title: Spine Surgery in Patients with Metastatic Breast Cancer: A Retrospective Analysis.
abstract: BACKGROUND
  Pathologic or iatrogenic symptomatic spinal lesions are common in metastatic breast cancer. Given the longer duration of overall survival provided by modern oncologic therapies, a prompt and effective treatment of such lesions may have a significant impact on patient's quality of life, improving pain and preventing deterioration of neurologic functions.
  
  
  METHODS
  A retrospective review was conducted on patients with breast cancer operated to the spine between 2005 and 2013. The series includes 41 patients and 57 vertebral levels treated (4 cervical, 35 dorsal, and 18 lumbar). There were 28 patients who received palliative surgery and 13 who received excisional surgery, according to their clinical conditions, Spinal Instability Neoplastic Score, and Tokuhashi scores.
  
  
  RESULTS
  Of the 41 patients, 38 presented with a median survival of 50 months (95% confidence interval [CI], 39-61), still preserving a Karnofsky Performance Status Scale score ≥60 and a retained ability to ambulate independently. The median overall survival after the first spine surgery was also 50 months (95% CI, 35-65), suggesting that in this cohort of patients, a reasonable quality of life was preserved almost to the end of their clinical history. In patients treated with palliative surgery, the median survival was 37 months (95% CI, 26-48). In those treated with complex surgery, it was 57 months (95% CI, 41-73; P = 0.03).
  
  
  CONCLUSIONS
  Major excisional surgery, albeit associated with an increased length of hospital stay, allowed in our series a prolonged survival compared with less aggressive types of surgery. However, percutaneous or open balloon kyphoplasty techniques have expanded indications for palliative surgery and even patients with lower Tokuhashi scores may benefit from rapid and sustained pain relief, preservation of neurologic function, and early mobilization.
authors.affiliation: Department of Neurosurgery, "Regina Elena" National Cancer Institute, Rome, Italy. Electronic address: telera@ifo.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Telera
authors.affiliation: Department of Neurosurgery, "Regina Elena" National Cancer Institute, Rome, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Caroli
authors.affiliation: Department of Neurosurgery, "Regina Elena" National Cancer Institute, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Raus
authors.affiliation: Department of Neurosurgery, "Regina Elena" National Cancer Institute, Rome, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Pompili
authors.affiliation: Department of Pathology, "Regina Elena" National Cancer Institute, Rome, Italy.
authors.forename: Maria Antonia
authors.initials: MA
authors.lastname: Carosi
authors.affiliation: Department of Clinical Oncology A, "Regina Elena" National Cancer Institute, Rome, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Di Santo
authors.affiliation: Department of Biostatistics, "Regina Elena" National Cancer Institute, Rome, Italy.
authors.forename: Isabella
authors.initials: I
authors.lastname: Sperduti
authors.affiliation: Department of Neurosurgery, "Regina Elena" National Cancer Institute, Rome, Italy.
authors.forename: Carmine Maria
authors.initials: CM
authors.lastname: Carapella
authors.affiliation: Department of Clinical Oncology A, "Regina Elena" National Cancer Institute, Rome, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Fabi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007796:Laminectomy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008875:Middle Aged; D011247:Pregnancy; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013125:Spinal Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Breast cancer; Kyphoplasty; Somatectomy; Spine surgery