Clinical outcome and survival after palliative surgery for spinal metastases

Hirabayashi, Hiroki; Ebara, Sohei; Kinoshita, Tetsuya; Yuzawa, Yukio; Nakamura, Isao; Takahashi, J.; Kamimura, Mikio; Ohtsuka, Kuniyoshi; Takaoka, Kunio

doi:10.1002/cncr.11039

Cited by 162 publications

(128 citation statements)

References 27 publications

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“…These symptoms should also be detected in patients with known prostate or breast cancer as hint of spinal metastases for a proper treatment to minimize the consequences of paraplegia. During this acute treatment a tumor staging is done by intraoperative biopsy and histology, tumor marker detecting and staging-CT [15,24]. As part of an interdisciplinary case conference the treatment regimen of the tumor should be specified ahead of the paraplegia treatment.…”

Section: Resultsmentioning

confidence: 99%

“…In case of bad Tomita score, a survival time of 12 months or reduced general health condition, the resection of the tumor is recommended only with stabilization. Other less invasive procedures are the augmenting of vertebral bodies with bone cement, a mono-or bisegmental laminectomy/laminoplasty or hemilaminectomy in small or lateralized tumors [14,15].…”

Section: Introductionmentioning

confidence: 99%

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Therapy of Spine Metastasis Causing Paralysis Symptoms – Operation and Rehabilitation

Homagk¹,

Pataraia²

2014

Surgery

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Most common manifestation of tumor metastasis after lungs and liver is the skeletal system with 60-80% of spine metastasis. In 30% of all cancer patients with metastatic spinal complaints are initial presentation of malignant primary disease while the primary paraplegia occurs in 5-10% of all spinal metastases. Thus a further operational metastases treatment is dependent on the entire metastasis status, the type and Tomita score as well as the risk of surgery considering general patient status. From 01.01.11 to 31.12.12 we included 16 patients with tumors. In 27% of the cases the first symptoms were paraplegia, but the primary tumor was determined in only one of these cases. 73% of patients underwent surgical treatment within the first 24 hours after admission. The hospital stay was 22 days. 56.3% of patients had incomplete paralysis at admission and 71% of these patients had postoperative improvement in neurological outcomes. All patients benefited as part of operational and rehabilitative treatment of a significant reduction in pain and 50% of patients were able to be discharged home. At the onset of paralytic symptoms we recommend immediate operation. In a multidisciplinary case conference the oncological treatment regimens should be defined also for the necessary paralysis treatment. Decision guidance is the height of paralysis, tumorgenesis, ASA classification and the pain symptoms of the patient. The treatment must adjusted and individualized according to the patient's general health, life expectancy, the primary tumor, the grading of metastasis and extent of neurological deficit.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Therapy of Spine Metastasis Causing Paralysis Symptoms – Operation and Rehabilitation

Homagk¹,

Pataraia²

2014

Surgery

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“…Nos Estados Unidos a incidência anual de metásta-ses da coluna vertebral é de 180.000 novos casos 1,2 . O envolvimento da coluna vertebral por metástases é mais freqüente no segmento torácico, em 60% a 80% dos casos, seguido pelo segmento lombossacral, em 15% a 30% 1 .…”

Section: Dr Asdrubal Falavigna -General Arcy Da Rocha Nóbrega 401 / unclassified

“…O acometimento de mais de um segmento da coluna vertebral é observado em 50% dos casos 1 . A compressão nervosa é a principal complicação das metástases toracolombares, sendo evidenciada em cerca de 20% dos pacientes 2 . As metástases toracolombares são usualmente originadas do tumor primário de localização na mama, prósta-ta e pulmão 1,3,4 .…”

Section: Dr Asdrubal Falavigna -General Arcy Da Rocha Nóbrega 401 / unclassified

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Metástases do segmento torácico e lombar da coluna vertebral: estudo prospectivo comparativo entre o tratamento cirúrgico e radioterápico com a imobilização externa e radioterapia

Falavigna

Neto²,

Ioppi³

et al. 2007

Arq. Neuro-Psiquiatr.

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RESUMO -As metástases ósseas que acometem o segmento torácico e lombar da coluna vertrebal têm como principais complicações o fenômeno doloroso e a compressão medular ou radicular. O tratamento adotado dependerá das condições clínicas e neurológicas do paciente e do grau de invasão tumoral. Foram analisados, prospectivamente, 32 pacientes acometidos por metástases do segmento torácico e lombar da coluna vertebral, sendo tratados com cirurgia de descompressão e estabilização interna seguida por radioterapia ou irradiação com mobilização externa. A seleção dos grupos foi estabelecida de acordo com a sensibilidade do tumor a radioterapia, condições clínicas, grau de estabilidade da coluna, grau de compressão medular/radicular e opção do paciente. A escala de Frankel e o teste visual de dor foram aplicados no momento do diagnóstico e após 1 e 6 meses. O grupo cirúrgico apresentou melhores resultados, mantendo a deambulação por mais tempo, pois manteve a força muscular nos pacientes Frankel E, propiciou a reversão do déficit neurológico pré-operatório em 61,5% dos casos e propiciou melhora significativa da dor.PAlAvRAS-ChAvE: metástases, coluna vertebral, cirurgia, radioterapia.Metastatic tumor of thoracic and lumbar spine: prospective study comparing the surgery and radiotherapy vs external immobilization with radiotherapy ABSTRACT -Bone metastases at the thoracic and lumbar segment of the spine are usually presented with painful sensation and medullar compression. The treatment is based on the clinical and neurological conditions of the patient and the degree of tumor invasion. In the present study, 32 patients with spinal metastasis of thoracic and lumbar segment were prospectively analyzed. These patients were treated by decompression and internal stabilization followed by radiotherapy or irradiation with external immobilization. The election of the groups was in accordance with the tumor radiotherapy sensitivity, clinical conditions, spinal stability, medullar or nerve compression and patient's decision. The Frankel scale and pain visual test were applied at the moment of diagnosis and after 1 and 6 months. The surgical group had better results with preserving the ambulation longer and significant reduction of pain. A compressão nervosa é a principal complicação das metástases toracolombares, sendo evidenciada em cerca de 20% dos pacientes 2 . As metástases toracolombares são usualmente originadas do tumor primário de localização na mama, prósta-ta e pulmão 1,3,4 . Estas lesões ocasionam prejuízo na qualidade de vida do paciente pela dor conseqüen-

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When Should Neuroendovascular Care for Patients With Acute Stroke Be Palliative?

Young

Regenhardt

Sokol

et al. 2021

AMA Journal of Ethics

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Noncurative surgeries intended to relieve suffering during serious illness or near end of life have been analyzed across palliative settings. Yet sparse guidance is available to inform clinical management decisions about whether, when, and which interventions should be offered when ischemic stroke and other neurological complications occur in patients whose survival is extended by other novel disease-modifying interventions. This case commentary examines key ethical and clinical considerations in palliative neuroendovascular care of patients with acute stroke.The American Medical Association designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ available through the AMA Ed Hub TM . Physicians should claim only the credit commensurate with the extent of their participation in the activity. CaseMr J is a 64-year-old man with metastatic non-small cell lung cancer (NSCLC), who, while eating, abruptly developed right hemiplegia and aphasia. He had been diagnosed 10 months earlier with NSCLC; his estimated life expectancy was approximately 1 year. After a course of chemotherapy with pemetrexed and carboplatin, Mr J started pembrolizumab, an antiprogrammed death-1 immune checkpoint inhibitor offered possibly to extend his life but not as a cure for his cancer. 1,2 Since diagnosis, Mr J has suffered multiple hematologic complications, including thrombosis and hemorrhage. When brought to an emergency department, he was confirmed as full code and intubated on arrival due to poor mental status and aspiration risk. Computed tomography (CT) imaging of his head and neck revealed normal brain parenchyma and occlusion of the proximal left middle cerebral artery (MCA), which supplies blood to most of the brain's left hemisphere, including areas critical for language and right-side sensorimotor function. 3 The mechanism of Mr J's left MCA occlusion was presumed to be thromboembolism, to which he was predisposed by hypercoagulability of malignancy, pembrolizumab, 4,5,6 and intracardiac hemostasis, given his known low left ventricular ejection fraction.

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Clinical outcome and survival after palliative surgery for spinal metastases

Cited by 162 publications

References 27 publications

Therapy of Spine Metastasis Causing Paralysis Symptoms – Operation and Rehabilitation

Therapy of Spine Metastasis Causing Paralysis Symptoms – Operation and Rehabilitation

Metástases do segmento torácico e lombar da coluna vertebral: estudo prospectivo comparativo entre o tratamento cirúrgico e radioterápico com a imobilização externa e radioterapia

When Should Neuroendovascular Care for Patients With Acute Stroke Be Palliative?

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