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Metastasis Bone Tumor at Spine

Metastasis Bone Tumor at Spine

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cancer metastasis on spine
cancer metastasis on spine

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Categories:Types, Presentations
Published by: Hening Tirta Kusumawardani on Jun 23, 2014
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06/23/2014

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METASTASIS BONE TUMOR AT SPINE

Kiki A. Rizki

Surgical Oncology Division,
Departement of Surgery Hasan Sadikin Hospital Bnadung



Introduction
• Metastases to the spine are a common problem
in a large oncology center

• Between 5% and 10% of all cancer patients
develop spinal metastases during the course of
their disease.

• The vertebral column is the most common site for
bony metastases, with an incidence of 30% to
70% in patients with metastatic neoplasms.
Common Primary Sites
• Breast (21%)
• Lung (14%)
• Prostate (7.5%)
• Renal (5%)
• GI (5%)
• Thyroid (2.5%)
Estimated New Cancer Cases* in the US in 2013
Level of Metastases
• Thoracolumbar 70%
• Lumbosacral 20%
• Cervical 10%

Clinical Presentation
• Pain (85%)
Hyperemia, expansion, nerve compression,
cord compression, pathologic fractures &
instability

• Weakness (34%)
Spinal cord compression in 20%

• Mass (13%)

• Constitutional Symptoms
AIM THERAPY
• Therapeutic intervention can alleviate pain,
preserve or improve neurologic function,
achieve mechanical stability, optimize local
tumor control, and improve quality of life
Osteoclast-Targeted Therapy Reduces
SREs in Breast Cancer
SURGERY
• Axial pain secondary to mechanical instability
can causes significant morbidity.

• With the advancement in spinal stabilization,
satisfactory neurologic improvement occurs in
48-88% of patients, with 80-100% rates of
pain relief.
SURGERY
• Radical surgery not only provides stabilization,
it also confers tissue diagnosis and reduces
tumor burden.
SURGERY
HORMONE THERAPY
• Women with metastatic disease that are ER
and/or PR positive are appropriate candidates
for initial endocrine therapy.

CHEMOTHERAPY
• Single agent vs combination regimen

• Combination chemotherapy is, however,
associated with an increase in toxicity, and is of
little survival benefit


• Standard clinical practice is to continue first-line
chemotherapy until progression
SUMMARY
• The vertebral column is the most common site for bony
metastases

• Patients with metastatic spinal tumors may present with
pain, neurologic deficit, or both.

• Therapeutic intervention can alleviate pain, preserve or
improve neurologic function, achieve mechanical stability,
optimize local tumor control, and improve quality of life.

• Treatment options available for metastatic spine tumors
include radiation therapy (RT), surgery, hormone therapy
and chemotherapy.

THANK YOU
In premenopausal women, endocrine therapies :
• selective ER modulators (tamoxifen or
toremifene);
• luteinizing hormone-releasing hormone (LHRH)
agonists (goserelin and leuprolide);
• surgical or radiotherapeutic oophorectomy;
• progestin (megestrol acetate);
• androgens (fluoxymesterone);
• high-dose estrogen (ethinyl estradiol).

• For postmenopausal women who are
antiestrogen naive or who are more than 1
year from previous antiestrogen therapy, the
options include either an aromatase inhibitor,
selective ER modulator, or an ER down-
regulator.

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