Patient-Reported Outcomes–Secondary Analysis of the SCORE-2 Trial Comparing 4 Gy × 5 to 3 Gy × 10 for Metastatic Epidural Spinal Cord Compression

Abstract Background Patient-reported outcomes (PRO) represent an important measure of cancer therapy effect. For patients with metastatic epidural spinal cord compression (MESCC), hybrid therapy using separation surgery and stereotactic radiosurgery preserves neurologic function and provides tumor control. There is currently a paucity of data reporting PRO after such combined modality therapy for MESCC. Delineation of hybrid surgery–radiosurgery therapy effect on PRO validates the hybrid approach as an effective therapy resulting in meaningful symptom relief. Patients and Methods Brief Pain Inventory (BPI) and MD Anderson Symptom Inventory—Spine Tumor (MDASI-SP), PROs validated in the cancer population, were prospectively collected. Patients with MESCC who underwent separation surgery followed by stereotactic radiosurgery were included. Separation surgery included a posterolateral approach without extensive cytoreductive tumor excision. A median postoperative radiosurgery dose of 2700 cGy was delivered. The change in PRO 3 months after the hybrid therapy represented the primary study outcome. Preoperative and postoperative evaluations were analyzed using the Wilcoxon signed-rank test for matched pairs. Results One hundred eleven patients were included. Hybrid therapy resulted in a significant reduction in the BPI items “worst” and “right now” pain (P < .0001), and in all BPI constructs (severity, interference with daily activities, and pain experience, P < .001). The MDASI-SP demonstrated reduction in spine-specific pain severity and interference with general activity (P < .001), along with decreased symptom interference (P < .001). Conclusions Validated PRO instruments showed that in patients with MESCC, hybrid therapy with separation surgery and radiosurgery results in a significant decrease in pain severity and symptom interference. These prospective data confirm the benefit of hybrid therapy for treatment of MESCC and should facilitate referral of patients with MESCC for surgical evaluation.

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178 Hybrid Surgery-Radiosurgery Therapy for Metastatic Epidural Spinal Cord Compression (MESCC): A Prospective Evaluation Using Patient-Reported Outcomes

Neurosurgery ◽

10.1093/neuros/nyx417.178 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 246-247

Author(s):

Ori Barzilai ◽

Mary Kate Amato ◽

Lily McLaughlin ◽

Anne Reiner ◽

Shahiba Ogilvie ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Patient Reported Outcomes ◽

Cord Compression ◽

Pain Severity ◽

Primary Study ◽

Hybrid Surgery ◽

Hybrid Therapy ◽

Therapy Effect ◽

Patient Reported

Abstract INTRODUCTION Patient-reported outcomes (PRO) represent an important measure of cancer therapy effect. For patients with metastatic epidural spinal cord compression (MESCC), hybrid therapy using separation surgery and stereotactic radiosurgery (SRS) preserves neurologic function and provides tumor control. There is currently a paucity of data reporting PRO after such combined modality therapy for MESCC. Delineation of hybrid surgery-radiosurgery therapy effect on PRO validates the hybrid approach as an effective therapy resulting in meaningful symptom relief. METHODS Brief Pain Inventory (BPI) and MD Anderson Symptom Inventory Spine Tumor (MDASI-SP), PROs validated in the cancer population, were prospectively collected. Patients with MESCC who underwent separation surgery followed by SRS were included. Separation surgery included a posterolateral approach without extensive cytoreductive tumor excision. A median post-operative radiosurgery dose of 2700 cGy was delivered. The change in PRO three months after the hybrid therapy represented the primary study outcome. Pre- and post-operative evaluations were analyzed using the Wilcoxon signed-rank test for matched pairs. RESULTS >One hundred and eleven patients were included. Hybrid therapy resulted in a significant reduction in the BPI items “worst” and “right now” pain (P < 0.0001), and in all BPI constructs (severity, interference with daily activities, and Pain Experience, P < 0.001). The MDASI-SP demonstrated reduction in spine specific pain severity and interference with general activity (P < 0.001), along with decreased symptom interference (P < 0.001). CONCLUSION Validated PRO instruments showed that in patients with MESCC, hybrid separation surgery-radiosurgery therapy results in a significant decrease in pain severity and symptom interference. These prospective data confirm the benefit of hybrid therapy for treatment of MESCC and should facilitate referral of patients with MESCC for surgical evaluation.

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Patient reported upper gastro-intestinal symptoms associated with fractionated image-guided conformal radiotherapy for metastatic spinal cord compression

Technical Innovations & Patient Support in Radiation Oncology ◽

10.1016/j.tipsro.2019.11.008 ◽

2020 ◽

Vol 13 ◽

pp. 1-5

Author(s):

Vanja Gram ◽

Lotte Stubkjær Fog ◽

Mette Hemer ◽

Helle Pappot ◽

Marianne C. Aznar ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Conformal Radiotherapy ◽

Cord Compression ◽

Metastatic Spinal Cord Compression ◽

Image Guided ◽

Patient Reported ◽

Intestinal Symptoms

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Factors associated with adjacent-level tumor progression in patients receiving surgery followed by radiosurgery for metastatic epidural spinal cord compression

Neurosurgical FOCUS ◽

10.3171/2021.2.focus201097 ◽

2021 ◽

Vol 50 (5) ◽

pp. E15

Author(s):

Vikram B. Chakravarthy ◽

Hammad A. Khan ◽

Shaarada Srivatsa ◽

Todd Emch ◽

Samuel T. Chao ◽

...

Keyword(s):

Spinal Cord ◽

Tumor Progression ◽

Spinal Cord Compression ◽

Subgroup Analysis ◽

Cord Compression ◽

Tumor Type ◽

Adjacent Level ◽

Factors Associated ◽

Patient Reported ◽

Index Level

OBJECTIVE Separation surgery followed by spine stereotactic radiosurgery (SSRS) has been shown to achieve favorable rates of local tumor control and patient-reported outcomes in patients with metastatic epidural spinal cord compression (MESCC). However, rates and factors associated with adjacent-level tumor progression (ALTP) in this population have not yet been characterized. The present study aimed to identify factors associated with ALTP and examine its association with overall survival (OS) in patients receiving surgery followed by radiosurgery for MESCC. METHODS Thirty-nine patients who underwent separation surgery followed by SSRS for MESCC were identified using a prospectively collected database and were retrospectively reviewed. Radiological measurements were collected from preoperative, postoperative, and post-SSRS MRI. Statistical analysis was conducted using the Kaplan-Meier product-limit method and Cox proportional hazards test. Subgroup analysis was conducted for patients who experienced ALTP into the epidural space (ALTP-E). RESULTS The authors’ cohort included 39 patients with a median OS of 14.7 months (range 2.07–96.3 months). ALTP was observed in 16 patients (41.0%) at a mean of 6.1 ± 5.4 months postradiosurgery, of whom 4 patients (10.3%) experienced ALTP-E. Patients with ALTP had shorter OS (13.0 vs 17.1 months, p = 0.047) compared with those without ALTP. Factors associated with an increased likelihood of ALTP included the amount of bone marrow infiltrated by tumor at the index level, amount of residual epidural disease following separation surgery, and prior receipt of radiotherapy at the index level (p < 0.05). Subgroup analysis revealed that primary tumor type, amount of preoperative epidural disease, time elapsed between surgery and radiosurgery, and prior receipt of radiotherapy at the index level were significantly associated with ALTP-E (p < 0.05). CONCLUSIONS To the authors’ knowledge, this study is the first to identify possible risk factors for ALTP, and they suggest that it may be associated with shorter OS in patients receiving surgery followed by radiosurgery for MESCC. Future studies with higher power should be conducted to further characterize factors associated with ALTP in this population.

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