State of the Art Treatment of Spinal Metastatic Disease

被引:135
|
作者
Barzilai, Ori [1 ]
Fisher, Charles G. [2 ,3 ]
Bilsky, Mark H. [1 ,4 ]
机构
[1] Mem Sloan Kettering Canc Ctr, Dept Neurosurg, 1275 York Ave, New York, NY 10065 USA
[2] Univ British Columbia, Dept Orthoped, Div Spine, Vancouver, BC, Canada
[3] Vancouver Coastal Hlth, Combined Neurosurg & Orthoped Spine Program, Vancouver, BC, Canada
[4] Weill Cornell Med Coll, Dept Neurol Surg, New York, NY USA
关键词
Spine; Tumor; Surgery; Radiosurgery; NOMS; SRS; ESCC; BODY RADIATION-THERAPY; VERTEBRAL COMPRESSION FRACTURE; RENAL-CELL CARCINOMA; INTENSITY-MODULATED RADIOTHERAPY; INSTABILITY NEOPLASTIC SCORE; PEDICLE SCREW FIXATION; ONCOLOGY STUDY-GROUP; STEREOTACTIC RADIOSURGERY; CORD COMPRESSION; SINGLE-FRACTION;
D O I
10.1093/neuros/nyx567
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Treatment paradigms for patients with spine metastases have evolved significantly over the past decade. Incorporating stereotactic radiosurgery into these paradigms has been particularly transformative, offering precise delivery of tumoricidal radiation doses with sparing of adjacent tissues. Evidence supports the safety and efficacy of radiosurgery as it currently offers durable local tumor control with low complication rates even for tumors previously considered radioresistant to conventional radiation. The role for surgical intervention remains consistent, but a trend has been observed toward less aggressive, often minimally invasive, techniques. Using modern technologies and improved instrumentation, surgical outcomes continue to improve with reduced morbidity. Additionally, targeted agents such as biologics and checkpoint inhibitors have revolutionized cancer care, improving both local control and patient survivals. These advances have brought forth a need for new prognostication tools and a more critical review of long-term outcomes. The complex nature of current treatment schemes necessitates a multidisciplinary approach including surgeons, medical oncologists, radiation oncologists, interventionalists, and pain specialists. This review recapitulates the current state-of-the-art, evidence-based data on the treatment of spinal metastases, integrating these data into a decision framework, NOMS, which integrates the 4 sentinel decision points in metastatic spine tumors: Neurologic, Oncologic, Mechanical stability, and Systemic disease and medical co-morbidities.
引用
收藏
页码:757 / 769
页数:13
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