title: Prolonged survival following aggressive treatment for metastatic breast cancer in the spine.
abstract: In 2007, members of our group reported a 21 month median survival for patients undergoing surgery for metastatic breast cancer in the spinal column. Cervical spine metastases were associated with decreased survival, Estrogen receptor positivity was associated with improved survival, and age and visceral metastases did not significantly impact survival. In the current study, we reassess these variables in the context of modern adjuvant therapies, and investigate the impact of the Spinal Instability Neoplastic Score (SINS). We report an observational cohort of 43 patients undergoing surgical resection for metastatic breast cancer of the spine treated at a single academic institution from June 2002 to August 2011. Patient medical records were reviewed in accordance with policies outlined by the University Institutional Review Board. Median overall survival following surgery for metastatic breast cancer in the spine was 26.8 months. 1 year overall survival was 66%. 5 year-overall survival was 4%. Age (p=0.12), preoperative functional status (p=0.17), location of metastasis (p=0.34), the presence of visceral metastases (p=0.68), and spinal instability (p=0.81) were not significant variables on survival analysis. Postoperative adjuvant therapy with a single modality (radiation or chemotherapy) was associated with a significantly lower median survival compared to dual therapy with chemotherapy and radiation (p=0.042). Patients that received radiation and chemotherapy after surgery were younger but demonstrated prolonged median survival versus single modality therapy. This data supports the concept that visceral metastases do not impact survival, however cervical spine lesions were not associated with decreased survival.
authors.affiliation: Department of Neurosurgery, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Zadnik
authors.forename: Lee
authors.initials: L
authors.lastname: Hwang
authors.forename: Derek G
authors.initials: DG
authors.lastname: Ju
authors.forename: Mari L
authors.initials: ML
authors.lastname: Groves
authors.forename: Jackson
authors.initials: J
authors.lastname: Sui
authors.forename: Alp
authors.initials: A
authors.lastname: Yurter
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Witham
authors.forename: Ali
authors.initials: A
authors.lastname: Bydon
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Wolinsky
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology*; D059248:Chemoradiotherapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D013125:Spinal Neoplasms / Q000401:mortality* / Q000556:secondary* / Q000628:therapy*; D016896:Treatment Outcome