AO Spine Clinical Practice Recommendations: Current Systemic Oncological Treatments with the Largest Impact on Patients with Metastatic Spinal Disease.
Marcin Czyz, Emerens G Wensink, Brian Coimbra, Michael Galgano, Shreyaskumar Patel, Kristin Redmond, Joost Rutges, Jiong Hao Jonathan Tan, Ori Barzilai, Nicolas Dea, Alessandro Gasbarrini, Ilya Laufer, Aron Lazary, Cordula Netzer, Jeremy J Reynolds, Laurence D Rhines, Arjun Sahgal, Charles G Fisher, Jorrit-Jan Verlaan
Author Information
Marcin Czyz: University Hospitals Birmingham, Birmingham, UK. ORCID
Emerens G Wensink: University Medical Center Utrecht, Utrecht, The Netherlands.
Brian Coimbra: ICESP Hospital das Clínicas da Universidade De São Paulo, São Paulo, Brazil.
Michael Galgano: University of North Carolina, Chapel Hill, NC, USA.
Shreyaskumar Patel: The University of Texas MD Anderson Cancer center, Houston, TX, USA.
Kristin Redmond: Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Joost Rutges: Erasmus University Medical Center, Rotterdam, The Netherlands. ORCID
Jiong Hao Jonathan Tan: National University Hospital, Singapore, Singapore. ORCID
Ori Barzilai: Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Nicolas Dea: University of British Columbia, Vancouver, BC, Canada.
Study DesignLiterature review with clinical recommendation.ObjectiveTo provide the readers with a concise curation of the latest literature in recent advances in systemic oncological therapies and their implications for decision-making in patients with metastatic spinal disease. This review aims to enhance spine specialist's understanding of modern oncological treatments to facilitate optimal timing and planning of local interventions.MethodsThe latest literature in the topic of advances in oncology was reviewed by a multidisciplinary group of experts in metastatic spinal disease and clinical recommendations were formulated. The recommendations were dichotomously graded into strong and conditional (weak) based on the integration of scientific methodology and content expert opinion. This opinion considered experience and practical issues such as risks, burdens, costs, patient values, and circumstances.ResultsFour high-impact studies were reviewed, demonstrating significant advancements in systemic treatments for metastatic cancers commonly affecting the spine. These studies showed improved survival outcomes and efficacy across breast cancer, colorectal cancer, prostate cancer, and renal cell carcinoma. The findings have important implications for surgical/radiotherapy planning, including considerations for timing of interventions, wound healing, and the potential for extended survival affecting construct durability requirements.ConclusionsRecent advances in systemic oncological treatments have important implications for managing metastatic spinal disease. Understanding these developments is crucial for spine specialists to optimize decision-making through a multidisciplinary approach, particularly regarding timing of local interventions, strategy of the surgical approach and reconstruction.[Formula: see text].
