Raphaële Charest-Morin1, Charles G Fisher1, Ann L Versteeg2, Arjun Sahgal3, Peter Pal Varga4, Daniel M Sciubba5, James M Schuster6, Michael H Weber7, Michelle J Clarke8, Laurence D Rhines9, Stefano Boriani10, Chetan Bettegowda5, Michael G Fehlings11, Paul M Arnold12, Ziya L Gokaslan13, Nicolas Dea1. 1. Department of Orthopaedics, Division of Spine, University of British Columbia and Vancouver General Hospital, Vancouver, BC, Canada. 2. Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, Netherlands. 3. Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada. 4. National Center for Spinal Disorders and Buda Health Center, Budapest, Hungary. 5. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 6. Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. 7. Department of Orthopaedic Surgery, McGill University, Montreal, Qc, Canada. 8. Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA. 9. Department of Neurosurgery, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA. 10. IRCCS Galeazzi Orthopedic Inst, Milan, Italy. 11. Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada. 12. Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS, USA. 13. Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
Abstract
BACKGROUND: Sacral metastases are rare and literature regarding their management is sparse. This multicenter, prospective, observational study aimed to determine health related-quality of life (HRQOL) and pain in patients treated for sacral metastases with surgery and/or radiation therapy (RT). The secondary objectives were to describe the adverse event (AE) profile and change in neurologic function in this population. METHODS: Twenty-three patients presenting with symptomatic sacral metastases were identified from the Epidemiology, Process and Outcomes of Spine Oncology (EPOSO) dataset, a prospective multicenter study on spinal metastases. Patients requiring surgery and/or RT between August 2013 and February 2017 were prospectively enrolled. HRQOL, assessed by the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQv2.0), the Short Form-36 version 2 (SF-36v2), and the EuroQol-5Dimension (EQ-5D) was documented at baseline, 6 weeks, 3 and 6 months post-treatment. Pain numeric rating scale (NRS), AEs, lower extremities motor score (ASIA), and bowel and bladder function were also recorded. RESULTS: Eight patients underwent surgery ± RT and 15 patients underwent RT alone. Mean age was 59.3 (SD 11.7) years and 13 patients were female. At 6 months, 3 (37.5%) surgical patients and 2 (13.3%) RT patients were deceased. There was a trend showing that surgical patients had worse baseline HRQOL and pain. Pain NRS, EQ-5D, SOSGOQv2.0, and the mental component of the SF-36v2 showed improvement, irrespective of treatment (P>0.05). Ten AEs occurred in the surgical cohort, dominated by wound complications (n=3). Bowel and bladder function improved at 6 weeks in both groups. CONCLUSIONS: Surgical treatment and RT are both valid treatment options for symptomatic sacral metastases. Improvement in HRQOL can be expected with an acceptable AE rate.
BACKGROUND: Sacral metastases are rare and literature regarding their management is sparse. This multicenter, prospective, observational study aimed to determine health related-quality of life (HRQOL) and pain in patients treated for sacral metastases with surgery and/or radiation therapy (RT). The secondary objectives were to describe the adverse event (AE) profile and change in neurologic function in this population. METHODS: Twenty-three patients presenting with symptomatic sacral metastases were identified from the Epidemiology, Process and Outcomes of Spine Oncology (EPOSO) dataset, a prospective multicenter study on spinal metastases. Patients requiring surgery and/or RT between August 2013 and February 2017 were prospectively enrolled. HRQOL, assessed by the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQv2.0), the Short Form-36 version 2 (SF-36v2), and the EuroQol-5Dimension (EQ-5D) was documented at baseline, 6 weeks, 3 and 6 months post-treatment. Pain numeric rating scale (NRS), AEs, lower extremities motor score (ASIA), and bowel and bladder function were also recorded. RESULTS: Eight patients underwent surgery ± RT and 15 patients underwent RT alone. Mean age was 59.3 (SD 11.7) years and 13 patients were female. At 6 months, 3 (37.5%) surgical patients and 2 (13.3%) RT patients were deceased. There was a trend showing that surgical patients had worse baseline HRQOL and pain. Pain NRS, EQ-5D, SOSGOQv2.0, and the mental component of the SF-36v2 showed improvement, irrespective of treatment (P>0.05). Ten AEs occurred in the surgical cohort, dominated by wound complications (n=3). Bowel and bladder function improved at 6 weeks in both groups. CONCLUSIONS: Surgical treatment and RT are both valid treatment options for symptomatic sacral metastases. Improvement in HRQOL can be expected with an acceptable AE rate.
Entities:
Keywords:
Sacral metastases; adverse events (AEs); health related-quality-of-life (HRQOL); radiation therapy (RT); surgery