Skip to main content
SpringerLink
Log in

Interdisciplinary clinical evaluation of 58 patients with lumbar-vertebral metastases from cervico-uterine cancer

  • Original Articles
  • Published:
Clinical and Translational Oncology Aims and scope Submit manuscript

Abstract

Introduction

Metastases in the vertebrae of patients with cervical cancer (CeCa) can be difficult to diagnose, and the treatment is palliative in many cases.

Objectives

The aim of this study was to assess the time required for diagnosis, the lesion’s loco-regional extent and the therapeutic schemes applied, in a retrospective series of 58 patients with CeCa and with lumbar spinal metastases.

Methods

The cases were studied using an updated interdisciplinary analysis to determine the clinical and radiological variables. This study evaluated the site and extent of bone lesions and correlated these variables with instability of the spine and cord compression.

Results

The diagnosis of vertebrae metastases of CeCa required more than 3 months in most cases. Lumbar vertebrae L4 and L5 and specifically the vertebral body were the most-frequently affected sites. Systemic and/or extra-compartmental-extended metastases (MosV4) were observed in 44/58 patients. Radiotherapy was the only option in this group and the palliative effect achieved was minimal, or null. In 14/58 patients there was intra compartmental-extended (MosV2) and extra-compartmental limited (MosV3) single vertebral metastases and the 3 different treatment schemes were administered. In the cases treated with marginal resection of metastases, vertebroplasty plus adjuvant radiotherapy achieved significant palliative effect.

Conclusions

In the present series of patients, the diagnosis of metastases of the lumbar vertebrae was late, and the disease was advanced. The results obtained with radiotherapy in advanced stage disease did not improve the quality of life of patients. Metastasectomy was the therapeutic scheme in cases with intermediate stage disease and was the basis of the integrated treatment. We believe that it is necessary to shorten the diagnostic time and to apply a staging system for vertebral metastases so that appropriate individualised selection of interdisciplinary treatment would be facilitated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Parkin DM, Bray FI, Devesa SS. Cancer burden in the year 2000. The global picture. Eur J Cancer: 2001;S4–66.

  2. Bosch FX, de Sanjose S. Human papillomavirus and cervical cancer-burden and assessment of causality. J Natl Cancer Inst Monogr. 2003;31:3–13.

    PubMed  Google Scholar 

  3. Blythe JG, Ptacek JJ, Buchbaum HJ, Latourette HB. Bony metastases from carcinoma of cervix: occurrence, diagnosis, and treatment. Cancer: 1975;36:475–84.

    Article  PubMed  CAS  Google Scholar 

  4. Barmeir E, Langer O, Levy JI, Nissenbaum M, DeMoor NG, Blumenthal NJ. Unusual skeletal metastases in carcinoma of the cervix. Gynecol Oncol. 1985;20:307–16.

    Article  PubMed  CAS  Google Scholar 

  5. Fagundes H, Perez CA, Grigsby PW, Lockett MA. Distant metastases after irradiation alone in carcinoma of the uterine cervix. Int J Radiat Oncol Biol Phys. 1992;191: 197–204.

    Google Scholar 

  6. Matsuyama T, Tsukamoto N, Imachi M, Nakano H. Bone metastasis from cervix cancer. Gynecol Oncol. 1989; 32:72–5.

    Article  PubMed  CAS  Google Scholar 

  7. Ratanatharathorn V, Powers WE, Steverson N, Han I, Ahmad K, Grimm J. Bone metastasis from cervical cancer. Cancer: 1994;73(9):2372–9.

    Article  PubMed  CAS  Google Scholar 

  8. Kim RY, Weppelmann B, Salter MM, Brascho DJ. Skeletal metastases from cancer of the uterine cervix: frequency, patterns, and radiotherapeutic significance. Int J Radiat Oncol Bio Phys. 1987;13:705–8.

    CAS  Google Scholar 

  9. Yu GZ, Yao ZH, Sun JH. Bone metastases from cancer of the cervix. Zhonghua Zhong Liu Za Zhi. 1994;16:231–3.

    PubMed  CAS  Google Scholar 

  10. Husband DJ. Malignant spinal cord compression: prospective study of delays in referral and treatment. BMJ. 1998;317:18–21.

    PubMed  CAS  Google Scholar 

  11. Janjan NA. Radiation for bone metastases: conventional techniques and the role of systemic radiopharmaceuticals. Cancer. 1997;80 8 Suppl:1628–45.

    Article  PubMed  CAS  Google Scholar 

  12. Gokaslan ZL, York JE, Walsch GL, et al. Transthoracic vertebrectomy for metastatic spinal tumors. J Neurosurg. 1998;89:599–609.

    Article  PubMed  CAS  Google Scholar 

  13. Healey JH. Complications of bone metastases. Surgical management. Cancer. 2000;88 12 Suppl:2940–51.

    Article  PubMed  CAS  Google Scholar 

  14. Fuller BG, Heiss J, Oldfield EH. Spinal cord compression. In: DeVita VT, Hellman S, Rosenberg SA, editors. Cancer. Principles and practice of Oncology. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 2617–33.

    Google Scholar 

  15. Valdespino GM, González AG, Ventura HJ, Castro CJ, Ortega EI. Algoritmo de estudio y tratamiento de pacientes con metástasis en columna vertebral. Rev Med IMSS. 1993;31(3):241–6.

    Google Scholar 

  16. Tomita K, Toribatake Y, Kawahara N, Ohnari H, Kose H. Total en bloc spondylectomy. A new surgical technique for primary malignant verebral tumors. Spine. 1997; 22(3):324–33.

    Article  PubMed  CAS  Google Scholar 

  17. Denis F. Spinal instability as defined by the three-column spine concept in acute spinal trauma. Clin Orthop. 1984;189:65–76.

    PubMed  Google Scholar 

  18. Tokuhashi Y, Matzuzaki H, Toriyama S. Scoring system for the preoperative evaluation of metastatic spine tumor prognosis. Spine. 1990;15:1110–3.

    Article  PubMed  CAS  Google Scholar 

  19. Valdespino VM, González AG, Ventura HJ, Valdespino CV. Resección marginal, más radioterapia adyuvante en pacientes con metástasis localizadas intracompartimiento (Mos 3) Estudio prospectivo. Cir Ciruj. 1998;66:58–65.

    Google Scholar 

  20. Sundaresan N, Rothman A, Manhart K, Kelliher K. Surgery for solitary metastases of the spine: rationale and results of treatment. Spine. 2002;15:1802–6.

    Article  Google Scholar 

  21. Tomita K, Kawahara N, Kobayashi T, Yoshida A, Murakami H, Akamaru T. Surgical strategy for spinal metastases. Spine. 2002;26,3:298–306.

    Article  Google Scholar 

  22. Hosono N, Yonenobu K, Fuji T, Ebara S, Yamashita K, Ono K. Vertebral body replacement with a ceramic protesis for metastatic spinal tumors. Spine. 1995;20:2254–62.

    Google Scholar 

  23. Sundaresan N, Steinberger AA, Moore F, et al. Indications and results of combined anterior-posterior approaches for spinal tumor surgery. J Neurosurg. 1996;85:438–46.

    Google Scholar 

  24. Dominkus M, Kepler P, Schwameis E, Kotz R. Surgical therapy of spinal metastases. Orthopade. 1998;27:282–6.

    PubMed  CAS  Google Scholar 

  25. Weigel B, Maghsudi M, Neuman C, Kretschmer R, Muller FJ, Nerlich M. Surgical management of symptomatic spinal metastases. Postoperative outcome and quality of life. Spine. 1999;24:2240–6.

    Article  PubMed  CAS  Google Scholar 

  26. Roodman D. Role of stromal-derived cytokines and growth factors in bone metatases. Cancer: 2003;97 3 Suppl:733–8.

    Article  Google Scholar 

  27. Mundy GR. Metastasis to bone: Causes, consequences and therapeutic opportunities. Nat Rev Cancer. 2002; 2:584–93.

    Article  PubMed  CAS  Google Scholar 

  28. Roodman DG. Mechanisms of bone metastasis. N Engl J Med. 2004;350(1):1655–64.

    Article  PubMed  CAS  Google Scholar 

  29. Detry C, Waltregny D, Quatresooz P, et al. Detection of bone sialoprotein in human (pre)neoplastic lesions of the uterine cervix. Calcif Tissue Int. 2003;73(1):9–14.

    Article  PubMed  CAS  Google Scholar 

  30. Janni W, Hepp F, Strobl B, et al. Patterns of disease recurrence influenced by hematogenous tumor cell dissemination in patients with cervical carcinoma of the uterus. Cancer. 2003;97:405–11.

    Article  PubMed  Google Scholar 

  31. Cormio G, Colomaria A, Di Vagno G, De Tommasi A, Loverro G, Selvaggi L. Surgical decompression and radiation therapy in epidural metastases from cervical cancer. Eur J Obstet Gynecol Reprod Biol. 2000;89:59–61.

    Article  PubMed  CAS  Google Scholar 

  32. de la Torre GDM, Aboharp HZ, Maza CR, Pérez MJA. Tratamiento quirúrgico de metástasis vertebral. Experiencia en el Hospital Juárez de México. Cir Ciruj. 2002; 70:26–30.

    Google Scholar 

  33. Ratliff JK, Cooper PR. Metastatic spine tumors. South Med J. 2004;97(3):246–53.

    Article  PubMed  Google Scholar 

  34. Maranzano E, Trippa F, Chirico L, Basagni ML, Rossi R. Management of metastatic spinal cord compression. Tumori. 2003;89(5):469–75.

    PubMed  Google Scholar 

  35. Vrionis FD, Small J. Surgical management of metastatic spinal neoplasms. Neurosurg Focus. 2003;15,5:E12.

    Google Scholar 

  36. Wenger M. Vertebroplasty for metastasis. Med Oncol. 2003;20(3):203–9.

    Article  PubMed  Google Scholar 

  37. Sakaura H, Hosono N, Mukai Y, Ishii T, Yonenobu K, Yoshikawa H. Outcome of total en bloc spondylectomy for solitary metastasis the thoracolumbar spine. J Spinal Disor Tech. 2004;17,4:297–300.

    Article  Google Scholar 

  38. Klimo P, Schmidt MH. Surgical management of spinal metastases. The Oncologist. 2004;9:188–96.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. División de Cirugía del Hospital de Oncología del Centro Médico Siglo XXI del IMSS, México

    Víctor Valdespino Gómez

  2. División de Ciencias Biológicas y de la Salud de la Universidad Autónoma Metropolitana, México

    Víctor Valdespino Gómez

  3. División de Radioterapia del Hospital de Oncología del Centro Médico Siglo XXI del IMSS, México

    Juan M. Salgado Cazares

  4. Ex Presidente del Capítulo Centro de la Asociación Mexicana de Cirujanos de Columna A.C., Ex-Jefe del Servicio de Columna del Hospital de Ortopedia Victorio de la Fuente del IMSS, México

    Gaspar González Astudillo

  5. Servicio de Oncología, Centro Médico Nacional 20 de Noviembre del ISSSTE, México

    Víctor E. Valdespino Castillo

Authors
  1. Víctor Valdespino Gómez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Juan M. Salgado Cazares
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gaspar González Astudillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Víctor E. Valdespino Castillo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Víctor Valdespino Gómez.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gómez, V.V., Salgado Cazares, J.M., Astudillo, G.G. et al. Interdisciplinary clinical evaluation of 58 patients with lumbar-vertebral metastases from cervico-uterine cancer. Clin Transl Oncol 7, 432–440 (2005). https://doi.org/10.1007/BF02716593

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02716593

Key words

Search

Navigation