TY - JOUR
T1 - Loss of Local Tumor Control After Index Surgery for Spinal Metastases
T2 - A Prospective Cohort Study
AU - Depreitere, Bart
AU - Ricciardi, Federico
AU - Arts, Mark
AU - Balabaud, Laurent
AU - Buchowski, Jacob Maciej
AU - Bunger, Cody
AU - Chung, Chun Kee
AU - Coppes, Maarten Hubert
AU - Fehlings, Michael George
AU - Kawahara, Norio
AU - Lee, Chong Suh
AU - Leung, Yee Ling
AU - Martin-Benlloch, Juan Antonio
AU - Massicotte, Eric Maurice
AU - Mazel, Christian
AU - Meyer, Bernhard
AU - Oner, Fetullah Cumhur
AU - Peul, Wilco
AU - Quraishi, Nasir
AU - Tokuhashi, Yasuaki
AU - Tomita, Katsuro
AU - Ulbricht, Christian
AU - Verlaan, Jorrit Jan
AU - Wang, Michael
AU - Crockard, Hugh Alan
AU - Choi, David
N1 - Funding Information:
Conflict of interest statement: This work was funded by the Global Spine Tumour Study Group, a registered charity of England and Wales, Charity Commission number 1134934, and DePuy Synthes (Johnson and Johnson). This study was performed in part at University College London Biomedical Research Centre, which receives funding from the National Institute for Health Research, United Kingdom. M. Arts: stock or other ownership: Nuvasive, Stryker, Galapagos, and Pharming; consulting or advisory role: Amedica, Zimmer Biomet, Silony, and EIT; research funding: Zimmer Biomet, Amedica, Intrinsics, and EIT; patent, royalties, other intellectual property: EIT. J. Buchowski: patent, royalties, other intellectual property interest: Globus Medical, K2M, and Wolters Kluwer Health; institutional fellowship support: AO Spine North America and OMeGA. M. Fehlings: consulting or advisory role: Pfizer, Zimmer Biomet, and InVivo Therapeutics. E. Massicotte: honoraria: AO Spine North America; travel, accommodations, expenses: AO Spine North America. C. Mazel: stock or other ownership: Amplitude; Honoraria: DePuy Spine, Medtronic, Zimmer; consulting or advisory role: Ethicon; Speakers' Bureau: DePuy Spine, Medtronic; patents, royalties or other intellectual property: CHD; travel, accommodations, expenses: DePuy, Medtronic, Zimmer, Clariance. N. Quraishi: honoraria: AO Spine, Medtronic, DePuy Synthes; speakers' bureau: AO Spine, Medtronic, DePuy Synthes; travel, accommodations, expenses: AO Spine, Medtronic, DePuy Synthes; J. J. Verlaan: consulting or advisory role: DePuy Synthes (inst); educational grant: DePuy Synthes (inst). M. Wang: stock or other ownership: Innovative Surgical Devices, Spinicity; consulting or advisory role: DePuy Spine, AesculapSpine, Jointax, K2M; research funding: Department of Defence; patents, royalties, other intellectual properties: Children's Hospital of LA, DePuy Spine, Springer Publishing, Quality Medical Publishing. D. Choi: research funding: DePuy Synthes (Inst).
Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2018/9
Y1 - 2018/9
N2 - Background: As survival after treatment for symptomatic spinal metastases increases, the incidence of local tumor recurrence also may increase. However, data regarding incidence and timing of recurrence or duration of survival after second surgeries are not readily available and may help to inform clinicians when to perform second surgeries. Objective: To identify features associated with loss of local control (LLC) at a previously treated or new spinal level. Methods: Clinical and surgical data were collected from a prospective cohort of 1421 patients who had surgery for symptomatic spinal metastases. Patients undergoing repeat spinal surgery for symptomatic LLC at the same or a different level were identified and analyzed. Results: In total, 3.0% patients underwent repeat surgery for symptomatic LLC after a median interval of 184 days from the first surgery; median survival was 6.1 months after second surgery. Factors associated with second surgery for LLC were the primary tumor type, number of spinal levels, Tomita staging, Tokuhashi and Karnofsky scores, anterior surgical approach, more aggressive surgical resection, and postoperative radiotherapy. In total, 1.5% patients were admitted for surgery for a different spinal level than the index operation after median 338 days from the first operation. Conclusions: The likelihood for repeat surgery due to LLC cannot be accurately predicted at the time of initial presentation. Factors associated with second surgery for LLC relate to less aggressive tumor biology and better survival. Most patients had a reasonable duration of survival after second surgery.
AB - Background: As survival after treatment for symptomatic spinal metastases increases, the incidence of local tumor recurrence also may increase. However, data regarding incidence and timing of recurrence or duration of survival after second surgeries are not readily available and may help to inform clinicians when to perform second surgeries. Objective: To identify features associated with loss of local control (LLC) at a previously treated or new spinal level. Methods: Clinical and surgical data were collected from a prospective cohort of 1421 patients who had surgery for symptomatic spinal metastases. Patients undergoing repeat spinal surgery for symptomatic LLC at the same or a different level were identified and analyzed. Results: In total, 3.0% patients underwent repeat surgery for symptomatic LLC after a median interval of 184 days from the first surgery; median survival was 6.1 months after second surgery. Factors associated with second surgery for LLC were the primary tumor type, number of spinal levels, Tomita staging, Tokuhashi and Karnofsky scores, anterior surgical approach, more aggressive surgical resection, and postoperative radiotherapy. In total, 1.5% patients were admitted for surgery for a different spinal level than the index operation after median 338 days from the first operation. Conclusions: The likelihood for repeat surgery due to LLC cannot be accurately predicted at the time of initial presentation. Factors associated with second surgery for LLC relate to less aggressive tumor biology and better survival. Most patients had a reasonable duration of survival after second surgery.
KW - Metastases
KW - Recurrence
KW - Repeat surgery
KW - Spine
KW - Surgery
KW - Tumor
UR - http://www.scopus.com/inward/record.url?scp=85049642456&partnerID=8YFLogxK
U2 - 10.1016/j.wneu.2018.04.170
DO - 10.1016/j.wneu.2018.04.170
M3 - Article
C2 - 29729472
AN - SCOPUS:85049642456
SN - 1878-8750
VL - 117
SP - e8-e16
JO - World Neurosurgery
JF - World Neurosurgery
ER -