title: Postoperative survival and functional outcomes for patients with metastatic gynecological cancer to the spine: case series and review of the literature.
abstract: OBJECTIVE
  Spinal metastases from gynecological cancers are rare, with few cases reported in the literature. In this study, the authors examine a series of patients with spinal metastases from gynecological cancer and review the literature.
  
  
  METHODS
  The cases of 6 consecutive patients who underwent spine surgery for metastatic gynecological cancer between 2007 and 2012 at a single institution were retrospectively reviewed. The recorded demographic, operative, and postoperative factors were reviewed, and the functional outcomes were determined by change in Karnofsky Performance Scale and the American Spine Injury Association (ASIA) score during follow-up. A systematic review of the literature was also performed to evaluate outcomes for patients with similar gynecological metastases to the spine.
  
  
  RESULTS
  In this series, details regarding metastatic gynecological cancers to the spine are as follows: 2 patients with cervical cancer (both presented at age 46 years, mean postoperative survival of 32 months), 2 patients with endometrial cancer (mean age of 40 years, mean postoperative survival of 26 months), and 2 patients with leiomyosarcoma (mean age of 44 years, mean postoperative survival of 20 months). All patients presented with pain, and no complications were noted following surgery. All patients with known follow-up had stable or improved neurological outcomes, performance status, and improved pain, without local recurrence of tumor. Overall median survival after diagnosis of metastatic spine lesions for all cases in the literature as well as those treated by the authors was 15 months. When categorized by type, median survival of patients with cervical cancer (n = 2), endometrial cancer (n = 26), and leiomyosarcoma (n = 16) was 32, 10, and 22.5 months, respectively.
  
  
  CONCLUSIONS
  Gynecological cancers metastasizing to the spine are rare. In this series, overall survival following diagnosis of spinal metastasis and surgery was 27 months, with cervical cancer, endometrial cancer, and leiomyosarcoma survival being 32, 26, and 20 months, respectively. Combined with literature cases, survival differs depending on primary histology, with decreasing survival from cervical cancer (32 months) to leiomyosarcoma (22.5 months) to endometrial cancer (10 months). Integrating such information with other patient factors may more accurately guide decision making regarding management of such spinal lesions.
authors.affiliation: Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Ann
authors.initials: A
authors.lastname: Liu
authors.affiliation: Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Eric W
authors.initials: EW
authors.lastname: Sankey
authors.affiliation: Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: C Rory
authors.initials: CR
authors.lastname: Goodwin
authors.affiliation: Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Kosztowski
authors.affiliation: Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Elder
authors.affiliation: Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Ali
authors.initials: A
authors.lastname: Bydon
authors.affiliation: Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Witham
authors.affiliation: Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Wolinsky
authors.affiliation: Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
authors.affiliation: Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
mesh_terms: D000328:Adult; D005260:Female; D005833:Genital Neoplasms, Female / Q000473:pathology*; D006801:Humans; D008875:Middle Aged; D020127:Recovery of Function / Q000502:physiology*; D012008:Recurrence; D013125:Spinal Neoplasms / Q000401:mortality* / Q000503:physiopathology / Q000556:secondary / Q000601:surgery; D016896:Treatment Outcome
keywords: ASIA = American Spine Injury Association; DVT = deep vein thrombosis; KPS = Karnofsky Performance Scale; UTI = urinary tract infection; cervical cancer; endometrial carcinoma; gynecological; leiomyosarcoma; metastasis; oncology; spine; surgery; tumor