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Cancers
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Current Strategies in Spine Tumor Treatment
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Current Strategies in Spine Tumor Treatment

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (8 January 2023) | Viewed by 13261

Special Issue Editors

Prof. Dr. Alexander Disch

E-Mail Website
Guest Editor
1. University Comprehensive Spine Center (UCSC), Dresden, Germany
2. University Center for Orthopaedics, Trauma & Plastic Surgery, Dresden, Germany
3. University Hospital Carl Gustav Carus at the TU Dresden, Dresden, Germany
Interests: spinal tumor; spine trauma; degenerative spinal disease; spinal deformity
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Klaus-Dieter Schaser

E-Mail Website
Guest Editor
1. University Center for Orthopaedics, Trauma & Plastic Surgery, Dresden, Germany
2. University Hospital Carl Gustav Carus at the TU Dresden, Dresden, Germany
Interests: musculoskeletal tumor; spinal tumor; spine trauma; general trauma surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Advances in the treatment of spinal tumors have benefited enormously from the tremendous progress in oncological therapies. At present, multidisciplinary teams guide patients from diagnosis through the course of the diseases, sparing no efforts to achieve better local and systemic control to elevate overall survival rates and increase patients’ quality of life. Substantiated suspicion of a spinal malignancy has to infer standardized diagnostic algorithms, ideally involving all related disciplines in order to start definitive treatment without any delay. A large portfolio of surgical techniques is provided, allowing individual treatment to be tailored to the different underlying tumor biologies and various stages in spinal malignancies. Pursuing that approach, the scope of successful treatment ranges from palliative pain reduction, and minimal invasive fixation techniques for the maintenance or restoration of spinal stability, up to complex multisegmental resections and reconstructions in far rarer primary spinal tumors. The application of intraoperative imaging like fused CT-/ MRI-/ PET- datasets for intra-/ postoperative 3D-imaging, navigation-assisted and stereotactic procedures is as relevant for modern spinal tumor surgery as the use of new implant materials and constructs. Whatever treatment is chosen, and in addition to local and systemic control, the resulting patients´ quality of life is an essential—and increasingly recognized—primary outcome goal.

This Special Issue of Cancers focuses on innovations, the latest technical advances, multidisciplinary interfaces in multimodal treatment and clinical outcome of surgical spinal tumor treatment.

Prof. Dr. Alexander Disch
Prof. Dr. Klaus-Dieter Schaser
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • multidisciplinary spinal tumor treatment
  • spinal metastases
  • primary spinal tumors
  • spine tumor surgery
  • onco-surgical outcome

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Published Papers (5 papers)

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Research

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14 pages, 1624 KiB  
Article
Extradural Primary Malignant Spinal Tumors in a Population Younger than 25 Years: An Ambispective International Multicenter Study on Onco-Surgical Outcomes
by Alexander C. Disch, Stefano Boriani, Alessandro Luzzati, Laurence D. Rhines, Charles G. Fisher, Aron Lazary, Ziya L. Gokaslan, Dean Chou, Michelle J. Clarke, Michael G. Fehlings, Klaus-Dieter Schaser, Nicole M. Germscheid, Jeremy J. Reynolds and The AO Spine Knowledge Forum Tumor
Cancers 2023, 15(3), 845; https://doi.org/10.3390/cancers15030845 - 30 Jan 2023
Cited by 1 | Viewed by 2090
Abstract
Extradural malignant primary spinal tumors are rare and outcome data, especially for younger patients, is limited. In a worldwide (11 centers) study (Predictors of Mortality and Morbidity in the Surgical Management of Primary Tumors of the Spine study; ClinicalTrials.gov Identifier NCT01643174) by the [...] Read more.
Extradural malignant primary spinal tumors are rare and outcome data, especially for younger patients, is limited. In a worldwide (11 centers) study (Predictors of Mortality and Morbidity in the Surgical Management of Primary Tumors of the Spine study; ClinicalTrials.gov Identifier NCT01643174) by the AO Spine Knowledge Forum Tumor, patients surgically treated for primary tumors of the spine between 1992 and 2012, were retrospectively analyzed from a prospective database of their medical history. Medical history, tumor characteristics, diagnostics, treatments, cross-sectional survival, and local recurrences were analyzed. Sixty-eight cases (32 f; 36 m), at an average age of 18.6 ± 4.7 years at the time of diagnosis, were identified (median follow-up 2.9 years). The most common entities were Ewing’s sarcoma (42.6%). Of the patients, 28% had undergone previous spine tumor surgery in another center (84% with intralesional margins). Resection was considered “Enneking appropriate” (EA) in 47.8% of the cases. Of the patients, 77.9% underwent chemotherapy and 50% radiotherapy. A local recurrence occurred in 36.4%. Over a third of patients died within a 10-year follow-up period. Kaplan-Meier-analysis demonstrated statistically significant overall survival (p = 0.007) and local recurrence rates (p = 0.042) for tumors treated with EA surgery versus Enneking inappropriate surgery. Aggressive resection of extradural primary malignant spinal tumors combined with adjuvant therapy reveals low local recurrence rates and better outcomes overall in younger patients. Full article
(This article belongs to the Special Issue Current Strategies in Spine Tumor Treatment)
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13 pages, 5241 KiB  
Article
Outcomes of Surgical Treatment for Extradural Benign Primary Spinal Tumors in Patients Younger than 25 Years: An Ambispective International Multicenter Study
by Alexander C. Disch, Stefano Boriani, Aron Lazary, Laurence D. Rhines, Alessandro Luzzati, Ziya L. Gokaslan, Charles G. Fisher, Michael G. Fehlings, Michelle J. Clarke, Dean Chou, Nicole M. Germscheid, Klaus-Dieter Schaser, Jeremy J. Reynolds and The AO Spine Knowledge Forum Tumor
Cancers 2023, 15(3), 650; https://doi.org/10.3390/cancers15030650 - 20 Jan 2023
Cited by 1 | Viewed by 2168
Abstract
Extradural primary spinal tumors were retrospectively analyzed from a prospective database of 1495 cases. All subjects with benign primary tumors under the age of 25 years, who were enrolled between 1990 and 2012 (Median FU was 2.4 years), were identified. Patient- and case-related [...] Read more.
Extradural primary spinal tumors were retrospectively analyzed from a prospective database of 1495 cases. All subjects with benign primary tumors under the age of 25 years, who were enrolled between 1990 and 2012 (Median FU was 2.4 years), were identified. Patient- and case-related characteristics were collected and statistically analyzed. Results: 161 patients (66f;95m; age 17.0 ± 4.7 years at time of diagnosis) were identified. The most common tumors were osteoblastomas n = 53 (32.9%), osteoid osteomas n = 45 (28.0%), and aneurysmal bone cysts n = 32 (19.9%). The tumor grade, according to the Enneking Classification S1/S2/S3, was 14/73/74 (8.7/45.3/46.0%), respectively. Tumor-related pain was present in 156 (96.9%) patients. Diagnosis was achieved by biopsies in 2/3 of the cases. Spinal fixation was used in >50% of the cases. Resection was Enneking appropriate in n = 100 (62.1%) of cases. Local recurrence occurred in 21 (13.1%) patients. Two patients died within a 10-year follow-up period. Conclusion: This is one of the largest international multicenter cohorts of young patients surgically treated for benign spinal tumors. The heterogenic young patient cohort presented at a mid-term follow-up without a correlation between the grade of aggressiveness in resection and local recurrence rates. Further prospective data are required to identify prognostic factors that determine oncological and functional outcomes for young patients suffering from these rare tumors. Full article
(This article belongs to the Special Issue Current Strategies in Spine Tumor Treatment)
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14 pages, 1111 KiB  
Article
Impact of Spinal Instrumentation on Neurological Outcome in Patients with Intermediate Spinal Instability Neoplastic Score (SINS)
by Moritz Lenschow, Maximilian Lenz, Niklas von Spreckelsen, Julian Ossmann, Johanna Meyer, Julia Keßling, Lukas Nadjiri, Sergej Telentschak, Kourosh Zarghooni, Peter Knöll, Moritz Perrech, Eren Celik, Max Scheyerer and Volker Neuschmelting
Cancers 2022, 14(9), 2193; https://doi.org/10.3390/cancers14092193 - 27 Apr 2022
Cited by 15 | Viewed by 1913
Abstract
Background: Adequate assessment of spinal instability using the spinal instability neoplastic score (SINS) frequently guides surgical therapy in spinal epidural osseous metastases and subsequently influences neurological outcome. However, how to surgically manage ‘impending instability’ at SINS 7–12 most appropriately remains uncertain. This study [...] Read more.
Background: Adequate assessment of spinal instability using the spinal instability neoplastic score (SINS) frequently guides surgical therapy in spinal epidural osseous metastases and subsequently influences neurological outcome. However, how to surgically manage ‘impending instability’ at SINS 7–12 most appropriately remains uncertain. This study aimed to evaluate the necessity of spinal instrumentation in patients with SINS 7–12 with regards to neurological outcome. Methods: We screened 683 patients with spinal epidural metastases treated at our interdisciplinary spine center. The preoperative SINS was assessed to determine spinal instability and neurological status was defined using the Frankel score. Patients were dichotomized according to being treated by instrumentation surgery and neurological outcomes were compared. Additionally, a subgroup analysis of groups with SINS of 7–9 and 10–12 was performed. Results: Of 331 patients with a SINS of 7–12, 76.1% underwent spinal instrumentation. Neurological outcome did not differ significantly between instrumented and non-instrumented patients (p = 0.612). Spinal instrumentation was performed more frequently in SINS 10–12 than in SINS 7–9 (p < 0.001). The subgroup analysis showed no significant differences in neurological outcome between instrumented and non-instrumented patients in either SINS 7–9 (p = 0.278) or SINS 10–12 (p = 0.577). Complications occurred more frequently in instrumented than in non-instrumented patients (p = 0.016). Conclusions: Our data suggest that a SINS of 7–12 alone might not warrant the increased surgical risks of additional spinal instrumentation. Full article
(This article belongs to the Special Issue Current Strategies in Spine Tumor Treatment)
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Review

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18 pages, 702 KiB  
Review
Holistic Approach to the Diagnosis and Treatment of Patients with Tumor Metastases to the Spine
by Hanna Nowak, Dominika Maria Szwacka, Monika Pater, Wojciech Krzysztof Mrugalski, Michał Grzegorz Milczarek, Magdalena Staniszewska, Roman Jankowski and Anna-Maria Barciszewska
Cancers 2022, 14(14), 3480; https://doi.org/10.3390/cancers14143480 - 18 Jul 2022
Cited by 9 | Viewed by 2662
Abstract
The treatment of neoplastic spine metastases requires multi-faceted assessment and an interdisciplinary approach to patients. The metastases do not show specific symptoms but are often the first confirmation of the presence of a primary tumor in a patient. The diagnostic process includes imaging [...] Read more.
The treatment of neoplastic spine metastases requires multi-faceted assessment and an interdisciplinary approach to patients. The metastases do not show specific symptoms but are often the first confirmation of the presence of a primary tumor in a patient. The diagnostic process includes imaging and invasive procedures, e.g., biopsy. It is essential to qualify the patient for an appropriate treatment using dedicated scales. Decompression of the spinal cord is a critical issue to save or restore neurological function in a patient with spine metastases. Surgical treatment ought to meet three criteria: release spinal cord and nerve roots, restore the spine’s anatomical relations, and ensure the internal stabilization of the spine. A good result from surgical treatment enables the continuation of radiotherapy, chemotherapy, hormone therapy, and targeted molecular therapy. Stereotactic radiosurgery and stereotactic body radiotherapy are more effective ways of treating spine metastases than conventional external beam radiotherapy. They allow higher doses of radiation, concentrated precisely at the tumor site. Our review summarizes the established and emerging concepts in the treatment of spine metastases. A holistic approach to the patient enables the selection of the appropriate therapy. Full article
(This article belongs to the Special Issue Current Strategies in Spine Tumor Treatment)
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Other

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14 pages, 1255 KiB  
Systematic Review
Evaluating the Optimal Management of Inoperable Giant Cell Tumors of the Spine: A Systematic Review and Meta-Analysis
by Paolo Palmisciano, Gianluca Ferini, Andrew L. Chen, Kishore Balasubramanian, Abdurrahman F. Kharbat, Navraj S. Sagoo, Othman Bin Alamer, Gianluca Scalia, Giuseppe E. Umana, Salah G. Aoun and Ali S. Haider
Cancers 2022, 14(4), 937; https://doi.org/10.3390/cancers14040937 - 14 Feb 2022
Cited by 5 | Viewed by 2736
Abstract
Background: Surgical resection remains the preferred treatment in spine giant cell tumors (SGCTs), but it is not always feasible. Conservative strategies have been studied for inoperable cases. We systematically reviewed the literature on inoperable SGCTs treated with denosumab, radiotherapy or selective arterial embolization [...] Read more.
Background: Surgical resection remains the preferred treatment in spine giant cell tumors (SGCTs), but it is not always feasible. Conservative strategies have been studied for inoperable cases. We systematically reviewed the literature on inoperable SGCTs treated with denosumab, radiotherapy or selective arterial embolization (SAE). Methods: PubMed, Scopus, Web-of-Science, Ovid-EMBASE, and Cochrane were searched following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to include studies of inoperable SGCTs treated with denosumab, radiotherapy or SAE. Treatment outcomes were analyzed and compared with a random-effect model meta-analysis. Results: Among the 17 studies included, 128 patients received denosumab, 59 radiotherapy, and 43 SAE. No significant differences in baseline patient characteristics were found between the three groups. All strategies were equally effective in providing symptom improvement (p = 0.187, I2 = 0%) and reduction in tumor volume (p = 0.738, I2 = 56.8%). Rates of treatment-related complications were low (denosumab: 12.5%; radiotherapy: 8.5%; SAE: 18.6%) and comparable (p = 0.311, I2 = 0%). Patients receiving denosumab had significantly lower rates of local tumor recurrence (10.9%) and distant metastases (0%) compared to patients receiving radiotherapy (30.5%; 8.5%) or SAE (35.6%; 7%) (p = 0.003, I2 = 32%; p = 0.002, I2 = 47%). Denosumab was also correlated with significantly higher overall survival rates at 18 months (99.2%) and 24 months (99.2%) compared to radiotherapy (91.5%; 89.6%) and SAE (92.5%; 89.4%) (p = 0.019, I2 = 8%; p = 0.004, I2 = 23%). Mortality was higher in patients receiving SAE (20.9%) or radiotherapy (13.6%) compared to denosumab (0.8%) (p < 0.001), but deaths mostly occurred for unrelated diseases. Conclusions: Denosumab, radiotherapy, and SAE are safe and effective for inoperable SGCTs. Clinical and radiological outcomes are mostly comparable, but denosumab may provide superior tumor control. Full article
(This article belongs to the Special Issue Current Strategies in Spine Tumor Treatment)
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