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01-08-2007 | Original Article

Surgical treatment strategies and outcome in patients with breast cancer metastatic to the spine: a review of 87 patients

Authors: Joseph A. Shehadi, Daniel M. Sciubba, Ian Suk, Dima Suki, Marcos V. C. Maldaun, Ian E. McCutcheon, Remi Nader, Richard Theriault, Laurence D. Rhines, Ziya L. Gokaslan

Published in: European Spine Journal | Issue 8/2007

Abstract

Aggressive surgical management of spinal metastatic disease can provide improvement of neurological function and significant pain relief. However, there is limited literature analyzing such management as is pertains to individual histopathology of the primary tumor, which may be linked to overall prognosis for the patient. In this study, clinical outcomes were reviewed for patients undergoing spinal surgery for metastatic breast cancer. Respective review was done to identify all patients with breast cancer over an eight-year period at a major cancer center and then to select those with symptomatic spinal metastatic disease who underwent spinal surgery. Pre- and postoperative pain levels (visual analog scale [VAS]), analgesic medication usage, and modifed Frankel grade scores were compared on all patients who underwent surgery. Univariate and multivariate analyses were used to assess risks for complications. A total of 16,977 patients were diagnosed with breast cancer, and 479 patients (2.8%) were diagnosed with spinal metastases from breast cancer. Of these patients, 87 patients (18%) underwent 125 spinal surgeries. Of the 76 patients (87%) who were ambulatory preoperatively, the majority (98%) were still ambulatory. Of the 11 patients (13%) who were nonambulatory preoperatively, four patients were alive at 3 months postoperatively, three of which (75%) regained ambulation. The preoperative median VAS of six was significantly reduced to a median score of two at the time of discharge and at 3, 6, and 12 months postoperatively (P < 0.001 for all time points). A total of 39% of patients experienced complications; 87% were early (within 30 days of surgery), and 13% were late. Early major surgical complications were significantly greater when five or more levels were instrumented. In patients with spinal metastases specifically from breast cancer, aggressive surgical management provides significant pain relief and preservation or improvement of neurological function with an acceptably low rate of complications.

Akeyson EW, McCutcheon IE (1996) Single-stage posterior vertebrectomy and replacement combined with posterior instrumentation for spinal metastasis. J Neurosurg 85:211–220PubMed

Barcena A, Lobato RD, Rivas JJ, Cordobes F, de Castro S, Cabrera A, Lamas E (1984) Spinal metastatic disease: analysis of factors determining functional prognosis and the choice of treatment. Neurosurgery 15:820–827PubMedCrossRef

Bilsky MH, Lis E, Raizer J, Lee H, Boland P (1999) The diagnosis and treatment of metastatic spinal tumor. Oncologist 4:459–469PubMed

Chataigner H, Onimus M (2000) Surgery in spinal metastasis without spinal cord compression indications and strategy related to the risk of recurrence. Eur Spine J 9:523–527

Chen LH, Chen WJ, Niu CC, Shih CH (2000) Anterior reconstructive spinal surgery with Zielke instrumentation for metastatic malignancies of the spine. Arch Orthop Trauma Surg 120:27–31PubMed

Ciray I, Lindman H, Astrom KG, Bergh J, Ahlstrom KH (2001) Early response of breast cancer bone metastases to chemotherapy evaluated with MR imaging. Acta Radiol 42:198–206PubMedCrossRef

Coleman RE, Rubens RD (1987) The clinical course of bone metastases from breast cancer. Br J Cancer 55:61–66PubMed

Coraddu M, Nurchi GC, Floris F, Meleddu V (1991) Surgical treatment of extradural spinal cord compression due to metastatic tumours. Acta Neurochir (Wien) 111:18–21CrossRef

Degen JW, Gagnon GJ, Voyadzis JM, McRae DA, Lunsden M, Dieterich S, Molzahn I, Henderson FC (2005) CyberKnife stereotactic radiosurgical treatment of spinal tumors for pain control and quality of life. J Neurosurg Spine 2:540–549PubMed

10.

DeLoach LJ, Higgins MS, Caplan AB, Stiff JL (1998) The visual analog scale in the immediate postoperative period: intrasubject variability and correlation with a numeric scale. Anesth Analg 86:102–106PubMedCrossRef

11.

Enkaoua EA, Doursounian L, Chatellier G, Mabesoone F, Aimard T, Saillant G (1997) Vertebral metastases: a critical appreciation of the preoperative prognostic tokuhashi score in a series of 71 cases. Spine 22:2293–2298PubMedCrossRef

12.

Esteva FJ, Valero V, Pusztai L, Boehnke-Michaud L, Buzdar AU, Hortobagyi GN (2001) Chemotherapy of metastatic breast cancer: what to expect in 2001 and beyond. Oncologist 6:133–146PubMedCrossRef

13.

Fourney DR, Gokaslan ZL (2005) Use of “MAPs” for determining the optimal surgical approach to metastatic disease of the thoracolumbar spine: anterior, posterior, or combined. Invited submission from the joint section meeting on disorders of the spine and peripheral nerves, March 2004. J Neurosurg Spine 2:40–49PubMed

14.

Fourney DR, Schomer DF, Nader R, Chlan-Fourney J, Suki D, Ahrar K, Rhines LD, Gokaslan ZL (2003) Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients. J Neurosurg 98:21–30PubMed

15.

Frankel HL, Hancock DO, Hyslop G, Melzak J, Michaelis LS, Ungar GH, Vernon JD, Walsh JJ (1969) The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I. Paraplegia 7:179–192PubMed

16.

Galasko CS (1972) Skeletal metastases and mammary cancer. Ann R Coll Surg Engl 50:3–28PubMed

17.

Gerszten PC, Welch WC (2004) Cyberknife radiosurgery for metastatic spine tumors. Neurosurg Clin N Am 15:491–501PubMedCrossRef

18.

Ghogawala Z, Mansfield FL, Borges LF (2001) Spinal radiation before surgical decompression adversely affects outcomes of surgery for symptomatic metastatic spinal cord compression. Spine 26:818–824PubMedCrossRef

19.

Gokaslan ZL (1996) Spine surgery for cancer. Curr Opin Oncol 8:178–181PubMed

20.

Gokaslan ZL, York JE, Walsh GL, McCutcheon IE, Lang FF, Putnam JB Jr, Wildrick DM, Swisher SG, Abi-Said D, Sawaya R (1998) Transthoracic vertebrectomy for metastatic spinal tumors. J Neurosurg 89:599–609PubMedCrossRef

21.

Harrison KM, Muss HB, Ball MR, McWhorter M, Case D (1985) Spinal cord compression in breast cancer. Cancer 55:2839–2844PubMedCrossRef

22.

Hatrick NC, Lucas JD, Timothy AR, Smith MA (2000) The surgical treatment of metastatic disease of the spine. Radiother Oncol 56:335–339PubMedCrossRef

23.

Hortobagyi GN, Theriault RL, Porter L, Blayney D, Lipton A, Sinoff C, Wheeler H, Simeone JF, Seaman J, Knight RD (1996) Efficacy of pamidronate in reducing skeletal complications in patients with breast cancer and lytic bone metastases. Protocol 19 aredia breast cancer study group. N Engl J Med 335:1785–1791PubMedCrossRef

24.

Hosono N, Yonenobu K, Fuji T, Ebara S, Yamashita K, Ono K (1995) Vertebral body replacement with a ceramic prosthesis for metastatic spinal tumors. Spine 20:2454–2462PubMedCrossRef

25.

Jackson RJ, Gokaslan ZL (2000) Spinal-pelvic fixation in patients with lumbosacral neoplasms. J Neurosurg 92:61–70PubMed

26.

Jonsson B, Petren-Mallmin M, Jonsson H Jr, Andreasson I, Rauschning W (1995) Pathoanatomical and radiographic findings in spinal breast cancer metastases. J Spinal Disord 8:26–38PubMed

27.

Kaplan E, Meier P (1958) Non-parametric estimation from incomplete observations. J Am Stat Assoc 53:457–481CrossRef

28.

Klekamp J, Samii H (1998) Surgical results for spinal metastases. Acta Neurochir (Wien) 140:957–967CrossRef

29.

Landreneau FE, Landreneau RJ, Keenan RJ, Ferson PF (1995) Diagnosis and management of spinal metastases from breast cancer. J Neurooncol 23:121–134PubMedCrossRef

30.

Lipton A, Theriault RL, Hortobagyi GN, Simeone J, Knight RD, Mellars K, Reitsma DJ, Heffernan M, Seaman JJ (2000) Pamidronate prevents skeletal complications and is effective palliative treatment in women with breast carcinoma and osteolytic bone metastases: long term follow-up of two randomized, placebo-controlled trials. Cancer 88:1082–1090PubMedCrossRef

31.

LoRusso P (2001) Analysis of skeletal-related events in breast cancer and response to therapy. Semin Oncol 28:22–27PubMedCrossRef

32.

Maranzano E, Latini P (1995) Effectiveness of radiation therapy without surgery in metastatic spinal cord compression: final results from a prospective trial. Int J Radiat Oncol Biol Phys 32:959–967PubMedCrossRef

33.

McDonnell MF, Glassman SD, Dimar JR 2nd, Puno RM, Johnson JR (1996) Perioperative complications of anterior procedures on the spine. J Bone Joint Surg Am 78:839–847PubMed

34.

Mercadante S (1997) Malignant bone pain: pathophysiology and treatment. Pain 69:1–18PubMedCrossRef

35.

Miller DJ, Lang FF, Walsh GL, Abi-Said D, Wildrick DM, Gokaslan ZL (2000) Coaxial double-lumen methylmethacrylate reconstruction in the anterior cervical and upper thoracic spine after tumor resection. J Neurosurg 92:181–190PubMed

36.

Okuyama T, Korenaga D, Tamura S, Maekawa S, Kurose S, Ikeda T, Sugimachi K (1999) Quality of life following surgery for vertebral metastases from breast cancer. J Surg Oncol 70:60–63PubMedCrossRef

37.

Onimus M, Papin P, Gangloff S (1996) Results of surgical treatment of spinal thoracic and lumbar metastases. Eur Spine J 5:407–411PubMedCrossRef

38.

Pascal-Moussellard H, Broc G, Pointillart V, Simeon F, Vital JM, Senegas J (1998) Complications of vertebral metastasis surgery. Eur Spine J 7:438–444PubMedCrossRef

39.

Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, Mohiuddin M, Young B (2005) Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet 366:643–648PubMedCrossRef

40.

Prie L, Lagarde P, Palussiere J, el Ayoubi S, Dilhuydy JM, Durand M, Vital JM, Kantor G (1997) Radiotherapy of spinal metastases in breast cancer. Apropos of a series of 108 patients. Cancer Radiother 1:234–239PubMed

41.

Scheid V, Buzdar AU, Smith TL, Hortobagyi GN (1986) Clinical course of breast cancer patients with osseous metastasis treated with combination chemotherapy. Cancer 58:2589–2593PubMedCrossRef

42.

Scott J, Huskisson EC (1976) Graphic representation of pain. Pain 2:175–184PubMedCrossRef

43.

Sherry MM, Greco FA, Johnson DH, Hainsworth JD (1986) Breast cancer with skeletal metastases at initial diagnosis. Distinctive clinical characteristics and favorable prognosis. Cancer 58:178–182PubMedCrossRef

44.

Siegal T (1985) Surgical decompression of anterior and posterior malignant epidural tumors compressing the spinal cord: a prospective study. Neurosurgery 17:424–432PubMedCrossRef

45.

Sinardet D, Chabane A, Khalil T, Seigneuret E, Sankari F, Lemaire JJ, Chazal J, Irthum B (2000) [Neurological outcome of 152 surgical patients with spinal metastasis]. Neurochirurgie 46:4–10PubMed

46.

Sundaresan N, Digiacinto GV, Hughes JE, Cafferty M, Vallejo A (1991) Treatment of neoplastic spinal cord compression: results of a prospective study. Neurosurgery 29:645–650PubMedCrossRef

47.

Sundaresan N, Galicich JH, Lane JM, Bains MS, McCormack P (1985) Treatment of neoplastic epidural cord compression by vertebral body resection and stabilization. J Neurosurg 63:676–684PubMedCrossRef

48.

Tokuhashi Y, Matsuzaki H, Toriyama S, Kawano H, Ohsaka S (1990) Scoring system for the preoperative evaluation of metastatic spine tumor prognosis. Spine 15:1110–1113PubMedCrossRef

49.

Tomita K, Kawahara N, Kobayashi T, Yoshida A, Murakami H, Akamaru T (2001) Surgical strategy for spinal metastases. Spine 26:298–306PubMedCrossRef

50.

Weigel B, Maghsudi M, Neumann C, Kretschmer R, Muller FJ, Nerlich M (1999) Surgical management of symptomatic spinal metastases. Postoperative outcome and quality of life. Spine 24:2240–2246PubMedCrossRef

51.

Wise JJ, Fischgrund JS, Herkowitz HN, Montgomery D, Kurz LT (1999) Complication, survival rates, and risk factors of surgery for metastatic disease of the spine. Spine 24:1943–1951PubMedCrossRef

52.

York JE, Gokaslan ZL (1999) Instrumentation of the spine in metastatic disease. Spine State Art Rev 13:335–350

Title: Surgical treatment strategies and outcome in patients with breast cancer metastatic to the spine: a review of 87 patients
Authors: Joseph A. Shehadi
Daniel M. Sciubba
Ian Suk
Dima Suki
Marcos V. C. Maldaun
Ian E. McCutcheon
Remi Nader
Richard Theriault
Laurence D. Rhines
Ziya L. Gokaslan
Publication date: 01-08-2007
Publisher: Springer-Verlag
Published in: European Spine Journal / Issue 8/2007
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-007-0357-3

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Surgical treatment strategies and outcome in patients with breast cancer metastatic to the spine: a review of 87 patients

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