TY - JOUR
T1 - Evaluation of the Metastatic Spine Disease Multidisciplinary Working Group Algorithms as Part of a Multidisciplinary Spine Tumor Conference
AU - Rudra, Soumon
AU - Lauman, Mary K.
AU - Stowe, Hayley
AU - Henke, Lauren E.
AU - Wallace, Adam N.
AU - Roach, Michael C.
AU - Huang, Jiayi
AU - Tsien, Christina I.
AU - Bradley, Jeffrey D.
AU - Santiago, Paul
AU - Buchowski, Jacob M.
AU - Jennings, Jack W.
AU - Robinson, Clifford G.
N1 - Funding Information:
The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: LH reports grants and personal fees from ViewRay, Inc, grants from Varian Medical Systems, outside the submitted work. MR reports personal fees from Varian Medical Systems, grants from Elekta, personal fees from BTG, outside the submitted work. JH reports research support from Pfizer and Cantex, personal fees from Viewray, outside the submitted work. CT reports speaker’s bureau/honoraria from Merck and Varian Medical Systems, consulting fees from AbbVie and Novocure, outside the submitted work. JDB reports grant and travel support from Mevion Medical Systems, consulting fees and advisory board position with AstraZeneca, advisory board position with ViewRay, Inc, outside the submitted work. PS reports stock/ownership investment with 3DSpine.com and Corelink, speaker’s bureau/honoraria from Stryker Spine and Ulrich Medical, consulting fees from Aesculap, Bioventus, Corelink, Invivo Technologies, Mizuho Osi and Salient Technologies, employment with Corelink, and other relationships with Globus, Ulrich Medical, and Zimmer, Inc, outside the submitted work. JMB reports grants from AO North America and Omega Medical Grants, consulting fees from Advance Medical, speaker’s bureau/honoraria from Globus and other relationships with K2M, outside the submitted work. JJ reports consulting fees from Medtronic and Merit Medial Endotek, outside the submitted work. CR reports grants from Varian Medical Systems and Elekta, stock/ownership investment with Radialogica, speaker’s bureau/honoraria with Varian Medical Systems and Merrit/DFINE, outside the submitted work. SR, ML, HS, and AW have no financial relationships to report.
Publisher Copyright:
© The Author(s) 2019.
PY - 2020/10/1
Y1 - 2020/10/1
N2 - Study Design: Retrospective cohort study. Objective: The Metastatic Spine Disease Multidisciplinary Working Group Algorithms are evidence and expert opinion–based strategies for utilizing radiation therapy, interventional radiology procedures, and surgery to treat 5 types of spine metastases: asymptomatic spinal metastases, uncomplicated spinal metastases, stable vertebral compression fractures (VCF), unstable VCF, and metastatic epidural spinal cord compression (MESCC). Evaluation of this set of algorithms in a clinical setting is lacking. The authors aimed to identify rate of treatment adherence to the Working Group Algorithms and, subsequently, update these algorithms based on actual patient management decisions made at a single-institution, multidisciplinary, spine tumor conference. Methods: Patients with metastatic spine disease from primary non-hematologic malignancies discussed at an institutional spine tumor conference from 2013 to 2016 were evaluated. Rates of Working Group Algorithms adherence were calculated for each type of metastasis. Based on the reasons for algorithm nonadherence, and patient outcomes in such cases, updated Working Group Algorithms recommendations were proposed. Results: In total, 154 eligible patients with 171 spine metastases were evaluated. Rates of algorithm adherence were as follows: asymptomatic (67%), uncomplicated (73%), stable VCF (20%), unstable VCF (32%), and MESCC (41%). The most common deviation from the Working Group Algorithms was surgery for MESCC despite poor prognostic factors, but this treatment strategy was supported based on median survival surpassing 6 months in these patients. Conclusions: Adherence to the Working Group Algorithm was lowest for MESCC and VCF patients, but many nonadherent treatments were supported by patient survival outcomes. We proposed updates to the Working Group Algorithm based on these findings.
AB - Study Design: Retrospective cohort study. Objective: The Metastatic Spine Disease Multidisciplinary Working Group Algorithms are evidence and expert opinion–based strategies for utilizing radiation therapy, interventional radiology procedures, and surgery to treat 5 types of spine metastases: asymptomatic spinal metastases, uncomplicated spinal metastases, stable vertebral compression fractures (VCF), unstable VCF, and metastatic epidural spinal cord compression (MESCC). Evaluation of this set of algorithms in a clinical setting is lacking. The authors aimed to identify rate of treatment adherence to the Working Group Algorithms and, subsequently, update these algorithms based on actual patient management decisions made at a single-institution, multidisciplinary, spine tumor conference. Methods: Patients with metastatic spine disease from primary non-hematologic malignancies discussed at an institutional spine tumor conference from 2013 to 2016 were evaluated. Rates of Working Group Algorithms adherence were calculated for each type of metastasis. Based on the reasons for algorithm nonadherence, and patient outcomes in such cases, updated Working Group Algorithms recommendations were proposed. Results: In total, 154 eligible patients with 171 spine metastases were evaluated. Rates of algorithm adherence were as follows: asymptomatic (67%), uncomplicated (73%), stable VCF (20%), unstable VCF (32%), and MESCC (41%). The most common deviation from the Working Group Algorithms was surgery for MESCC despite poor prognostic factors, but this treatment strategy was supported based on median survival surpassing 6 months in these patients. Conclusions: Adherence to the Working Group Algorithm was lowest for MESCC and VCF patients, but many nonadherent treatments were supported by patient survival outcomes. We proposed updates to the Working Group Algorithm based on these findings.
KW - interventional radiology
KW - radiation therapy
KW - spinal cord compression
KW - spinal metastases
KW - spine surgery
KW - vertebral compression fractures
UR - http://www.scopus.com/inward/record.url?scp=85090776213&partnerID=8YFLogxK
U2 - 10.1177/2192568219882649
DO - 10.1177/2192568219882649
M3 - Article
C2 - 32905719
AN - SCOPUS:85090776213
SN - 2192-5682
VL - 10
SP - 888
EP - 895
JO - Global Spine Journal
JF - Global Spine Journal
IS - 7
ER -