Outcome analysis of surgery for symptomatic spinal metastases in long-term cancer survivors

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OBJECTIVE

As patients with metastatic cancer live longer, an increased emphasis is placed on long-term therapeutic outcomes. The current study evaluates outcomes of long-term cancer survivors following surgery for spinal metastases.

METHODS

The study population included patients surgically treated at a tertiary cancer center between January 2010 and December 2015 who survived at least 24 months postoperatively. A retrospective chart and imaging review was performed to collect data regarding patient demographics; tumor histology; type and extent of spinal intervention; radiation data, including treatment dose and field; long-term sequelae, including local tumor control; and reoperations, repeat irradiation, or postoperative kyphoplasty at a previously treated level.

RESULTS

Eighty-eight patients were identified, of whom 44 were male, with a mean age of 61 years. The mean clinical follow-up for the cohort was 44.6 months (range 24.2–88.3 months). Open posterolateral decompression and stabilization was performed in 67 patients and percutaneous minimally invasive surgery in 21. In the total cohort, 84% received postoperative adjuvant radiation and 27% were operated on for progression following radiation. Posttreatment local tumor progression was identified in 10 patients (11%) at the index treatment level and 5 additional patients had a marginal failure; all of these patients were treated with repeat irradiation with 5 patients requiring a reoperation. In total, at least 1 additional surgical intervention was performed at the index level in 20 (23%) of the 88 patients: 11 for hardware failure, 5 for progression of disease, 3 for wound complications, and 1 for postoperative hematoma. Most reoperations (85%) were delayed at more than 3 months from the index surgery. Wound infections or dehiscence requiring additional surgical intervention occurred in 3 patients, all of which occurred more than a year postoperatively. Kyphoplasty at a previously operated level was performed in 3 cases due to progressive fractures.

CONCLUSIONS

Durable tumor control can be achieved in long-term cancer survivors surgically treated for symptomatic spinal metastases with limited complications. Complications observed after long-term follow-up include local tumor recurrence/progression, marginal tumor control failures, early or late hardware complications, late wound complications, and progressive spinal instability or deformity.

ABBREVIATIONS EBRT = external beam radiation therapy; KPS = Karnofsky Performance Scale; MIS = minimally invasive surgery; NOMS = neurological, oncological, mechanical instability, and systemic status and comorbidities; SBRT = stereotactic body radiation therapy.

Article Information

Correspondence Ilya Laufer: Memorial Sloan Kettering Cancer Center, New York, NY. lauferi@mskcc.org.

INCLUDE WHEN CITING Published online April 26, 2019; DOI: 10.3171/2019.2.SPINE181306.

Disclosures Dr. Lis reports being a consultant for Medtronic. Dr. Yamada reports being a consultant to Vision RT and Varian Medical Systems, and being a speaker for the Chordoma Foundation and the Institute for Medical Education. Dr. Laufer reports being a consultant to Globus, SpineWave, DePuy/Synthes, Medtronic, and Brainlab.

© AANS, except where prohibited by US copyright law.

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