Factors affecting survival in 43 consecutive patients after surgery for spinal metastases from thyroid carcinoma

Sellin, Jonathan N.; Suki, Dima; Harsh, Viraat; Elder, Benjamin D.; Fahim, Daniel K.; McCutcheon, Ian E.; Rao, Ganesh; Rhines, Laurence D.; Tatsui, Claúdio E.

doi:10.3171/2015.1.spine14431

Cited by 43 publications

(27 citation statements)

References 36 publications

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“…1, 5,11,16, 27, 30 The practice has become the standard of care at many institutions for patients with oligometastatic disease, and consensus contouring guidelines have been published. 6 Emerging data suggest comparable efficacy in the postoperative setting, 2,3,12,19,22,24,27,33,34 and the practice has been increasingly used in both academic and private practice settings. Nonetheless, few guidelines exist to promote safe and effective application of this emerging technology.…”

Section: Discussionmentioning

confidence: 99%

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Consensus guidelines for postoperative stereotactic body radiation therapy for spinal metastases: results of an international survey

Redmond¹,

Soltys

et al. 2017

SPI

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OBJECTIVE Although postoperative stereotactic body radiation therapy (SBRT) for spinal metastases is increasingly performed, few guidelines exist for this application. The purpose of this study is to develop consensus guidelines to promote safe and effective treatment for patients with spinal metastases. METHODS Fifteen radiation oncologists and 5 neurosurgeons, representing 19 centers in 4 countries and having a collective experience of more than 1300 postoperative spine SBRT cases, completed a 19-question survey about postoperative spine SBRT practice. Responses were defined as follows: 1) consensus: selected by ≥ 75% of respondents; 2) predominant: selected by 50% of respondents or more; and 3) controversial: no single response selected by a majority of respondents. RESULTS Consensus treatment indications included: radioresistant primary, 1–2 levels of adjacent disease, and previous radiation therapy. Contraindications included: involvement of more than 3 contiguous vertebral bodies, ASIA Grade A status (complete spinal cord injury without preservation of motor or sensory function), and postoperative Bilsky Grade 3 residual (cord compression without any CSF around the cord). For treatment planning, co-registration of the preoperative MRI and postoperative T1-weighted MRI (with or without gadolinium) and delineation of the cord on the T2-weighted MRI (and/or CT myelogram in cases of significant hardware artifact) were predominant. Consensus GTV (gross tumor volume) was the postoperative residual tumor based on MRI. Predominant CTV (clinical tumor volume) practice was to include the postoperative bed defined as the entire extent of preoperative tumor, the relevant anatomical compartment and any residual disease. Consensus was achieved with respect to not including the surgical hardware and incision in the CTV. PTV (planning tumor volume) expansion was controversial, ranging from 0 to 2 mm. The spinal cord avoidance structure was predominantly the true cord. Circumferential treatment of the epidural space and margin for paraspinal extension was controversial. Prescription doses and spinal cord tolerances based on clinical scenario, neurological compromise, and prior overlapping treatments were controversial, but reasonable ranges are presented. Fifty percent of those surveyed practiced an integrated boost to areas of residual tumor and density override for hardware within the beam path. Acceptable PTV coverage was controversial, but consensus was achieved with respect to compromising coverage to meet cord constraint and fractionation to improve coverage while meeting cord constraint. CONCLUSIONS The consensus by spinal radiosurgery experts suggests that postoperative SBRT is indicated for radioresistant primary lesions, disease confined to 1–2 vertebral levels, and/or prior overlapping radiotherapy. The GTV is the postoperative residual tumor, and the CTV is the postoperative bed defined as the entire extent of preoperative tumor and anatomical compartment plus residual disease. Hardware and scar do not need to be included in CTV. While predominant agreement was reached about treatment planning and definition of organs at risk, future investigation will be critical in better understanding areas of controversy, including whether circumferential treatment of the epidural space is necessary, management of paraspinal extension, and the optimal dose fractionation schedules.

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Section: Discussionmentioning

confidence: 99%

“…2,3,12,19,22,24,27,33,34 In contrast to the situation with spine SBRT for intact vertebral me-tastases, however, there are presently few recommendations to guide the use of SBRT for spinal metastases after spinal surgery. The approach is technically challenging, and there are numerous considerations unique to the postoperative spine patient.…”

mentioning

confidence: 99%

Consensus guidelines for postoperative stereotactic body radiation therapy for spinal metastases: results of an international survey

Redmond¹,

Soltys

et al. 2017

SPI

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“…Although patients in this group were treated for a neurological deficiency with a poor prognosis, 5 patients (5.6%) responded well to the surgical removal of the bone metastatic tissue followed by 131 I treatment. In recent studies, preoperative neurological deficit was significantly associated with worse overall survival and preoperative embolization was significantly associated with improved overall survival [21,22]. The disease-specific survival of patients with papillary and follicular thyroid carcinoma is fairly good, although inadequate treatment of bone metastasis can result in severe morbidities.…”

Section: Discussionmentioning

confidence: 99%

Long-term follow-up of papillary and follicular thyroid carcinomas with bone metastasis

Lin

Chen

et al. 2017

PLoS ONE

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The aims of this study were to investigate papillary and follicular thyroid carcinomas with bone metastasis in various clinical presentations and to determine the prognostic factors after multimodality treatment. A retrospective analysis was performed of 3,120 patients with papillary and follicular thyroid carcinoma. Of these patients, 131 (including 97 women, 71.8%) were diagnosed with bone metastasis and underwent follow-up at the Chang Gung Medical Center. Patients with bone metastasis were categorized into two groups. Group A was comprised of patients who were diagnosed with bone metastasis either before thyroidectomy or within 6 months of the initial thyroidectomy (90 patients, 68.7%). Group B was comprised of patients with bone metastasis who received a diagnosis 6 months post-thyroidectomy in the follow-up period (41 patients, 31.3%). After a mean follow-up period of 8.4 ± 7.0 years, there were 88 deaths (67.2%) attributed to thyroid cancer and 13 patients (9.9%) achieved disease-free status. A multivariate analysis showed that older age, early diagnosis, and brain metastasis were each associated with a poor prognosis. The difference in disease-specific mortality rates between groups A and B was significant (p < 0.0001). In conclusion, papillary and follicular thyroid cancers with bone metastasis have a high rate of mortality. Despite this high mortality, 9.9% patients still had an excellent response to treatment.

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“…A further 163 studies were excluded due to the absence of HR, 95% CI, or survival curves. 1/163 study did not present an effect size for HR in multivariate analysis although it significantly originated from visceral metastasis as assessed by univariate analysis and was included in multivariate Cox proportional hazard model. Six studies with the selection of repeated patients were excluded.…”

Section: Resultsmentioning

confidence: 99%

Visceral Metastasis: A Prognostic Factor of Survival in Patients with Spinal Metastases

Lun

Chen

Feng

et al. 2020

Orthopaedic Surgery

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Objective: To characterize the visceral metastasis as a predictive tool for the survival of patients with spinal metastases through an exploratory meta-analysis.Methods: Two investigators independently searched PubMed and Embase databases for eligible studies from 2000-2016. The effect estimates for the hazard ratio (HR) or risk ratio (RR) and 95% confidence interval (CI) were collected and pooled with a random-or fixed-effect model.Results: In total, 18 eligible studies were retrieved with 5468 participants from nine countries. The overall pooled effect size for HR and RR was 1.50 and 3.79, respectively, which was proved to be statistically significant. In the subgroup of prostate cancer (PCa) and non-small cell lung cancer (NSCLC), statistical significance and marginal statistical significance was presented for the pooled HR (HR = 1.76, 95% CI 1.35-2.29) and (RR = 1.56, 95% CI 0.99-2.48), respectively. However, in the subgroup of thyroid cancer, breast cancer, and renal cancer, statistical significance was not achieved (HR = 1.17, 95% CI 0.75-1.83, Z = 0.70, P = 0.486). The results did not show any evidence of publication bias. Conclusions:This study demonstrated that visceral metastasis was a significant prognostic factor in patients with spinal metastases as a whole. Interestingly, the onset of visceral metastases differentially impacted the survival in different primary tumors. Therefore, the prognostic value of visceral metastasis might be related to the type of primary tumor.

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Factors affecting survival in 43 consecutive patients after surgery for spinal metastases from thyroid carcinoma

Cited by 43 publications

References 36 publications

Consensus guidelines for postoperative stereotactic body radiation therapy for spinal metastases: results of an international survey

Consensus guidelines for postoperative stereotactic body radiation therapy for spinal metastases: results of an international survey

Long-term follow-up of papillary and follicular thyroid carcinomas with bone metastasis

Visceral Metastasis: A Prognostic Factor of Survival in Patients with Spinal Metastases

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