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Comparative Study
. 2019 Mar 1;125(5):770-778.
doi: 10.1002/cncr.31870. Epub 2018 Nov 29.

Survival, local control, and health-related quality of life in patients with oligometastatic and polymetastatic spinal tumors: A multicenter, international study

Ori Barzilai  1 , Anne L Versteeg  2 , Arjun Sahgal  3 , Laurence D Rhines  4 , Mark H Bilsky  1   5 , Daniel M Sciubba  6 , James M Schuster  7 , Michael H Weber  8 , Peter Pal Varga  9 , Stefano Boriani  10 , Chetan Bettegowda  6 , Michael G Fehlings  11 , Yoshiya Yamada  12 , Michelle J Clarke  13 , Paul M Arnold  14 , Ziya L Gokaslan  15 , Charles G Fisher  16 , Ilya Laufer  1   5 , The Ao Spine Knowledge Forum Tumor  17
Affiliations
Comparative Study

Survival, local control, and health-related quality of life in patients with oligometastatic and polymetastatic spinal tumors: A multicenter, international study

Ori Barzilai et al. Cancer. .

Abstract

Background: The treatment of oligometastatic (≤5 metastases) spinal disease has trended toward ablative therapies, yet to the authors' knowledge little is known regarding the prognosis of patients presenting with oligometastatic spinal disease and the value of this approach. The objective of the current study was to compare the survival and clinical outcomes of patients with cancer with oligometastatic spinal disease with those of patients with polymetastatic (>5 metastases) disease.

Methods: The current study was an international, multicenter, prospective study. Patients who were admitted to a participating spine center with a diagnosis of spinal metastases and who underwent surgical intervention and/or radiotherapy between August 2013 and May 2017 were included. Data collected included demographics, overall survival, local control, and treatment information including surgical, radiotherapy, and systemic therapy details. Health-related quality of life (HRQOL) measures included the EuroQOL 5 dimensions 3-level questionnaire (EQ-5D-3L), the 36-Item Short Form Health Survey (SF-36v2), and the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ).

Results: Of the 393 patients included in the current study, 215 presented with oligometastatic disease and 178 presented with polymetastatic disease. A significant survival advantage of 90.1% versus 77.3% at 3 months and 77.0% versus 65.1% at 6 months from the time of treatment was found for patients presenting with oligometastatic disease compared with those with polymetastatic disease. It is important to note that both groups experienced significant improvements in multiple HRQOL measures at 6 months after treatment, with no differences in these outcome measures noted between the 2 groups.

Conclusions: The treatment of oligometastatic disease appears to offer a significant survival advantage compared with polymetastatic disease, regardless of treatment choice. HRQOL measures were found to improve in both groups, demonstrating a palliative benefit for all treated patients.

Keywords: health-related quality of life (HRQOL); oligometastases; polymetastases; spine; survival; tumor.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES

Ori Barzilai has received fellowship support to his institution from Globus for work performed outside of the current study. Anne L. Versteeg has received consulting and travel accommodations from AOSpine International for work performed outside of the current study. Arjun Sahgal has acted as a paid advisor for AbbVie; has taken part in past educational seminars with Elekta AB, Accuray Inc, Varian Medical Systems, and Brainlab; has received a research grant from Elekta AB; has received travel accommodations and expenses from Elekta AB, Varian Medical Systems, and Brainlab; and is a member of the Elekta MR Linac Research Consortium for work performed outside of the current study. Laurence D. Rhines has educational commitments with Stryker for work performed outside of the current study. Mark H. Bilsky has acted as a member of the Speaker’s Bureau for Varian Medical Systems and Brainlab, has received royalties from DePuy Synthes, and has received royalties/fellowship support from Globus Spine for work performed outside of the current study. Daniel M. Sciubba has acted as a paid consultant for Medtronic, DePuy Synthes, Stryker, NuVasive, K2M, Baxter, and Misonix for work performed outside of the current study. Chetan Bettegowda has acted as a paid consultant for DePuy Synthes for work performed outside of the current study. Yoshiya Yamada has acted as a member of the Speakers’ Bureau for Varian Medical Systems, Brainlab, Vision RT, and the Institute for Medical Education for work performed as part of the current study and has acted as a member of the Medical Advisory Board for the Chordoma Foundation for work performed outside of the current study. Paul M. Arnold has received travel accommodations and expenses from AOSpine North America; has intellectual property rights and interests, equity, and a position of responsibility as part of Evoke Medical; has equity from Z-Plasty; has received consulting fees from Stryker Orthopaedics, Ulrich, SpineGuard, In Vivo Therapeutics, and In Vivo; and has received consulting fees, travel accommodations, and expenses from Stryker Spine, Spine Wave, and Medtronic for work performed outside of the current study. Ziya L. Gokaslan has received research support from AOSpine North America and has stock ownership in Spinal Kinetics for work performed outside of the current study. Charles G. Fisher has received consulting and royalty fees from Medtronic, has received research grants from the Orthopedic Research and Education Foundation, and has received fellowship support paid to his institution from AOSpine and Medtronic for work performed outside of the current study. Ilya Laufer has received personal fees from Globus, Medtronic, DePuy Synthes, Spine Wave, and Brainlab for work performed outside of the current study.

Figures

Figure 1.
Figure 1.
Kaplan-Meier plots demonstrating 2-year overall mortality differences for patients with oligometastatic (in blue) and polymetastatic (in red) disease, including 95% confidence limits and patients at risk. (Top) Entire patient cohort. (Center) Patients treated with surgery with or without radiotherapy. (Bottom) Patients treated with radiotherapy alone.
Figure 2.
Figure 2.
Kaplan-Meier plot demonstrating 2-year overall mortality differences for patients with solitary spine metastases (in blue) and the rest of the oligometastatic cohort (in red), including 95% confidence limits and patients at risk. Mets indicates metastases.
Figure 3.
Figure 3.
Outcomes regarding health-related quality of life. Differences in the mean scores of outcome endpoints were calculated at 6 months for each group. EQ 5D indicates EuroQOL 5 dimensions questionnaire; Pain NRS, numeric rating scale for pain; SF-36v2 MCS, 36-Item Short Form Health Survey mental component score; SF-36v2 PCS, 36-Item Short Form Health Survey physical component score; SOSGOQ2.0, Spine Oncology Study Group Outcomes Questionnaire 2. *P<.001.
See this image and copyright information in PMC

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