Abstract
Background: The treatment of oligometastatic (≤5 metastases) spinal disease has trended toward ablative therapies, yet to the authors’ knowledge little is known regarding the prognosis of patients presenting with oligometastatic spinal disease and the value of this approach. The objective of the current study was to compare the survival and clinical outcomes of patients with cancer with oligometastatic spinal disease with those of patients with polymetastatic (>5 metastases) disease. Methods: The current study was an international, multicenter, prospective study. Patients who were admitted to a participating spine center with a diagnosis of spinal metastases and who underwent surgical intervention and/or radiotherapy between August 2013 and May 2017 were included. Data collected included demographics, overall survival, local control, and treatment information including surgical, radiotherapy, and systemic therapy details. Health-related quality of life (HRQOL) measures included the EuroQOL 5 dimensions 3-level questionnaire (EQ-5D-3L), the 36-Item Short Form Health Survey (SF-36v2), and the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ). Results: Of the 393 patients included in the current study, 215 presented with oligometastatic disease and 178 presented with polymetastatic disease. A significant survival advantage of 90.1% versus 77.3% at 3 months and 77.0% versus 65.1% at 6 months from the time of treatment was found for patients presenting with oligometastatic disease compared with those with polymetastatic disease. It is important to note that both groups experienced significant improvements in multiple HRQOL measures at 6 months after treatment, with no differences in these outcome measures noted between the 2 groups. Conclusions: The treatment of oligometastatic disease appears to offer a significant survival advantage compared with polymetastatic disease, regardless of treatment choice. HRQOL measures were found to improve in both groups, demonstrating a palliative benefit for all treated patients.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 770-778 |
| Number of pages | 9 |
| Journal | Cancer |
| Volume | 125 |
| Issue number | 5 |
| DOIs | |
| State | Published - Mar 1 2019 |
| Externally published | Yes |
Keywords
- health-related quality of life (HRQOL)
- oligometastases
- polymetastases
- spine
- survival
- tumor
ASJC Scopus subject areas
- Oncology
- Cancer Research
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In: Cancer, Vol. 125, No. 5, 01.03.2019, p. 770-778.
Research output: Contribution to journal › Article › peer-review
}
TY - JOUR
T1 - Survival, local control, and health-related quality of life in patients with oligometastatic and polymetastatic spinal tumors
T2 - A multicenter, international study
AU - Barzilai, Ori
AU - Versteeg, Anne L.
AU - Sahgal, Arjun
AU - Rhines, Laurence D.
AU - Bilsky, Mark H.
AU - Sciubba, Daniel M.
AU - Schuster, James M.
AU - Weber, Michael H.
AU - Pal Varga, Peter
AU - Boriani, Stefano
AU - Bettegowda, Chetan
AU - Fehlings, Michael G.
AU - Yamada, Yoshiya
AU - Clarke, Michelle J.
AU - Arnold, Paul M.
AU - Gokaslan, Ziya L.
AU - Fisher, Charles G.
AU - Laufer, Ilya
AU - the, A.
N1 - Funding Information: Ori Barzilai has received fellowship support to his institution from Globus for work performed outside of the current study. Anne L. Versteeg has received consulting and travel accommodations from AOSpine International for work performed outside of the current study. Arjun Sahgal has acted as a paid advisor for AbbVie; has taken part in past educational seminars with Elekta AB, Accuray Inc, Varian Medical Systems, and Brainlab; has received a research grant from Elekta AB; has received travel accommodations and expenses from Elekta AB, Varian Medical Systems, and Brainlab; and is a member of the Elekta MR Linac Research Consortium for work performed outside of the current study. Laurence D. Rhines has educational commitments with Stryker for work performed outside of the current study. Mark H. Bilsky has acted as a member of the Speaker’s Bureau for Varian Medical Systems and Brainlab, has received royalties from DePuy Synthes, and has received royalties/fellowship support from Globus Spine for work performed outside of the current study. Daniel M. Sciubba has acted as a paid consultant for Medtronic, DePuy Synthes, Stryker, NuVasive, K2M, Baxter, and Misonix for work performed outside of the current study. Chetan Bettegowda has acted as a paid consultant for DePuy Synthes for work performed outside of the current study. Yoshiya Yamada has acted as a member of the Speakers’ Bureau for Varian Medical Systems, Brainlab, Vision RT, and the Institute for Medical Education for work performed as part of the current study and has acted as a member of the Medical Advisory Board for the Chordoma Foundation for work performed outside of the current study. Paul M. Arnold has received travel accommodations and expenses from AOSpine North America; has intellectual property rights and interests, equity, and a position of responsibility as part of Evoke Medical; has equity from Z-Plasty; has received consulting fees from Stryker Orthopaedics, Ulrich, SpineGuard, In Vivo Therapeutics, and In Vivo; and has received consulting fees, travel accommodations, and expenses from Stryker Spine, Spine Wave, and Medtronic for work performed outside of the current study. Ziya L. Gokaslan has received research support from AOSpine North America and has stock ownership in Spinal Kinetics for work performed outside of the current study. Charles G. Fisher has received consulting and royalty fees from Medtronic, has received research grants from the Orthopedic Research and Education Foundation, and has received fellowship support paid to his institution from AOSpine and Medtronic for work performed outside of the current study. Ilya Laufer has received personal fees from Globus, Medtronic, DePuy Synthes, Spine Wave, and Brainlab for work performed outside of the current study. This study was organized and funded by AOSpine International through the AOSpine Knowledge Forum Tumor, a focused group of international spine oncology experts acting on behalf of AOSpine. Study support was provided directly through the AOSpine Research Department and the AO Clinical Investigation and Documentation units. A research grant for the current study was received from the Orthopedic Research and Education Foundation. The current study was part of an international, multicenter, prospective cohort study performed by the AOSpine Knowledge Forum Tumor and including 10 tertiary spine centers across North America and Europe (Epidemiology, Process and Outcomes of Spine Oncology [EPOSO]; ClinicalTrials.gov identifier: NCT01825161). The study included patients aged 18 to 75 years who underwent surgery and/or RT for symptomatic spinal metastases. Patients were excluded if they were admitted for the treatment of a primary spinal tumor or were diagnosed with a primary spinal cord tumor. The research protocol was approved by the local ethics board of each of the participating spine centers and informed consent was obtained from all study participants. Patients were included in the analyses if they were admitted to a participating spine center with a diagnosis of spinal metastases, underwent surgical intervention and/or RT between August 2013 and May 2017, and reached a 3-month follow-up visit or died before then. Prospectively collected data included demographic data, survival, local tumor control, tumor histology, number and location of spinal metastases, Epidural Spine Cord Compression (ESCC) as defined by the ESCC score, spinal instability as defined by the Spinal Instability Neoplastic Score (SINS), and systemic disease burden. Treatment information collected included surgical and RT details and the use of adjuvant therapies. Measures of health-related QOL (HRQOL) included a numeric rating scale (NRS) for pain. The EuroQOL 5 dimensions 3-level questionnaire (EQ-5D-3L), 36-Item Short Form Health Survey (SF-36v2), and the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ) were evaluated at baseline and during follow-up at fixed time points until 2 years after treatment or death. Data regarding functional status as defined by the Eastern Cooperative Oncology Group (ECOG) also were collected. Data were captured and stored in a secure Web-based application (REDCap; Vanderbilt University, Nashville, Tennessee). The extent of systemic disease was assessed by the treating physician at each individual participating site. At the time of the initial presentation, aside from the treated index spinal lesion, other known sites of disease involvement were specified as none, visceral, brain, axial skeletal (spine/pelvis), appendicular skeletal, or other. The number of metastases likewise was specified as ≤5 or >5. Patients were classified as having oligometastatic disease or polymetastatic disease based on the following definitions. Patients were considered to have oligometastatic disease when they demonstrated 1 to 5 spinal metastases with no other systemic metastases or 1 spinal metastasis and ≤5 systemic metastases. Patients were defined as having polymetastatic disease when they demonstrated >5 systemic metastases, >1 spinal metastases and ≤5 systemic metastases, or >5 spinal metastases with no other systemic metastases. It is interesting to note that, as previously mentioned, to the best of our knowledge no clear definition of oligometastatic disease currently is available, and because 5 metastases was a commonly used number in previous reports, it was selected for the current analysis. Descriptive statistics were used to represent demographic data (mean and the standard deviation or median for continuous variables and the absolute number and frequency distribution for categorical variables). Student t tests and chi-square tests were used to compare differences in continuous variables and proportions between patients who underwent surgery and/or RT. The Cochran-Armitage test for trend was applied to detect linear differences in ordinal baseline parameters (ECOG, American Spinal Injury Association, and ESCC). Mixed effect models were used to model differences in clinical outcomes (NRS pain, SOSGOQ, SF-36v2, and EQ-5D-3L) over time between the surgery and/or RT group. The mixed effect models were adjusted for treatment; baseline ECOG, American Spinal Injury Association, and SINS scores; and the duration of symptoms. The log-rank test was used to compare overall survival up to 2 years after treatment between both analysis groups. Patients who did not reach the final study visit were censored at the time of their last visit. Significance was defined as P <.05. All statistical analyses were performed using SAS statistical software (version 9.4; SAS Institute Inc, Cary, North Carolina). Funding Information: This study was organized and funded by AOSpine International through the AOSpine Knowledge Forum Tumor, a focused group of international spine oncology experts acting on behalf of AOSpine. Study support was provided directly through the AOSpine Research Department and the AO Clinical Investigation and Documentation units. A research grant for the current study was received from the Orthopedic Research and Education Foundation. Funding Information: Ori Barzilai has received fellowship support to his institution from Globus for work performed outside of the current study. Anne L. Versteeg has received consulting and travel accommodations from AOSpine International for work performed outside of the current study. Arjun Sahgal has acted as a paid advisor for AbbVie; has taken part in past educational seminars with Elekta AB, Accuray Inc, Varian Medical Systems, and Brainlab; has received a research grant from Elekta AB; has received travel accommodations and expenses from Elekta AB, Varian Medical Systems, and Brainlab; and is a member of the Elekta MR Linac Research Consortium for work performed outside of the current study. Laurence D. Rhines has educational commitments with Stryker for work performed outside of the current study. Mark H. Bilsky has acted as a member of the Speaker’s Bureau for Varian Medical Systems and Brainlab, has received royalties from DePuy Synthes, and has received royalties/fellowship support from Globus Spine for work performed outside of the current study. Daniel M. Sciubba has acted as a paid consultant for Medtronic, DePuy Synthes, Stryker, NuVasive, K2M, Baxter, and Misonix for work performed outside of the current study. Chetan Bettegowda has acted as a paid consultant for DePuy Synthes for work performed outside of the current study. Yoshiya Yamada has acted as a member of the Speakers’ Bureau for Varian Medical Systems, Brainlab, Vision RT, and the Institute for Medical Education for work performed as part of the current study and has acted as a member of the Medical Advisory Board for the Chordoma Foundation for work performed outside of the current study. Paul M. Arnold has received travel accommodations and expenses from AOSpine North America; has intellectual property rights and interests, equity, and a position of responsibility as part of Evoke Medical; has equity from Z-Plasty; has received consulting fees from Stryker Orthopaedics, Ulrich, SpineGuard, In Vivo Therapeutics, and In Vivo; and has received consulting fees, travel accommodations, and expenses from Stryker Spine, Spine Wave, and Medtronic for work performed outside of the current study. Ziya L. Gokaslan has received research support from AOSpine North America and has stock ownership in Spinal Kinetics for work performed outside of the current study. Charles G. Fisher has received consulting and royalty fees from Medtronic, has received research grants from the Orthopedic Research and Education Foundation, and has received fellowship support paid to his institution from AOSpine and Medtronic for work performed outside of the current study. Ilya Laufer has received personal fees from Globus, Medtronic, DePuy Synthes, Spine Wave, and Brainlab for work performed outside of the current study. Publisher Copyright: © 2018 American Cancer Society
PY - 2019/3/1
Y1 - 2019/3/1
N2 - Background: The treatment of oligometastatic (≤5 metastases) spinal disease has trended toward ablative therapies, yet to the authors’ knowledge little is known regarding the prognosis of patients presenting with oligometastatic spinal disease and the value of this approach. The objective of the current study was to compare the survival and clinical outcomes of patients with cancer with oligometastatic spinal disease with those of patients with polymetastatic (>5 metastases) disease. Methods: The current study was an international, multicenter, prospective study. Patients who were admitted to a participating spine center with a diagnosis of spinal metastases and who underwent surgical intervention and/or radiotherapy between August 2013 and May 2017 were included. Data collected included demographics, overall survival, local control, and treatment information including surgical, radiotherapy, and systemic therapy details. Health-related quality of life (HRQOL) measures included the EuroQOL 5 dimensions 3-level questionnaire (EQ-5D-3L), the 36-Item Short Form Health Survey (SF-36v2), and the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ). Results: Of the 393 patients included in the current study, 215 presented with oligometastatic disease and 178 presented with polymetastatic disease. A significant survival advantage of 90.1% versus 77.3% at 3 months and 77.0% versus 65.1% at 6 months from the time of treatment was found for patients presenting with oligometastatic disease compared with those with polymetastatic disease. It is important to note that both groups experienced significant improvements in multiple HRQOL measures at 6 months after treatment, with no differences in these outcome measures noted between the 2 groups. Conclusions: The treatment of oligometastatic disease appears to offer a significant survival advantage compared with polymetastatic disease, regardless of treatment choice. HRQOL measures were found to improve in both groups, demonstrating a palliative benefit for all treated patients.
AB - Background: The treatment of oligometastatic (≤5 metastases) spinal disease has trended toward ablative therapies, yet to the authors’ knowledge little is known regarding the prognosis of patients presenting with oligometastatic spinal disease and the value of this approach. The objective of the current study was to compare the survival and clinical outcomes of patients with cancer with oligometastatic spinal disease with those of patients with polymetastatic (>5 metastases) disease. Methods: The current study was an international, multicenter, prospective study. Patients who were admitted to a participating spine center with a diagnosis of spinal metastases and who underwent surgical intervention and/or radiotherapy between August 2013 and May 2017 were included. Data collected included demographics, overall survival, local control, and treatment information including surgical, radiotherapy, and systemic therapy details. Health-related quality of life (HRQOL) measures included the EuroQOL 5 dimensions 3-level questionnaire (EQ-5D-3L), the 36-Item Short Form Health Survey (SF-36v2), and the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ). Results: Of the 393 patients included in the current study, 215 presented with oligometastatic disease and 178 presented with polymetastatic disease. A significant survival advantage of 90.1% versus 77.3% at 3 months and 77.0% versus 65.1% at 6 months from the time of treatment was found for patients presenting with oligometastatic disease compared with those with polymetastatic disease. It is important to note that both groups experienced significant improvements in multiple HRQOL measures at 6 months after treatment, with no differences in these outcome measures noted between the 2 groups. Conclusions: The treatment of oligometastatic disease appears to offer a significant survival advantage compared with polymetastatic disease, regardless of treatment choice. HRQOL measures were found to improve in both groups, demonstrating a palliative benefit for all treated patients.
KW - health-related quality of life (HRQOL)
KW - oligometastases
KW - polymetastases
KW - spine
KW - survival
KW - tumor
UR - http://www.scopus.com/inward/record.url?scp=85057864279&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85057864279&partnerID=8YFLogxK
U2 - 10.1002/cncr.31870
DO - 10.1002/cncr.31870
M3 - Article
C2 - 30489634
AN - SCOPUS:85057864279
SN - 0008-543X
VL - 125
SP - 770
EP - 778
JO - Cancer
JF - Cancer
IS - 5
ER -