TY - JOUR
T1 - Health related quality of life outcomes following surgery and/or radiation for patients with potentially unstable spinal metastases
AU - AOSpine Knowledge Forum Tumor
AU - Versteeg, Annemarie L.
AU - Sahgal, Arjun
AU - Rhines, Laurence D.
AU - Sciubba, Daniel M.
AU - Schuster, James M.
AU - Weber, Michael H.
AU - Lazary, Aron
AU - Boriani, Stefano
AU - Bettegowda, Chetan
AU - Fehlings, Michael G.
AU - Clarke, Michelle J.
AU - Arnold, Paul M.
AU - Gokaslan, Ziya L.
AU - Fisher, Charles G.
N1 - Funding Information:
We are grateful to the Orthopaedic Research and Education Foundation (OREF) for their grant to support this study. We are grateful to the collaborating centers' local clinical research personnel and support staff for their active participation. This study was organized and funded by 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. Study support was provided directly through AOSpine's Research department and AO's Clinical Investigation and Documentation unit. We thank Christian Knoll for performing the statistical analysis. A research grant was received from the Orthopaedic Research and Education Foundation. This study was organized and funded by AOSpine International, through the AOSpine Knowledge Forum Tumor.
Funding Information:
Author Disclosures: ALV: Support for travel to meetings for the study or other purposes: AOSpine International (B). AS: Support for travel to meetings for the study or other purposes: AOSpine International; Speaking and/or Teaching Arrangements: Elekta, AB, accuray Inc, Varian medical systems; Trips/Travel: Elekta and Varian; Grants: Elekta. LDR: Speaking and/or Teaching Arrangements: Stryker. DMS: Consulting and royalties: Medtronic, Depuy-Synthes, Stryker, Nuvasive, K2M. JMS: Nothing to disclose. MHW: Nothing to disclose. AL: Nothing to disclose. SB: Nothing to disclose. CB: Nothing to disclose. MGF: Nothing to disclose. MJC: Nothing to disclose. PMA: Consulting: Stryker orthopaedics, Ulrich, Spineguard, In Vivo Therapeutics; Trips/Travel: AOspine North America Stryker Spine, Spinewave, Medtronis. ZLG: Ownership: Spinal Kinetics; Research Support (Investor salary, staff/materials): AOSpine North America. CGF: Grant: OREF; Royalties: Medtronic; Consulting: Medtronic; Fellowship Support: AOSpine and Medtronic.
Publisher Copyright:
© 2020 The Authors
PY - 2021/3
Y1 - 2021/3
N2 - 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.
AB - 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.
KW - Quality of life
KW - Radiation
KW - Spinal instability
KW - Spinal metastases
KW - Spine
KW - Surgery
UR - http://www.scopus.com/inward/record.url?scp=85095870550&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85095870550&partnerID=8YFLogxK
U2 - 10.1016/j.spinee.2020.10.017
DO - 10.1016/j.spinee.2020.10.017
M3 - Article
C2 - 33098985
AN - SCOPUS:85095870550
SN - 1529-9430
VL - 21
SP - 492
EP - 499
JO - Spine Journal
JF - Spine Journal
IS - 3
ER -