Decision Making in Patients With Metastatic Spine. The Role of Minimally Invasive Treatment Modalities

Alfredo Conti; Güliz Acker; Anne Kluge; Franziska Loebel; Anita Kreimeier; Volker Budach; Peter Vajkoczy; Ilaria Ghetti; Antonino F Germano'; Carolin Senger

doi:10.3389/fonc.2019.00915

Decision Making in Patients With Metastatic Spine. The Role of Minimally Invasive Treatment Modalities

Front Oncol. 2019 Sep 19:9:915. doi: 10.3389/fonc.2019.00915. eCollection 2019.

Authors

Alfredo Conti^{1

2}, Güliz Acker^{1

2

3}, Anne Kluge^{3

4}, Franziska Loebel^{1

2

3}, Anita Kreimeier^{3

4}, Volker Budach^{3

4}, Peter Vajkoczy^{1

2

3}, Ilaria Ghetti⁵, Antonino F Germano'⁵, Carolin Senger^{3

4}

Affiliations

¹ Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.
² Berlin Institute of Health, Berlin, Germany.
³ Charité CyberKnife Center, Charité Universitätsmedizin Berlin, Berlin, Germany.
⁴ Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.
⁵ Department of Neurosurgery, University of Messina, Messina, Italy.

Abstract

Spine metastases affect more than 70% of terminal cancer patients that eventually suffer from severe pain and neurological symptoms. Nevertheless, in the overwhelming majority of the cases, a spinal metastasis represents just one location of a diffuse systemic disease. Therefore, the best practice for treatment of spinal metastases depends on many different aspects of an oncological disease, including the assessment of neurological status, pain, location, and dissemination of the disease as well as the ability to predict the risk of disease progression with neurological worsening, benefits and risks associated to treatment and, eventually, expected survival. To address this need for a framework and algorithm that takes all aspects of care into consideration, we reviewed available evidence on the multidisciplinary management of spinal metastases. According to the latest evidence, the use of stereotactic radiosurgery (SRS) or stereotactic body radiotherapy (SBRT) for spinal metastatic disease is rapidly increasing. Indeed, aggressive surgical resection may provide the best results in terms of local control, but carries a significant rate of post-surgical morbidity whose incidence and severity appears to be correlated to the extent of resection. The multidisciplinary management represents, according to current evidence, the best option for the treatment of spinal metastases. Noteworthy, according to the recent literature evidence, cases that once required radical surgical resection followed by low-dose conventional radiotherapy, can now be more effectively treated by minimally invasive spinal surgery (MISS) followed by spine SRS with decreased morbidity, improved local control, and more durable pain control. This combination allows also extending this standard of care to patients that would be too sick for an aggressive surgical treatment.

Keywords: minimally invasive spine surgery; radiosurgery; separation surgery; spinal metastasis; stereotactic body radiotherapy.

Publication types

Review