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| EDITORIAL |
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| Year : 2022 | Volume
: 5
| Issue : 2 | Page : 143-144 |
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Evolution of management of spinal tumors
Gautam R Zaveri1, Venkatesh Krishnan2
1 Department of Spine Surgery, Jaslok Hospital & Research Centre, Mumbai, Maharashtra, India
2 Department of Spine Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| Date of Submission | 13-Aug-2021 |
| Date of Decision | 06-Sep-2021 |
| Date of Acceptance | 06-Apr-2022 |
| Date of Web Publication | 08-Jun-2022 |
Correspondence Address:
Gautam R Zaveri
Department of Spine Surgery, Jaslok Hospital & Research Centre, Mumbai 400026, Maharashtra
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/isj.isj_81_21
How to cite this article:
Zaveri GR, Krishnan V. Evolution of management of spinal tumors. Indian Spine J 2022;5:143-4 |
| Introduction | |  |
There has been a rapid evolution in cancer management over the past two decades. Early diagnosis of cancer, availability of newer systemic therapies including chemotherapy, immunotherapy, hormonal therapy, targeted molecular therapy, and advancements in radiotherapy have resulted in significantly improved life expectancy.
Metastatic spinal disease (MSD) is the most common malignant affliction of the axial skeleton. Symptomatic patients usually present with pain, neurologic deficit, and loss of function. The primary goal of treatment of MSD is palliation, that is, to improve quality of life while limiting complications. Successful treatment must provide pain relief, allow preservation or recovery of neurologic function, and enable return to activities of daily living.
Although systemic control of the cancer determines the overall survival of a patient, local control of the spinal metastasis is required in order to alleviate pain, and preserve neurology and function. Local control of the metastasis also influences the overall survival of the patient. A longer life expectancy necessitates strategies for more lasting local tumor control in patients with spinal metastasis[1]
Radiotherapy alone or surgery followed by radiotherapy are the principal modalities for local control of MSD. Before the availability of radiotherapy, laminectomy for spinal cord decompression was the treatment for metastatic spinal cord compression (MSCC). However, laminectomy fell into disrepute because of poor neurological outcomes resulting from inability to access the anterior spinal cord compression. In addition, laminectomy further destabilizes the spinal column resulting in pain, progressive deformity, and even neurologic deficit. Surgery was almost abandoned in favor of radiotherapy when studies showed that the outcomes following laminectomy with or without postoperative radiation were no better than those with radiation alone.[2],[3]
Surgery re-emerged as the preferred treatment for MSCC following Patchell’s landmark study that showed hugely superior outcomes in terms of regaining and retaining ambulation with modern spine surgery followed by radiation compared to radiation alone.[4],[5] With the advent of stereotactic body radiotherapy (SBRT), the pendulum has again swung in favor of radiotherapy as the primary treatment modality for local control of spinal metastasis with surgery being reserved for patients with spinal instability, significant epidural spinal cord compression with neurologic deficit and radioresistant tumors (in centers where stereotactic body radiation therapy [SBRT] is not available).[6],[7]
The rapid evolution in systemic therapies, and the introduction of SBRT for the management of spinal metastasis has challenged traditional paradigms for decision-making in patients with MSD, making it difficult for the treating team to decide on the most appropriate treatment strategy for a particular patient. The current symposium combines the best available evidence with expert opinion to guide practicing spinal surgeons in the management of MSD. Review articles on chemotherapy and radiotherapy provide an insight into the principal role of these modalities in the treatment armamentarium. Dr. Naresh Kumar and his team from the National University Hospital, Singapore have extensively discussed the role of spinal surgery. Dr. K Venkatesh’s literature review of the outcomes of surgery provides objectivity to surgical decision-making in MSD. The spine clinic section at the end highlights the need for a patient-specific approach to decision making depending on the technology and expertise available in ones’ practice.
We thank all the authors for their immense contributions. We sincerely hope that you enjoy and gain from the material presented in this symposium.
Financial support and sponsorship
Not applicable.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Cofano F, Monticelli M, Ajello M, Zenga F, Marengo N, Di Perna G, et al. The targeted therapies era beyond the surgical point of view: What spine surgeons should know before approaching spinal metastases. Cancer Control 2019;26:1073274819870549.  |
| 2. | Young RF, Post EM, King GA Treatment of spinal epidural metastases. Randomized prospective comparison of laminectomy and radiotherapy. J Neurosurg 1980;53:741-8. |
| 3. | Sørensen S, Børgesen SE, Rohde K, Rasmusson B, Bach F, Bøge-Rasmussen T, et al. Metastatic epidural spinal cord compression. Results of treatment and survival. Cancer 1990;65:1502-8. |
| 4. | Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: A randomised trial. Lancet 2005;366:643-8. |
| 5. | Siegal T, Siegal T, Robin G, Lubetzki-Korn I, Fuks Z Anterior decompression of the spine for metastatic epidural cord compression: A promising avenue of therapy? Ann Neurol 1982;11:28-34. |
| 6. | Garg AK, Shiu AS, Yang J, Wang XS, Allen P, Brown BW, et al. Phase ½ trial of single-session stereotactic body radiotherapy for previously unirradiated spinal metastases. Cancer 2012;118: 5069-77. |
| 7. | Yamada Y, Katsoulakis E, Laufer I, Lovelock M, Barzilai O, McLaughlin LA, et al. The impact of histology and delivered dose on local control of spinal metastases treated with stereotactic radiosurgery. Neurosurg Focus 2017;42:E6. |
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