X-ref For other Roundups in this issue that cross-reference with Oncology see: Research Roundup 1.
Survival in metastatic spinal disease
Metastatic spinal disease is one of the most common presentations of metastatic bone disease. Associated with carcinomas, adenomas and myelomas, this is a common site for metastatic spread. The typical patient presents to oncological and spinal services rather than to surgical oncologists, and there is a definite debate about who should undergo which intervention. One of the key pieces in the complicated jigsaw of decision making is estimation of survival. If a patient isn’t going to live too long then a kyphoplasty, radiotherapy or a watch-and-wait protocol might be appropriate. On the other hand, if the prognosis is many years the same tumour may be treated with decompression and multilevel instrumentation.
There has been significant difficulty with survival estimation, and in the last edition of 360 we reported on the development of the Boston prognostic score which is designed to estimate the survival of patients presenting with metastatic spinal disease. A research team in Akita (Japan) have reported a small series of 31 patients, all with vertebral metastasis, which perhaps provides food for thought.1 These authors report on patients with lung cancer and have compared their post-operative prognosis with those with other primary diagnoses following surgical treatment. As perhaps might be expected with a series like this, at the 16-month average follow-up point only 22% of patients were alive. However, the lung cancer metastatic group appeared to derive the same post-operative benefit as those being operated upon for other primary diagnoses.
The authors utilised the revised Tokuhashi score and report that this prognostic tool may well underestimate the survival of lung cancer patients and that, in this series at least, these patients derived the same benefit from surgical intervention as those with vertebral …