Metastasis Bone Tumor at Spine

8/12/2019 Metastasis Bone Tumor at Spine

1/53

METASTASIS BONE TUMOR AT SPINE

Kiki A. Rizki

Surgical Oncology Division,

Departement of Surgery Hasan Sadikin Hospital Bnadung


2/53

Introduction

Metastases to the spine are a common problemin a large oncology center

Between 5% and 10% of all cancer patientsdevelop spinal metastases during the course oftheir disease.

The vertebral column is the most common site forbony metastases, with an incidence of 30% to70% in patients with metastatic neoplasms.


3/53

Common Primary Sites

Breast (21%)

Lung (14%)

Prostate (7.5%) Renal (5%)

GI (5%)

Thyroid (2.5%)


4/53

Estimated New Cancer Cases* in the US in 2013


5/53

Level of Metastases

Thoracolumbar 70%

Lumbosacral 20%

Cervical 10%


6/53

Clinical Presentation

Pain (85%)

Hyperemia, expansion, nerve compression,cord compression, pathologic fractures &

instability

Weakness (34%)

Spinal cord compression in 20%

Mass (13%)

Constitutional Symptoms


7/53


8/53


9/53


10/53


11/53


12/53

AIM THERAPY

Therapeutic intervention can alleviate pain,

preserve or improve neurologic function,

achieve mechanical stability, optimize local

tumor control, and improve quality of life


13/53


14/53


15/53


16/53


17/53


18/53


19/53


20/53


21/53


22/53


23/53

O t l t T t d Th R d


24/53

Osteoclast-Targeted Therapy Reduces

SREs in Breast Cancer


25/53


26/53


27/53


28/53


29/53


30/53


31/53


32/53


33/53


34/53


35/53


36/53


37/53

SURGERY

Axial pain secondary to mechanical instability

can causes significant morbidity.

With the advancement in spinal stabilization,

satisfactory neurologic improvement occurs in

48-88% of patients, with 80-100% rates of

pain relief.


38/53

SURGERY

Radical surgery not only provides stabilization,

it also confers tissue diagnosis and reduces

tumor burden.


39/53

SURGERY


40/53

HORMONE THERAPY

Women with metastatic disease that are ER

and/or PR positive are appropriate candidates

for initial endocrine therapy.


41/53


42/53

CHEMOTHERAPY

Single agent vs combination regimen

Combination chemotherapy is, however,

associated with an increase in toxicity, and is oflittle survival benefit

Standard clinical practice is to continue first-linechemotherapy until progression


43/53


44/53

SUMMARY

The vertebral column is the most common site for bonymetastases

Patients with metastatic spinal tumors may present with

pain, neurologic deficit, or both.

Therapeutic intervention can alleviate pain, preserve orimprove neurologic function, achieve mechanical stability,optimize local tumor control, and improve quality of life.

Treatment options available for metastatic spine tumorsinclude radiation therapy (RT), surgery, hormone therapyand chemotherapy.


45/53

THANK YOU


46/53


47/53


48/53

In premenopausal women, endocrine therapies :

selective ER modulators (tamoxifen ortoremifene);

luteinizing hormone-releasing hormone (LHRH)agonists (goserelin and leuprolide);

surgical or radiotherapeutic oophorectomy;

progestin (megestrol acetate);

androgens (fluoxymesterone);

high-dose estrogen (ethinyl estradiol).


49/53

For postmenopausal women who are

antiestrogen naive or who are more than 1

year from previous antiestrogen therapy, the

options include either an aromatase inhibitor,selective ER modulator, or an ER down-

regulator.


50/53


51/53


52/53


53/53

Documents

Metastasis Bone Tumor at Spine