An integrated multidisciplinary algorithm for the management of spinal metastases: an International Spine Oncology Consortium report - 30/12/17

Doi : 10.1016/S1470-2045(17)30612-5

Daniel E Spratt, MD ^a,^⁎ , Whitney H Beeler, MD ^a, Fabio Y de Moraes, MD ^e,^f, Laurence D Rhines, ProfMD ^g, Joseph J Gemmete, ProfMD ^b, Neeraj Chaudhary, MD ^b, David B Shultz, PhD ^e, Sean R Smith, MD ^c, Alejandro Berlin, MD ^e, Max Dahele, PhD ^h, Ben J Slotman, ProfMD ^h, Kelly C Younge, PhD ^a, Mark Bilsky, ProfMD ⁱ, Paul Park, MD ^d, Nicholas J Szerlip, MD ^d

^a Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA

^b Department of Radiology, University of Michigan, Ann Arbor, MI, USA

^c Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA

^d Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA

^e Department of Radiation Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada

^f Department of Radiation Oncology, Hospital Sirio-Libanes, São Paulo, Brazil

^g Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

^h Department of Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands

ⁱ Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

^* Correspondence to: Dr Daniel E Spratt, University of Michigan, Department of Radiation Oncology, University Hospital, Ann Arbor, MI 48109, USA Correspondence to: Dr Daniel E Spratt, University of Michigan Department of Radiation Oncology University Hospital Ann Arbor MI 48109 USA

Summary

Spinal metastases are becoming increasingly common because patients with metastatic disease are living longer. The close proximity of the spinal cord to the vertebral column limits many conventional therapeutic options that can otherwise be used to treat cancer. In response to this problem, an innovative multidisciplinary approach has been developed for the management of spinal metastases, leveraging the capabilities of image-guided stereotactic radiosurgery, separation surgery, vertebroplasty, and minimally invasive local ablative approaches. In this Review, we discuss the variables that should be considered during the management of these patients and review the role of each discipline and their respective management options to provide optimal care. This work is synthesised into a practical algorithm to aid clinicians in the management of patients with spinal metastasis.

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Plan

Introduction

Data collection

Search strategy and selection criteria

Assessment of patient and systemic options

Performance status

Systemic burden of disease

Effective systemic treatment options

Mechanical stability, neurological risk, oncological parameters, and preferred treatment (MNOP) algorithm

Mechanical stability

Neurological risk

Oncological parameters

Preferred treatment

Spinal metastasis treatment

Radiotherapy

Surgery

Neurointerventional procedures

Cancer rehabilitation management

Conclusion

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Vol 18 - N° 12

P. e720-e730 - décembre 2017 Retour au numéro

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An integrated multidisciplinary algorithm for the management of spinal metastases: an International Spine Oncology Consortium report - 30/12/17

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