Central Nervous System
PV QA 2 - Poster Viewing Q&A 2
MO_9_2681 - A Multicenter Prospective Cohort Study Evaluating Quality of Life after Radiation or Surgery for Potentially Unstable Spinal Metastases
Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3
Arjun Sahgal, MD
Sunnybrook Health Sciences Centre
Sunnybrook Health Sciences Centre: Physician: Employee
Elekta AB: Honoraria, Research Grants, Travel Expenses
AO Spine: AO Spine Tumor Forum committee member; International Society of Stereotactic Radiosurgery: Ex Officio
A Multicenter Prospective Cohort Study Evaluating Quality of Life after Radiation or Surgery for Potentially Unstable Spinal Metastases
A. Sahgal1, A. L. Versteeg2, L. D. Rhines3, D. M. Sciubba4, J. M. Schuster5, M. H. Weber6, P. P. Varga7, S. Boriani8, C. Bettegowda4, M. G. Fehlings9, M. J. Clarke10, P. M. Arnold11, Z. L. Gokaslan12, and C. G. Fisher13; 1Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada, 2Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands, 3Division of Surgery, Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 4Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, 5Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, 6Division of Surgery, McGill University and Montreal General Hospital, Montreal, QC, Canada, 7National Center for Spinal Disorders and Buda Health Center, Budapest, Hungary, 8GSpine4 Spine Surgery Division, IRCCS Galeazzi Orthopedic Institute, Milan, Italy, 9Division of Orthopedic surgery, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada, 10Department of Neurosurgery, Mayo Clinic, Rochester, MN, 11Department of Neurosurgery, The University of Kansas Hospital, Kansas City, KS, 12Department of Neurosurgery, The Warren Alpert Medical School of Brown University and Rhode Island Hospital and The Miriam Hospital, Providence, RI, 13Division of Spine, Department of Orthopaedics, University of British Columbia and Vancouver General Hospital, Vancouver, BC, Canada
Purpose/Objective(s): The purpose of this study was to compare health related quality of life (HRQOL) outcomes for surgery and/or radiotherapy in patients with potentially unstable spinal metastases.
Materials/Methods: A multicenter prospective observational study specific to patients undergoing radiation and/or surgical intervention for the treatment of symptomatic spinal metastases was conducted. Patients with potentially unstable spinal metastases, defined as a Spinal Instability Neoplastic Score (SINS) between 7 and 12, were included. HRQOL scores were modeled and compared between treatment groups using mixed effect models with adjustment for baseline differences.
Results: In total, 120 patients were treated with surgery +/- radiotherapy and 82 with radiotherapy alone. At baseline, surgically treated patients presented with worse performance status, HRQOL, numeric rating scale (NRS) pain scores, and a greater median SINS score [10 versus 8 in those treated with radiotherapy alone (p<0.001)]. Significant differences in the distribution of individual SINS factors were also observed between both treatment groups. From baseline to 12 weeks post-treatment, surgically treated patients experienced a greater improvement in HRQOL with a 12-point increase in adjusted mean SOSGOQ2.0 score (95%CI 5.1 – 19.0, p<0.001) as compared to a 6.2-point gain in those treated with radiotherapy alone (95%CI -2.2 – 14.6, p=0.352). In addition, the gain in the SOSGOQ2.0 score exceeded the minimal clinically important difference threshold in 63% of the surgical cohort as compared to 44% in the radiotherapy alone cohort (p=0.017).
Conclusion: For patients presenting with potentially unstable spinal metastases, treatment with surgery +/- radiotherapy resulted in greater and clinically meaningful changes in HRQOL as compared to patients treated with radiotherapy alone. However, these results must be taken into context according to differences in individual SINS factors and grouping of SINS factors that comprise the individual cohorts.
Author Disclosure: A. Sahgal: Independent Contractor; Sunnybrook Health Sciences Centre. Research Grant; Elekta AB. Honoraria; Varian, Elekta AB, Accuray Inc. Travel Expenses; Elekta AB, Varian. Ex Officio; International Society of Stereotactic Radiosurgery. AO Spine Tumor Forum committee member; AO Spine. A.L. Versteeg: Research Grant; AOSpine International. Consultant; AOSpine International. L.D. Rhines: None. D.M. Sciubba: Consultant; Medtronic, Stryker, Nuvasive, Deputy-Synthes, K2M, Baxter. J.M. Schuster: None. M.H. Weber: None. S. Boriani: Member of Steering Committee; AOSpine KF Tumor. P.M. Arnold: Consultant; Stryker Spine, Medtronic. Stock; Z-Plasty, SpineEx. Intellectual property rights and interest; Ulrich, Spinewave, CTL, Evoke Medical. LSRS: Nonfinancial, Co-Chair; Lumbar Spine Research Society, AANS/CNS. Scientific Advisory Board; Asterias. Z.L. Gokaslan: Research Grant; AO Spine North America. Stock; Spinal Kinetics. Editorial Boards; Various. C.G. Fisher: Salary; Vancouver Coastal Health. Royalty; Medtronic. Consultant; Medtronic, Nuvasive.