scholarly journals A multicenter, descriptive epidemiologic survey of the clinical features of spinal metastatic disease in China

2020 ◽  
Author(s):  
Hao-ran Zhang ◽  
Rui-qi Qiao ◽  
Xiong-gang Yang ◽  
Ming-you Xu ◽  
Yong-cheng Hu
Keyword(s):  
Primary Tumor ◽  
Spinal Metastasis ◽  
Spinal Metastases ◽  
Spinal Tumors ◽  
Tumor Type ◽  
Female Ratio ◽  
Treatment Methods ◽  
Systemic Treatments ◽  
Epidemiological Characteristics ◽  
Primary Tumor Type

Abstract Background: Spinal metastases have unique epidemiological features and treatment methods. Unfortunately, the relative scarcity of spinal metastases has limited the widespread development of descriptive epidemiological studies, especially in Asian countries. The purpose of this study was to describe the epidemiological characteristics of patients with metastatic spinal tumors in China between 2007 and 2019.Methods: From January 2007 and July 2019, data on patients with spinal metastases were collected from five cancer centers in China, and demographic characteristics, primary tumor types, segments and numbers of vertebral lesions, disease-related scores, and treatment methods were reviewed.Results: A total of 2228 patients with spinal metastases were reviewed in this study, including 1279 male patients and 949 female patients, and the male to female ratio was 1.35: 1. More than half of patients developed metastatic diseases between the ages of 50 years and 69 years (64%). Overall, lung cancer (824 cases, 37%) was the most common primary tumor type and the most common level of spinal involvement was multi-level of metastases (860 cases, 39%). 705 patients (32%) had undergone surgical treatments, 1028 patients (46%) had undergone radiotherapy for metastatic vertebrae, and 855 patients (38%) had received systemic treatments. The age, primary tumor type, number of involved vertebrae, Frankel grade, and spinal instability neoplastic score would affect the surgical decision-making.Conclusions: This study provides insight into the epidemiological characteristics of spinal metastasis and health care service utilization in spinal metastasis patients in China.

Recent advances and new discoveries in the pipeline of the treatment of primary spinal tumors and spinal metastases: A scoping review

2021 ◽  
Author(s):  
Julio C Furlan ◽  
Jefferson R Wilson ◽  
Eric M Massicotte ◽  
Arjun Sahgal ◽  
Fehlings G Michael
Keyword(s):  
Spinal Cord ◽  
Scoping Review ◽  
Clinical Studies ◽  
Spinal Metastasis ◽  
Spinal Cord Tumor ◽  
Treatment Strategies ◽  
Spinal Metastases ◽  
Spinal Tumors ◽  
Spinal Neoplasms ◽  
Primary Tumors

Abstract The field of spinal oncology has substantially evolved over the past decades. This review synthesizes and appraises what was learned and what will potentially be discovered from the recently completed and ongoing clinical studies related to the treatment of primary and secondary spinal neoplasms. This scoping review included all clinical studies on the treatment of spinal neoplasms registered in the ClinicalTrials.gov website from February/2000 to December/2020. The terms “spinal cord tumor”, “spinal metastasis”, and “metastatic spinal cord compression” were used. Of the 174 registered clinical studies on primary spinal tumors and spinal metastasis, most of the clinical studies registered in this American registry were interventional studies led by single institutions in North America (n=101), Europe (n=43), Asia (n=24) or other continents (n=6). The registered clinical studies mainly focused on treatment strategies for spinal neoplasms (90.2%) that included investigating stereotactic radiosurgery (n=33), radiotherapy (n=21), chemotherapy (n=20), and surgical technique (n=11). Of the 69 completed studies, the results from 44 studies were published in the literature. In conclusion, this review highlights the key features of the 174 clinical studies on spinal neoplasms that were registered from 2000 to 2020. Clinical trials were heavily skewed towards the metastatic population as opposed to the primary tumours which likely reflects the rarity of the latter condition and associated challenges in undertaking prospective clinical studies in this population. This review serves to emphasize the need for a focused approach to enhancing translational research in spinal neoplasms with a particular emphasis on primary tumors.

scholarly journals Prognostic factors and a new scoring system for survival of patients irradiated for bone metastases

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Dirk Rades ◽  
Rapha Haus ◽  
Steven E. Schild ◽  
Stefan Janssen
Keyword(s):  
Multivariate Analysis ◽  
Bone Metastases ◽  
Primary Tumor ◽  
Scoring System ◽  
Survival Rates ◽  
Karnofsky Performance Score ◽  
Tumor Type ◽  
Factor Scores ◽  
Survival Times ◽  
Primary Tumor Type

Abstract Background Personalized therapy for bone metastases should consider the patients’ remaining lifespan. Estimation of survival can be facilitated with scoring tools. A new tool was developed, specifically designed to estimate 12-month survival. Methods In 445 patients irradiated for bone metastases, radiotherapy regimen plus 13 factors (age, gender, Karnofsky performance score (KPS), primary tumor type, interval between cancer diagnosis and RT of bone metastases, visceral metastases, other (non-irradiated) bone metastases, sites of bone metastases, number of irradiated sites, pathological fracture, fractionation of RT, pre-RT surgery, pre-RT administration of bisphosphonates/denosumab, pre-RT systemic anticancer treatment) were retrospectively analyzed for survival. Factors achieving significance (p < 0.05) or borderline significance (p < 0.055) on multivariate analysis were used for the scoring system. Twelve-month survival rates were divided by 10 (factor scores); factor scores were summed for each patient (patient scores). Results On multivariate analysis, survival was significantly associated with KPS (hazard ratio (HR) 1.91, p < 0.001) and primary tumor type (HR 1.12, p < 0.001); age achieved borderline significance (HR 1.14, p = 0.054). These factors were used for the scoring tool. Patient scores ranged from 8 to 17 points. Three groups were designated: 8–9 (A), 10–14 (B) and 15–17 (C) points. Twelve-month survival rates were 9, 38 and 72% (p < 0.001); median survival times were 3, 8 and 24 months. Conclusions This new tool developed for patients irradiated for bone metastases at any site without spinal cord compression allows one to predict the survival of these patients and can aid physicians when assigning the treatment to individual patients.

scholarly journals Decompression surgery for spinal metastases: a systematic review

2016 ◽  
Vol 41 (2) ◽  
pp. E2 ◽  
Author(s):  
Dara Bakar ◽  
Joseph E. Tanenbaum ◽  
Kevin Phan ◽  
Vincent J. Alentado ◽  
Michael P. Steinmetz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Prospective Studies ◽  
Primary Tumor ◽  
Spinal Metastases ◽  
Neurological Function ◽  
Spinal Tumors ◽  
Decompression Surgery ◽  
Inclusion Criteria ◽  
Posterior Decompression ◽  
Wide Range

OBJECTIVE The aim of this study was to systematically review the literature on reported outcomes following decompression surgery for spinal metastases. METHODS The authors conducted MEDLINE, Scopus, and Web of Science database searches for studies reporting clinical outcomes and complications associated with decompression surgery for metastatic spinal tumors. Both retrospective and prospective studies were included. After meeting inclusion criteria, articles were categorized based on the following reported outcomes: survival, ambulation, surgical technique, neurological function, primary tumor histology, and miscellaneous outcomes. RESULTS Of the 4148 articles retrieved from databases, 36 met inclusion criteria. Of those included, 8 were prospective studies and 28 were retrospective studies. The year of publication ranged from 1992 to 2015. Study size ranged from 21 to 711 patients. Three studies found that good preoperative Karnofsky Performance Status (KPS ≥ 80%) was a significant predictor of survival. No study reported a significant effect of time-to-surgery following the onset of spinal cord compression symptoms on survival. Three studies reported improvement in neurological function following surgery. The most commonly cited complication was wound infection or dehiscence (22 studies). Eight studies reported that preoperative ambulatory or preoperative motor status was a significant predictor of postoperative ambulatory status. A wide variety of surgical techniques were reported: posterior decompression and stabilization, posterior decompression without stabilization, and posterior decompression with total or subtotal tumor resection. Although a wide range of functional scales were used to assess neurological outcomes, four studies used the American Spinal Injury Association (ASIA) Impairment Scale to assess neurological function. Four studies reported the effects of radiation therapy and local disease control for spinal metastases. Two studies reported that the type of treatment was not significantly associated with the rate of local control. The most commonly reported primary tumor types included lung cancer, prostate cancer, breast cancer, renal cancer, and gastrointestinal cancer. CONCLUSIONS This study reports a systematic review of the literature on decompression surgery for spinal metastases. The results of this study can help educate surgeons on the previously published predictors of outcomes following decompression surgery for metastatic spinal disease. However, the authors also identify significant gaps in the literature and the need for future studies investigating the optimal practice with regard to decompression surgery for spinal metastases.

Bronchioloalveolar lung CTCs retain cytomorphologic features of primary tumor type

2008 ◽  
Vol 26 (15_suppl) ◽  
pp. 19118-19118 ◽  
Author(s):  
D. Marrinucci ◽  
K. Bethel ◽  
J. M. Fisher ◽  
D. Lazar ◽  
P. Kuhn ◽  
...  
Keyword(s):  
Primary Tumor ◽  
Tumor Type ◽  
Primary Tumor Type

scholarly journals Biologic subtypes of melanoma predict survival benefit of combination anti-PD1+anti-CTLA4 immune checkpoint inhibitors versus anti-PD1 monotherapy

2021 ◽  
Vol 9 (1) ◽  
pp. e001642
Author(s):  
April A N Rose ◽  
Susan M Armstrong ◽  
David Hogg ◽  
Marcus O Butler ◽  
Samuel D Saibil ◽  
...  
Keyword(s):  
Metastatic Melanoma ◽  
Immune Checkpoint ◽  
Primary Tumor ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Advanced Melanoma ◽  
Unknown Primary ◽  
Tumor Type ◽  
Multivariable Analyses ◽  
Primary Tumor Type

PurposeAnti-programmed cell death protein 1 (PD1)±anti-cytotoxic T-lymphocyte associated protein 4 (CTLA4) immune checkpoint inhibitors (ICIs) are standard therapeutic options for metastatic melanoma. We assessed whether biologic subtype according to primary tumor type or genomic subtype can function as predictive biomarkers for anti-PD1±anti-CTLA4 ICI in patients with advanced melanoma.MethodsWe performed a single-center retrospective cohort analysis of patients who received anti-PD1±anti-CTLA4 ICI for advanced melanoma between 2012 and 2019. Primary tumor type, BRAF and NRAS mutation status, and other covariates were abstracted from chart review. Log-rank tests and multivariable Cox regression models were used to assess differences in clinical progression-free (cPFS) and overall survival (OS).ResultsWe identified 230 patients who received 249 lines of anti-PD1±anti-CTLA4 ICI for unresectable or metastatic disease. Of these patients, 74% were cutaneous, 11% mucosal, 8% unknown primary and 7% acral. BRAF and NRAS mutations were identified in 35% and 28% of patients, respectively. In multivariable analyses of the entire cohort, acral or mucosal primary tumor type, >3 metastatic sites, elevated LDH were predictive of shorter cPFS and OS. Combination ICI therapy was associated with longer cPFS (HR 0.57, 95% CI 0.38 to 0.86, p=0.007) and OS (HR 0.42, 95% CI 0.28 to 0.65, p<0.001). Combination ICI was significantly associated with longer OS in unknown primary and mucosal melanoma. There was a non-significant trend toward longer OS with anti-PD1+anti-CTLA4 in cutaneous melanoma, but not in acral melanoma. In multivariable analyses, combination ICI was associated with longer OS in NRAS (HR 0.24, 95% CI 0.10 to 0.62, p=0.003, n=69) and BRAF V600E/K (HR 0.47, 95% CI 0.24 to 0.90, p=0.024, n=86) mutant melanoma but not BRAF/NRAS wild-type (n=94) melanoma.ConclusionsIn our cohort, primary melanoma tumor type and genomic subtype were independent predictive markers of cPFS and OS for patients with metastatic melanoma receiving anti-PD1 ICI. Primary tumor type and genomic subtype—including NRAS—should be further evaluated in prospective clinical trials to determine their value as predictive markers. Biologic subtypes may facilitate clinical decision-making when recommending combination ICI treatment (anti-PD1±anti-CTLA4) versus anti-PD1 alone for patients with metastatic melanoma.

Racial and Gender Disparities and the Role of Primary Tumor Type on Inpatient Outcomes Following Craniotomy for Brain Metastases

2012 ◽  
Vol 19 (8) ◽  
pp. 2657-2663 ◽  
Author(s):  
Miriam Nuño ◽  
Debraj Mukherjee ◽  
Adam Elramsisy ◽  
Kristin Nosova ◽  
Shivanand P. Lad ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Primary Tumor ◽  
Gender Disparities ◽  
Tumor Type ◽  
Inpatient Outcomes ◽  
And Gender ◽  
Primary Tumor Type

scholarly journals Brain metastasis PD-L1 and CD8 expression is dependent on primary tumor type and its PD-L1 and CD8 status

2020 ◽  
Vol 8 (2) ◽  
pp. e000597
Author(s):  
Florian Camy ◽  
Georgia Karpathiou ◽  
Jean Marc Dumollard ◽  
Nicolas Magne ◽  
Jean Luc Perrot ◽  
...  
Keyword(s):  
Primary Tumor ◽  
Metastatic Tumor ◽  
Molecular Data ◽  
Tumor Type ◽  
Metastatic Tumors ◽  
Primary Tumors ◽  
Kaplan Meier ◽  
Product Limit ◽  
Simple Regression Analysis ◽  
Primary Tumor Type

BackgroundBrain metastases (Bmets) are frequent; however, limited data exist on the efficacy of immunotherapy in these lesions. The aims of the study were to analyze the immunohistochemical expressions of programmed death ligand 1 (PD-L1) and CD8 in Bmets and to compare them with their expressions in paired primary tumors, as well as correlate the results with clinicopathological features.MethodsThis is a retrospective study of 233 patients with Bmets and 111 paired primaries. Clinical, histological, and molecular data were recorded and compared with the immunohistochemical results of PD-L1 and CD8 expressions. The statistical analysis included χ2 test, Cramer’s V test, factorial analyses of variance, simple regression analysis, and Kaplan-Meier analysis with log-rank product limit estimation.ResultsPD-L1 expression was found in 23.6% of Bmets and in 29.0% of primary tumors with concordant expression between them in 75.5% of cases. Bmets PD-L1 expression was associated with primary tumor PD-L1 expression and the primary tumor type. Significant CD8 peritumoral expression was found in 68.6% of Bmets and in 87.7% of primary tumors. CD8 expression was concordant between primary and metastatic tumors in 73.3% of cases. Bmets CD8 expression was associated with primary tumor CD8 expression and primary tumor type. PD-L1 expression was associated with CD8 expression in both primary and metastatic tumors. The concordance between primary and metastatic tumor PD-L1 expression was independent of all factors studied. The concordance between primary and metastatic CD8 expressions was marginally associated to the time of Bmets development. No prognostic role for PD-L1 and CD8 expression in Bmets was found.ConclusionPD-L1 and CD8 Bmets expressions are associated with the primary tumor type and its PD-L1 and CD8 expressions. No factor predicts the discordance for PD-L1 expression, while time to Bmets development is associated with CD8 expression discordance.

A clinical score (CS) for patients with well-differentiated neuroendocrine tumors (WD NETs) under consideration for peptide receptor radionuclide therapy (PRRT) with Lu 177-dotatate.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 363-363
Author(s):  
Satya Das ◽  
Liping Du ◽  
Aimee Schad ◽  
Shikha Jain ◽  
Aaron Jessop ◽  
...  
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Primary Tumor ◽  
Multivariable Analysis ◽  
Cox Proportional Hazards Model ◽  
Tumor Board ◽  
Cancer Center ◽  
Tumor Type ◽  
Primary Tumor Site ◽  
Point Increase ◽  
Systemic Treatments

363 Background: Despite the benefit of PRRT for patients with WD NETs, questions remain regarding sequencing and optimal patient selection for the treatment. We developed a CS at Vanderbilt Ingram Cancer Center (VICC) that we hoped would predict outcomes for patients with WD NETs receiving PRRT. Methods: Patients with progressive WD NETs (N = 146) under consideration for PRRT with Lu 177-dotatate between 3/1/2016-3/17/2020 at VICC (N = 122) and Rush Medical Center (RMC) (N = 24) were scored. The CS included 5 categories: available non-PRRT treatments for tumor type, prior systemic treatments, patient symptoms, tumor burden in critical organs and peritoneal carcinomatosis presence. All categories were scored from 0-2 except the peritoneal carcinomatosis category which was scored from 0-1; scoring criteria were determined by the VICC NET tumor board. All patients at VICC were prospectively scored, while patients from RMC were scored retrospectively with the investigator blinded to patient outcomes. The primary outcome, progression-free survival (PFS) was estimated by the Kaplan‐Meier method; a Cox proportional‐hazards model adjusting primary tumor site, tumor grade and number of PRRT doses administered (none, 1-2 doses or 3-4 doses) was used to analyze effect of CS. Results: Median patient age was 62.7 while median CS was 5 (range 1-8); the most common primary tumor sites were small intestinal (N = 81) and pancreatic (N = 37). A total of 101 patients and 31 patients received 3-4 doses and no doses of PRRT, respectively. On multivariable analysis, in patients treated with 3-4 doses of PRRT, for each 2-point increase in CS, the estimated hazard ratio (HR) for PFS was 3.26 (95% confidence interval (CI) 2.05-5.19). On multivariable analysis, in patients who received no doses of PRRT, for each 2-point increase in CS, the estimated HR for PFS was 1.37 (95% CI .78-2.41). Conclusions: Among patients treated with 3-4 doses PRRT, those with lower CS had better PFS with the treatment compared to patients with higher CS. This PFS difference, based upon CS, was not observed in patients who did not receive PRRT, suggesting the predictive utility of the CS for patients with WD NETs receiving PRRT with Lu 177-dotatate. Though the CS needs to be validated, it is the first of its kind reported.

scholarly journals Trifluridine/tipiracil in patients with metastatic gastroesophageal junction cancer: a subgroup analysis from the phase 3 TAGS study

2021 ◽  
Author(s):  
Wasat Mansoor ◽  
Hendrik-Tobias Arkenau ◽  
Maria Alsina ◽  
Kohei Shitara ◽  
Peter Thuss-Patience ◽  
...  
Keyword(s):  
Primary Tumor ◽  
Gastroesophageal Junction ◽  
Best Supportive Care ◽  
Tumor Type ◽  
Phase 3 ◽  
Gastroesophageal Junction Cancer ◽  
Disease Site ◽  
Previously Treated ◽  
Grade 3 ◽  
Primary Tumor Type

Abstract Background Patients with advanced gastroesophageal junction cancer (GEJC) have poor survival outcomes, and GEJC-specific data from trials evaluating agents in gastric cancers (GCs) as a whole are lacking. Trifluridine/tipiracil (FTD/TPI) was approved for previously treated metastatic GC or GEJC (mGC/mGEJC) based on results of the phase 3 TAGS trial. Subgroup analyses by primary tumor type (GC or GEJC) in TAGS are reported here. Methods Pa tients with mGC/mGEJC treated with  ≥ 2 prior chemotherapy regimens were randomized (2:1) to receive FTD/TPI or placebo, plus best supportive care. A pre-planned sub-analysis was performed to evaluate efficacy and safety outcomes by primary tumor type (GEJC or GC). Results Of 507 randomized patients, 145 (29%) had GEJC and 360 (71%) had GC as the primary disease site. Baseline characteristics were generally similar between the GEJC and GC subgroups, except that more patients in the GEJC subgroup had received  ≥ 3 prior regimens (72 vs. 59% in the GC subgroup). Survival benefit with FTD/TPI was observed in both subgroups. The overall survival hazard ratio for FTD/TPI vs placebo was 0.75 (95% CI 0.50–1.11) and 0.67 (95% CI 0.52–0.87) in the GEJC and GC subgroups, respectively. Grade ≥ 3 adverse events of any cause were reported in 75 (77%) and 192 (81%) FTD/TPI-treated patients in the GEJC and GC subgroups, respectively. No new safety concerns were noted with FTD/TPI. Conclusion As in patients with GC, FTD/TPI showed an efficacy benefit in patients with GEJC in the TAGS trial, along with demonstrating a manageable safety profile.

COMPLICATIONS OF SURGICAL TREATMENT OF SPINAL METASTASES

2021 ◽  
Vol 20 (4) ◽  
pp. 300-304
Author(s):  
Priscila Barile Marchi Candido ◽  
Fernanda Maris Peria ◽  
Vinicius Nogueira Toledo ◽  
Herton Rodrigo Tavares Costa ◽  
Helton Luiz Aparecido Defino
Keyword(s):  
Retrospective Study ◽  
Surgical Treatment ◽  
Spinal Metastasis ◽  
Spinal Metastases ◽  
Tumor Location ◽  
Karnofsky Performance Scale ◽  
Tumor Type ◽  
Level Of Evidence ◽  
Epidural Compression ◽  
Performance Scale

ABSTRACT Objectives: To evaluate the complications of surgical treatment in a group of patients with spinal metastasis with epidural compression, undergoing surgical treatment. Methods: This is a comparative retrospective study (level of evidence III), which evaluated 96 patients with spinal metastases undergoing surgical treatment. Intra- and postoperative complications were obtained from the patients’ medical records and correlated with the following clinical characteristics: tumor type, tumor location, neurological deficit, age, number of affected vertebrae, Tokuhashi scale, Tomita scale, Karnofsky performance scale, and type of approach. Results: Complications of surgical treatment were observed in 29 (30.20%) patients. Surgical wound infection was the most frequent complication, observed in 15% of patients. Conclusions: Surgical treatment of spinal metastases presents complications in about 30% of patients and their occurrence should be considered in the treatment planning, weighing the risks and benefits for achieving the treatment goals. Level III evidence; Retrospective Study.

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