the treatment of spine tumors: what are the diagnostic and therapeutic indications and outcomes? Spine. 2009;34(22S):S93–100.CrossRefPubMedGoogle Scholar
  56. 56.
    Rompe JD, Hopf CG, Eysel P. Outcome after palliative posterior surgery for metastatic disease of the spine–evaluation of 106 consecutive patients after decompression and stabilisation with the Cotrel-Dubousset instrumentation. Arch Orthop Trauma Surg. 1999;119(7–8):394–400.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Adedayo O. Ashana
    • 1
  • Andrew B. Kay
    • 2
  • Justin Earl Bird
    • 3
  1. 1.Department of Orthopedic Spine SurgeryOSS HealthYorkUSA
  2. 2.Department of Orthopaedic SurgeryHouston Methodist HospitalHoustonUSA
  3. 3.Department of Orthopaedic OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA

Personalised recommendations