Journal
SPINE JOURNAL
Volume 21, Issue 3, Pages 492-499Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.spinee.2020.10.017
Keywords
Quality of life; Radiation; Spinal metastases; Spine; Surgery; Spinal instability
Categories
Funding
- Orthopaedic Research and Education Foundation (OREF)
- AOSpine International, through the AOSpine Knowledge Forum Tumor, a pathology-focused working group of international spine experts acting on behalf of AOSpine in the domain of scientific expertise
- AOSpine's Research department
- AO's Clinical Investigation and Documentation unit
- Orthopaedic Research and Education Foundation
- AOSpine International, through the AOSpine Knowledge Forum Tumor
Ask authors/readers for more resources
Surgery in patients with potentially unstable spinal metastases showed significant and sustained improvements in pain and HRQOL up to 1-year post-surgery, while treatment with radiotherapy alone resulted in short-term pain relief but no significant changes in HRQOL. Different clinical profiles were observed in patients treated with surgery or radiotherapy alone within the SINS potentially unstable group.
BACKGROUND: Currently there is no prospective pain and health related quality of life (HRQOL) data of patients with potentially unstable spinal metastases who were treated with surgery +/- radiation or radiation alone. METHODS: An international prospective cohort multicenter study of patients with potentially unstable spinal metastases, defined by a SINS score 7 to 12, treated with surgery +/- radiation or radiotherapy alone was conducted. HRQOL was evaluated with the numeric rating scale (NRS) pain score, the SOSGOQ2.0, the SF-36, and the EQ-5D at baseline and 6, 12, 26, and 52 weeks after treatment. RESULTS: A total of 136 patients were treated with surgery +/- radiotherapy and 84 with radiotherapy alone. At baseline, surgically treated patients were more likely to have mechanical pain, a lytic lesion, a greater median Spinal Instability Neoplastic score, vertebral compression fracture, lower performance status, HRQOL, and pain scores. From baseline to 12 weeks post-treatment, surgically treated patients experienced a 3.0-point decrease in NRS pain score (95% CI -4.1 to -1.9, p<.001), and a 12.7-point increase in SOSGOQ2.0 score (95% CI 6.3-19.1, p<.001). Patients treated with radiotherapy alone experienced a 1.4-point decrease in the NRS pain score (95% CI -2.9 to 0.0, p=.046) and a 6.2-point increase in SOSGOQ2.0 score (95% CI -2.0 to 14.5, p=.331). Beyond 12 weeks, significant improvements in pain and HRQOL metrics were maintained up to 52-weeks follow-up in the surgical cohort, as compared with no significant changes in the radiotherapy alone cohort. CONCLUSIONS: Patients treated with surgery demonstrated clinically and statistically significant improvements in pain and HRQOL up to 1-year postsurgery. Treatment with radiotherapy alone resulted in improved pain scores, but these were not sustained beyond 3 months and HRQOL outcomes demonstrated nonsignificant changes over time. Within the SINS potentially unstable group, distinct clinical profiles were observed in patients treated with surgery or radiotherapy alone. (C) 2020 The Authors. Published by Elsevier Inc.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available