The NOMS approach to metastatic tumors: Integrating new technologies to improve outcomes Review
| Authors: | Newman, W. C.; Larsen, A. G.; Bilsky, M. H. |
| Review Title: | The NOMS approach to metastatic tumors: Integrating new technologies to improve outcomes |
| Abstract: | Treatment paradigms for patients with spine metastases have evolved significantly over the past two decades. The most transformative change to these paradigms has been the integration of spinal stereotactic radiosurgery (sSRS). sSRS allows for the delivery of tumoricidal radiation doses with sparing of nearby organs at risk, particularly the spinal cord. Evidence supports the safety and efficacy of radiosurgery as it currently offers durable local tumor control with low complication rates even for tumors previously considered radioresistant to conventional external beam radiation therapy. The role for surgical intervention remains consistent, but a trend has been observed toward less aggressive, often minimally invasive techniques. Using modern technologies and improved instrumentation, surgical outcomes continue to improve with reduced morbidity. Additionally, targeted agents such as biologics and checkpoint inhibitors have revolutionized cancer care by improving both local control and patient survival. These advances have brought forth a need for new prognostication tools and a more critical review of long-term outcomes. The complex nature of current treatment schemes necessitates a multidisciplinary approach including surgeons, medical oncologists, radiation oncologists, interventionalists and pain specialists. This review recapitulates the current state-of-the-art, evidence-based data on the treatment of spinal metastases and integrates these data into a decision framework, NOMS, which is based on four sentinel pillars of decision making in metastatic spine tumors: Neurological status, Oncologic tumor behavior, Mechanical stability, and Systemic disease burden and medical co-morbidities. © 2023 SECOT |
| Keywords: | spinal cord; spinal metastases; noms |
| Journal Title: | Revista Espanola de Cirugia Ortopedica y Traumatologia |
| Volume: | 67 |
| Issue: | 6 |
| ISSN: | 1888-4415 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2023-11-01 |
| Start Page: | 487 |
| End Page: | 499 |
| Language: | English, Spanish |
| DOI: | 10.1016/j.recot.2023.04.008 |
| PROVIDER: | scopus |
| PUBMED: | 37116749 |
| DOI/URL: | |
| Notes: | The Spanish translation of the title is "El enfoque de NOMS para los tumores metastásicos: integración de nuevas tecnologías para mejorar los resultados" and be accessed via DOI: 10.1016/j.recot.2023.08.013 -- Source: Scopus |
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