Integrating evidence-based medicine for treatment of spinal metastases into a decision framework: Neurologic, oncologic, mechanicals stability, and systemic disease Journal Article


Authors: Barzilai, O.; Laufer, I.; Yamada, Y.; Higginson, D. S.; Schmitt, A. M.; Lis, E.; Bilsky, M. H.
Article Title: Integrating evidence-based medicine for treatment of spinal metastases into a decision framework: Neurologic, oncologic, mechanicals stability, and systemic disease
Abstract: Patients with cancer are frequently affected by spinal metastases. Treatment is palliative, with the principle goals of pain relief, preservation of neurologic function, and improvement in quality of life. In the past decade, we have witnessed a dramatic change in the treatment paradigms due to the development of improved surgical strategies and systemic and radiation therapy. The most important change to these paradigms has been the integration of spinal stereotactic radiosurgery (SSRS), allowing delivery of tumoricidal radiation doses with sparing of nearby organs at risk. High-dose SSRS provides durable tumor control when used either as definitive therapy or as a postoperative adjuvant therapy. Integration of SSRS has fundamentally changed the indications for and type of surgery performed for metastatic spine tumors. Although the role for surgical intervention is well established, a clear trend toward less-aggressive, often minimally invasive techniques has been observed. Targeted therapies are also rapidly changing the way cancer is being treated and have demonstrated improved survival for a number of malignancies. As these treatment decisions become more complex, a multidisciplinary approach including medical oncologists, radiation oncologists, surgeons, interventionalists, and pain specialists is required. In this article, the current evidence affecting the treatment of spinal metastases is integrated into a decision framework that considers four principal assessments of a patient’s spine disease: NOMS (neurologic, oncologic, mechanical instability, and systemic disease). © 2017 by American Society of Clinical Oncology.
Journal Title: Journal of Clinical Oncology
Volume: 35
Issue: 21
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2017-07-20
Start Page: 2419
End Page: 2427
Language: English
DOI: 10.1200/jco.2017.72.7362
PROVIDER: scopus
PUBMED: 28640703
DOI/URL:
Notes: Review -- Export Date: 2 August 2017 -- Source: Scopus
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MSK Authors
  1. Eric Lis
    102 Lis
  2. Yoshiya Yamada
    357 Yamada
  3. Mark H Bilsky
    220 Bilsky
  4. Ilya Laufer
    97 Laufer