Breaking News
February 20, 2018 - Safe sleep recommendations for parents that may help reduce child’s risk of SUID
February 20, 2018 - Why Do So Few Docs Have Buprenorphine Waivers?
February 20, 2018 - Low levels of alcohol good for the brain
February 20, 2018 - Experimental treatment improves invisible symptoms of a man with spinal cord injury
February 20, 2018 - Myriad’s EndoPredict offers better prediction of breast cancer recurrence, analysis shows
February 20, 2018 - Researchers identify fifteen genes that determine our facial features
February 20, 2018 - Morning Break: New Health IT Player; Luxturna No Bargain; Nuclear Freakout
February 20, 2018 - How does it compare? Hospice care at home, at assisted living facility, at nursing home
February 19, 2018 - Scientists develop water-soluble warped nanographene for bioimaging
February 19, 2018 - It’s Not Your Imagination: You’re Hungrier After Losing Weight
February 19, 2018 - Antihypertensive Use At Delivery Rising in Preeclampsia
February 19, 2018 - A centuries-old math equation used to solve a modern-day genetics challenge
February 19, 2018 - Liquid biopsies could be used as new predictive marker for metastatic TNBC
February 19, 2018 - Russian researchers develop new multi-layered biodegradable scaffolds
February 19, 2018 - Are ‘Vaccine Skeptics’ Responsible for Flu Deaths?
February 19, 2018 - Hidden genetic effects behind immune diseases may be missed, study suggests
February 19, 2018 - Emergency nurses experience regular verbal and physical abuse
February 19, 2018 - Study sheds light on biology that guides behavior across different stages of life
February 19, 2018 - Morning Break: Transgender Breast Feeding; Brazilian ‘Pro-Vaxxers’; Post-Stroke Exercise
February 19, 2018 - Meningitis vaccination strategy in Africa found to be effective, economical
February 19, 2018 - Researchers uncover how excess calcium may influence development of Parkinson’s disease
February 19, 2018 - Psoriasis drug also effective at reducing aortic inflammation
February 19, 2018 - Excess emissions can make serious contributions to air pollution, study shows
February 19, 2018 - Researchers reveal potential biological roots behind individuality
February 19, 2018 - Diabetes Drugs Differ on HF; School-Based Obesity Program Flop; Plaque Type in ACS
February 19, 2018 - Surgical infections linked to drug-resistant bugs, study suggests
February 19, 2018 - Poor awareness may hinder a child’s early dental care
February 19, 2018 - Research finds rising trend in incidence of merkel cell carcinoma
February 19, 2018 - Researchers uncover Ras protein’s role in uncontrolled cancer growth
February 19, 2018 - FDA Approves Apalutamide (Erleada) to Help Curb a Tough-to-Treat Prostate Cancer
February 19, 2018 - Educational Tool Boosts Cervical Length Screening
February 19, 2018 - Spider’s web inspires removable implant that may control type 1 diabetes
February 19, 2018 - Scientists develop fluorescent probe to identify cancer stem cells
February 19, 2018 - University Hospital of Santiago de Compostela participates in large pancreatic cancer study
February 19, 2018 - New blood test shows promise to revolutionize diagnosis of tick-borne diseases
February 19, 2018 - Report: Use, Not Price, Drives State Health Costs
February 19, 2018 - Emergency services crews often unprepared for diabetic crises
February 19, 2018 - Scientists in Sweden create DNA nanowires that offer hope for treatment of diseases
February 19, 2018 - ID Break: Clean Hands, Fewer Abx; $11 Million HIV Cure?; MenB Vax for Kids
February 19, 2018 - Patient exposure to X-rays depends on how dentists are paid
February 19, 2018 - Study reveals parents’ views toward children’s tanning bed use
February 19, 2018 - Shot may help reduce risk of shingles
February 19, 2018 - FDA approves first treatment to reduce risk of NSCLC progression
February 19, 2018 - FDA Expands Approval of Imfinzi (durvalumab) to Reduce the Risk of Non-Small Cell Lung Cancer Progressing
February 19, 2018 - D.C. Week: Congress Passes Spending Bill
February 19, 2018 - Heart-muscle patches made with human cells improve heart attack recovery
February 19, 2018 - FDA Approves First Blood Test to Detect Concussions
February 19, 2018 - Survival Bump in Bladder Cancer with Keytruda
February 18, 2018 - Scientists describe the mechanism of heart regeneration in the zebrafish
February 18, 2018 - Scientists uncover the structure of microtubule motor proteins
February 18, 2018 - Light-activated cancer drugs without toxic side effects are closer to becoming reality
February 18, 2018 - Pioneering research could provide novel insight into how genomic information is read
February 18, 2018 - Pearls From: David Putrino, PhD
February 18, 2018 - Researchers uncover how cancer stem cells drive triple-negative breast cancer
February 18, 2018 - Morning Break: Anti-Anti-Vaxxers; Private Piercings Prohibited; A Case for Pelvic Massage
February 18, 2018 - Lower-dose radiation effective, safe for HPV+ head and neck cancer after induction chemo
February 18, 2018 - Specialist residential service for adults with autism opens in Swansea
February 18, 2018 - FDA Moves to Limit Loperamide Doses per Package
February 18, 2018 - Alcohol use disorder – Genetics Home Reference
February 18, 2018 - Autism might be better detected using new two-minute questionnaire
February 18, 2018 - Hand hygiene-intervention practices may reduce risk of infection among nursing home patients
February 18, 2018 - Researchers develop most sophisticated mini-livers to date
February 18, 2018 - Obamacare Helped More Young Women Get Prenatal Care: Study
February 18, 2018 - School-Based Program Fails to Dent Kids’ Obesity
February 18, 2018 - Research compares neural activity in children with and without autism spectrum disorder
February 18, 2018 - Poor fitness levels increase the risk dementia, concludes study
February 18, 2018 - Risk Score May Reveal if Kids are Victims of Ill-Treatment
February 18, 2018 - Adding Folic Acid to Corn Masa Flour May Prevent Birth Defects
February 18, 2018 - Acute treatment suppresses posttraumatic arthritis in ankle injury
February 18, 2018 - A Role for Budesonide in Autoimmune Hepatitis?
February 18, 2018 - Lupus patients exhibit altered cell proteins, a discovery with potential implications for diagnostics
February 18, 2018 - Muscle plays vital role in regulating heat loss from the hands
February 18, 2018 - High-tech brain scans can provide new way to define intelligence
February 18, 2018 - Study reveals the association between ultra-processed foods and cancer
February 18, 2018 - Prescription Opioid Use Tied to Higher Pneumonia Risk
February 18, 2018 - A non-invasive method to detect Alzheimer’s disease
February 18, 2018 - Deletion of specific enzyme leads to improvement in memory and cognitive functions
February 18, 2018 - Amyloid protein may be transmitted through neurosurgical instruments, study suggests
February 18, 2018 - Electric brain signals of males and females show differences
February 18, 2018 - American Heart Association commends McDonald’s for offering healthier menu in kids’ meals
New algorithm provides personalized treatment approach for patients with metastatic spine cancer

New algorithm provides personalized treatment approach for patients with metastatic spine cancer

image_pdfDownload PDFimage_print

Every kind of cancer can spread to the spine, yet two physician-scientists who treat these patients describe a paucity of guidance for effectively providing care and minimizing pain.

To resolve the confusion and address the continually changing landscape of spine oncology, a recent Michigan Medicine-led publication details a guide to explain the management of spinal metastases.

Published in The Lancet Oncology, the work is the result of reviewing all of the existing studies and pulling in experts from across the world to provide insight. The goal, says senior author Nicholas Szerlip, M.D., a neurosurgeon at the University of Michigan, is to get all providers on the same page.

First author Daniel Spratt, M.D., who with Szerlip co-founded U-M’s multidisciplinary spine oncology clinic, says patients with spine metastases are commonly managed in silos without integrated care. A patient with a spine metastasis might see a variety of subspecialty doctors. Recommendations could range from pain management to more aggressive treatment, and referring providers don’t always know what will come out of a referral to spine oncology experts, or when a referral is necessary.

“Spine oncology is such a multidisciplinary pathology,” says Szerlip, an associate professor. “We wanted to form a transparent understanding so everyone, from the oncologists and primary care providers to fellow neurosurgeons who aren’t specifically trained on this, could lean on one algorithm in language we can all understand.”

Spratt describes the algorithm, a report from the researchers’ new International Spine Oncology Consortium, as a step-by-step method designed to help comprehensively manage these patients as they grow in number and their life spans lengthen after diagnosis. He says the goal is to help providers treat the patient and not just the tumor, taking into account the patient’s performance status, life expectancy, burden of systemic disease and available treatment options.

“Most of the frameworks that have been available prior to this have focused on just surgery or just radiation,” Spratt says. “This algorithm integrates all of the specialties together, including PM&R, radiology and medical oncology, to provide a much more personalized treatment approach for patients with metastatic cancer to the spine.”

A different approach

Cancer can spread widely through the body, yet this algorithm specifically focuses on metastases to the spine. Researchers say a metastasis in the spine throws a wrench in typical treatment plans because of the sensitivity of the spinal cord. Quality of life can worsen much faster.

“A spine metastasis causes a lot of pain,” Szerlip says. “People can live with metastases in other areas of the body without much discomfort, but bone pain hurts a lot, and the ability to treat a tumor near the spinal cord is less. Surgeries on other bones are much easier than surgeries on the spine, and less morbid.”

Popular treatment paths address both the neurologic benefit and the oncologic benefit. That might mean a surgical decompression of the tumor, followed by radiation to attempt to control the cancer. Spratt is particularly excited about offering spine stereotactic body radiotherapy (SBRT), a form of high-dose radiation that requires just one to three treatments. Conventional radiation results in only about a 50 percent reduction in pain three months after treatment, and the cancer is eliminated for only a short time. Spratt says spine SBRT is a game changer, showing greater than 90 percent pain reduction and more effectively controlling tumor growth beyond one year post-treatment.

“With this technique, you’ve basically spared the spinal cord so you can give a much higher dose just millimeters away,” he says.

Patients are living longer

Most patients who present with metastatic spine cancer know they have cancer and have had it for some time, Szerlip says. The cancers that most often lead to spine metastasis tend to be renal cell, breast, prostate, sarcoma and lung, the researchers say.

But not all patients who could benefit from a spine oncology clinic will set foot inside one. Szerlip and Spratt say their algorithm will also raise awareness for doctors who care for people with metastatic spine cancer.

“If you look back 10 or 20 years, you’d see people with spine metastasis lived in the order of months,” Spratt says. “Now, with new systemic therapies, targeted therapies and immunotherapies, it may be years.”

That means there is more opportunity to treat the cancer, to manage the patient’s comfort and to prevent painful and debilitating compression that can result after a period of living with a tumor pressing on your spinal cord.

Szerlip says not long ago, physicians were much less likely to send a spinal metastasis patient to a neurosurgeon because of the high morbidity of surgeries. Now, he says, spine oncology clinics can offer additional options and surgical procedures with less morbidity than in the past. However, these huge surgeries are still highly morbid.

A long-term project

The algorithm that leads to these treatment decisions takes the user through a series of steps starting with an assessment of life expectancy. Then, the systemic burden of the disease is considered, followed by a calculation of how controlled the disease is, and then a consideration of systemic treatment options. It’s the result of combing through 243 studies and learning about what other spine oncology clinics’ practices look like.

However, Szerlip says much more data are needed to continue to develop best practices and prove that current efforts are most effective.

“Identifying which patients should get these treatments is also difficult,” he says. The researchers are working with oncologists to help determine who will live long enough to benefit from these procedures.

He says basic science research will be important to continue to develop treatments specifically for spine metastases, because they develop differently than other metastases.

Source:

https://labblog.uofmhealth.org/rounds/new-algorithm-decodes-spine-oncology-treatment?utm_source=twitter&utm_medium=paid&utm_content=%20Radiation_Oncology%20&utm_campaign=new-algorithm-decodes-spine-oncology-treatment

Tagged with:

About author

Related Articles