The NOMS framework: Approach to the treatment of spinal metastatic tumors Journal Article
| Authors: | Laufer, I.; Rubin, D. G.; Lis, E.; Cox, B. W.; Stubblefield, M. D.; Yamada, Y.; Bilsky, M. H. |
| Article Title: | The NOMS framework: Approach to the treatment of spinal metastatic tumors |
| Abstract: | Background. Spinal metastases frequently arise in patients with cancer. Modern oncology provides numerous treatment options that include effective systemic, radiation, and surgical options.We delineate and provide the evidence for the neurologic, oncologic, mechanical, and systemic (NOMS) decision framework, which is used at Memorial Sloan-Kettering Cancer Center to determine the optimaltherapyfor patientswithspinemetastases. Methods.Weprovide a literature review of the integral publications that serve as the basis for the NOMS framework and report the results of systematic implementation of theNOMSguided treatment. Results. TheNOMSdecision framework consists of the neurologic, oncologic, mechanical, and systemic considerations and incorporates the use of conventional externalbeamradiation, spinal stereotactic radiosurgery, and minimally invasive and open surgical interventions. Review of radiation oncology and surgical literature that examine the outcomes of treatment of spinal metastatic tumors provides support for theNOMSdecision framework. Application of the NOMS paradigm integrates multimodality therapy to optimize local tumor control, pain relief, and restoration or preservation of neurologic function and minimizes morbidity in this often systemically ill patient population. Conclusion. NOMS paradigm provides a decision framework that incorporates sentinel decision points in the treatment of spinal metastases. Consideration of the tumor sensitivity to radiation in conjunction with the extent of epidural extension allows determination of the optimal radiation treatment and the need for surgical decompression. Mechanical stability of the spine and the systemic disease considerations further help determine the need and the feasibility of surgical intervention. ©AlphaMed Press 2013. |
| Keywords: | cancer radiotherapy; radiation dose; tumor volume; postoperative complication; radiation dose fractionation; spinal cord compression; scoring system; stereotactic radiosurgery; external beam radiotherapy; cancer control; decision making; spinal cord metastasis; neurologic examination; kyphoplasty; randomized controlled trial (topic); joint stability; image guided radiotherapy; radicular pain |
| Journal Title: | The Oncologist |
| Volume: | 18 |
| Issue: | 6 |
| ISSN: | 1083-7159 |
| Publisher: | Oxford University Press |
| Date Published: | 2013-01-01 |
| Start Page: | 744 |
| End Page: | 751 |
| Language: | English |
| DOI: | 10.1634/theoncologist.2012-0293 |
| PROVIDER: | scopus |
| PUBMED: | 23709750 |
| PMCID: | PMC4063402 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 1 August 2013" - "CODEN: OCOLF" - "Source: Scopus" |
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