Survival, local control, and health-related quality of life in patients with oligometastatic and polymetastatic spinal tumors: A multicenter, international study

Ori Barzilai; Anne L Versteeg; Arjun Sahgal; Laurence D Rhines; Mark H Bilsky; Daniel M Sciubba; James M Schuster; Michael H Weber; Peter Pal Varga; Stefano Boriani; Chetan Bettegowda; Michael G Fehlings; Yoshiya Yamada; Michelle J Clarke; Paul M Arnold; Ziya L Gokaslan; Charles G Fisher; Ilya Laufer; The Ao Spine Knowledge Forum Tumor

doi:10.1002/cncr.31870

Survival, local control, and health-related quality of life in patients with oligometastatic and polymetastatic spinal tumors: A multicenter, international study

Cancer. 2019 Mar 1;125(5):770-778. doi: 10.1002/cncr.31870. Epub 2018 Nov 29.

Authors

Ori Barzilai¹, Anne L Versteeg², Arjun Sahgal³, Laurence D Rhines⁴, Mark H Bilsky^{1

5}, Daniel M Sciubba⁶, James M Schuster⁷, Michael H Weber⁸, Peter Pal Varga⁹, Stefano Boriani¹⁰, Chetan Bettegowda⁶, Michael G Fehlings¹¹, Yoshiya Yamada¹², Michelle J Clarke¹³, Paul M Arnold¹⁴, Ziya L Gokaslan¹⁵, Charles G Fisher¹⁶, Ilya Laufer^{1

5}, The Ao Spine Knowledge Forum Tumor¹⁷

Affiliations

¹ Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York.
² Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands.
³ Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, Ontario, Canada.
⁴ Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
⁵ Department of Neurological Surgery, Weill Cornell Medical College, New York, New York.
⁶ Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
⁷ Department of Neurosurgery, Hospital, University of Pennsylvania, Philadelphia, Pennsylvania.
⁸ Division of Surgery, McGill University, Montreal General Hospital, Montreal, Quebec, Canada.
⁹ National Center for Spinal Disorders and Buda Health Center, Budapest, Hungary.
¹⁰ GSpine4 Spine Surgery Division, IRCCS Galeazzi Orthopedic Institute, Milan, Italy.
¹¹ Division of Neurosurgery and Spine Program, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada.
¹² Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
¹³ Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota.
¹⁴ Department of Neurosurgery, The University of Kansas Hospital, Kansas City, Kansas.
¹⁵ Department of Neurosurgery, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, The Miriam Hospital, Brown University, Providence, Rhode Island.
¹⁶ Division of Spine, Department of Orthopaedics, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada.
¹⁷ Research Department, AOSpine International, Davos, Switzerland.

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.

Keywords: health-related quality of life (HRQOL); oligometastases; polymetastases; spine; survival; tumor.

Publication types

Comparative Study
Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Female
Humans
International Cooperation
Male
Middle Aged
Neoplasm Metastasis
Orthopedic Procedures
Prognosis
Prospective Studies
Quality of Life / psychology*
Radiotherapy
Spinal Neoplasms / psychology
Spinal Neoplasms / secondary*
Spinal Neoplasms / therapy*
Survival Analysis
Treatment Outcome

Grants and funding

P30 CA008748/CA/NCI NIH HHS/United States