TY - JOUR
T1 - State of the art treatment of spinal metastatic disease
AU - Barzilai, Ori
AU - Fisher, Charles G.
AU - Bilsky, Mark H.
N1 - Publisher Copyright:
© 2017 by the Congress of Neurological Surgeons.
PY - 2018/6/1
Y1 - 2018/6/1
N2 - Treatment paradigms for patients with spine metastases have evolved signifcantly overthe past decade. Incorporating stereotactic radiosurgery into these paradigms has beenparticularly transformative, offering precise delivery of tumoricidal radiation doses withsparing of adjacent tissues. Evidence supports the safety and efcacy of radiosurgeryas it currently offers durable local tumor control with low complication rates even fortumors previously considered radioresistant to conventional radiation. The role for surgicalintervention remains consistent, but a trend has been observed toward less aggressive,often minimally invasive, techniques. Using modern technologies and improved instrumentation, surgical outcomes continue to improve with reduced morbidity. Additionally,targeted agents such as biologics and checkpoint inhibitors have revolutionized cancercare, improving both local control and patient survivals. These advances have broughtforth a need for new prognostication tools and a more critical review of long-termoutcomes. The complex nature of current treatment schemes necessitates a multidisciplinary approach including surgeons, medical oncologists, radiation oncologists, interventionalists, and pain specialists. This review recapitulates the current state-of-the-art,evidence-based data on the treatment of spinal metastases, integrating these data into adecision framework, NOMS, which integrates the 4 sentinel decision points in metastaticspine tumors: Neurologic, Oncologic, Mechanical stability, and Systemic disease andmedical co-morbidities.
AB - Treatment paradigms for patients with spine metastases have evolved signifcantly overthe past decade. Incorporating stereotactic radiosurgery into these paradigms has beenparticularly transformative, offering precise delivery of tumoricidal radiation doses withsparing of adjacent tissues. Evidence supports the safety and efcacy of radiosurgeryas it currently offers durable local tumor control with low complication rates even fortumors previously considered radioresistant to conventional radiation. The role for surgicalintervention remains consistent, but a trend has been observed toward less aggressive,often minimally invasive, techniques. Using modern technologies and improved instrumentation, surgical outcomes continue to improve with reduced morbidity. Additionally,targeted agents such as biologics and checkpoint inhibitors have revolutionized cancercare, improving both local control and patient survivals. These advances have broughtforth a need for new prognostication tools and a more critical review of long-termoutcomes. The complex nature of current treatment schemes necessitates a multidisciplinary approach including surgeons, medical oncologists, radiation oncologists, interventionalists, and pain specialists. This review recapitulates the current state-of-the-art,evidence-based data on the treatment of spinal metastases, integrating these data into adecision framework, NOMS, which integrates the 4 sentinel decision points in metastaticspine tumors: Neurologic, Oncologic, Mechanical stability, and Systemic disease andmedical co-morbidities.
KW - ESCC
KW - NOMS
KW - Radiosurgery
KW - SRS
KW - Spine
KW - Surgery
KW - Tumor
UR - http://www.scopus.com/inward/record.url?scp=85058841632&partnerID=8YFLogxK
U2 - 10.1093/neuros/nyx567
DO - 10.1093/neuros/nyx567
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C2 - 29481645
AN - SCOPUS:85058841632
SN - 0148-396X
VL - 82
SP - 757
EP - 769
JO - Neurosurgery
JF - Neurosurgery
IS - 6
ER -