title: Surgical treatment strategies and outcome in patients with breast cancer metastatic to the spine: a review of 87 patients.
abstract: Aggressive surgical management of spinal metastatic disease can provide improvement of neurological function and significant pain relief. However, there is limited literature analyzing such management as is pertains to individual histopathology of the primary tumor, which may be linked to overall prognosis for the patient. In this study, clinical outcomes were reviewed for patients undergoing spinal surgery for metastatic breast cancer. Respective review was done to identify all patients with breast cancer over an eight-year period at a major cancer center and then to select those with symptomatic spinal metastatic disease who underwent spinal surgery. Pre- and postoperative pain levels (visual analog scale [VAS]), analgesic medication usage, and modified Frankel grade scores were compared on all patients who underwent surgery. Univariate and multivariate analyses were used to assess risks for complications. A total of 16,977 patients were diagnosed with breast cancer, and 479 patients (2.8%) were diagnosed with spinal metastases from breast cancer. Of these patients, 87 patients (18%) underwent 125 spinal surgeries. Of the 76 patients (87%) who were ambulatory preoperatively, the majority (98%) were still ambulatory. Of the 11 patients (13%) who were nonambulatory preoperatively, four patients were alive at 3 months postoperatively, three of which (75%) regained ambulation. The preoperative median VAS of six was significantly reduced to a median score of two at the time of discharge and at 3, 6, and 12 months postoperatively (P < 0.001 for all time points). A total of 39% of patients experienced complications; 87% were early (within 30 days of surgery), and 13% were late. Early major surgical complications were significantly greater when five or more levels were instrumented. In patients with spinal metastases specifically from breast cancer, aggressive surgical management provides significant pain relief and preservation or improvement of neurological function with an acceptably low rate of complications.
authors.affiliation: Department of Neurosurgery, M. D. Anderson Cancer Center, Houston, TX, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Shehadi
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
authors.forename: Ian
authors.initials: I
authors.lastname: Suk
authors.forename: Dima
authors.initials: D
authors.lastname: Suki
authors.forename: Marcos V C
authors.initials: MV
authors.lastname: Maldaun
authors.forename: Ian E
authors.initials: IE
authors.lastname: McCutcheon
authors.forename: Remi
authors.initials: R
authors.lastname: Nader
authors.forename: Richard
authors.initials: R
authors.lastname: Theriault
authors.forename: Laurence D
authors.initials: LD
authors.lastname: Rhines
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D011379:Prognosis; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000150:complications / Q000556:secondary* / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome