TY - JOUR
T1 - Metastatic spine disease in lung cancer patients
T2 - national patterns of radiation and surgical care
AU - Kelly, Patrick D.
AU - Zuckerman, Scott L.
AU - Than, Khoi
AU - Attia, Albert
AU - Jaboin, Jerry J.
N1 - Funding Information:
Funding: This work was supported by the National Cancer Institute of the National Institutes of Health (grant number T32CA106183 to PD Kelly).
Publisher Copyright:
© 2019, AME Publishing Company. All rights reserved.
PY - 2019/9/29
Y1 - 2019/9/29
N2 - Background: Lung cancer is the most common source of spinal metastases. As our treatment of spinal metastases evolves, national trends in radiation therapy (RT), including spinal stereotactic neurosurgery, have yet to been established. Methods: We performed a retrospective review of lung cancer patients within the National Cancer Database (NCDB) between 2004 and 2014 who received radiation to the vertebral column. Results: A total of 29,144 lung cancer patients received either external beam RT (EBRT), stereotactic radiosurgery (SRS), or particle-based RT to the spine. EBRT was the most common modality throughout all years, though SRS use increased over time (Spearman’s rank correlation, P<0.01). A surgical procedure on a distant metastasis was performed in 1,547 (5.3%) patients. Median survival was 6.24 months for patients receiving EBRT and 9.3 months for those receiving SRS, a significant difference (log rank test, P<0.01), which persisted when adjusting for other predictors (multivariable Cox regression, P<0.01). Conclusions: In conclusion, spinal SRS is steadily growing in the treatment of lung metastases to the spine, and surgery on distant metastases is becoming more frequent. There was a survival advantage for patients receiving SRS over EBRT. As the use of SRS—in addition to separation surgery—grows in radioresistant pathology, further study of improved survival and recurrence rates are needed.
AB - Background: Lung cancer is the most common source of spinal metastases. As our treatment of spinal metastases evolves, national trends in radiation therapy (RT), including spinal stereotactic neurosurgery, have yet to been established. Methods: We performed a retrospective review of lung cancer patients within the National Cancer Database (NCDB) between 2004 and 2014 who received radiation to the vertebral column. Results: A total of 29,144 lung cancer patients received either external beam RT (EBRT), stereotactic radiosurgery (SRS), or particle-based RT to the spine. EBRT was the most common modality throughout all years, though SRS use increased over time (Spearman’s rank correlation, P<0.01). A surgical procedure on a distant metastasis was performed in 1,547 (5.3%) patients. Median survival was 6.24 months for patients receiving EBRT and 9.3 months for those receiving SRS, a significant difference (log rank test, P<0.01), which persisted when adjusting for other predictors (multivariable Cox regression, P<0.01). Conclusions: In conclusion, spinal SRS is steadily growing in the treatment of lung metastases to the spine, and surgery on distant metastases is becoming more frequent. There was a survival advantage for patients receiving SRS over EBRT. As the use of SRS—in addition to separation surgery—grows in radioresistant pathology, further study of improved survival and recurrence rates are needed.
KW - Bone neoplasms
KW - lung neoplasms
KW - neurosurgical procedures
KW - radiosurgery
KW - spine
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U2 - 10.21037/jss.2019.08.11
DO - 10.21037/jss.2019.08.11
M3 - Article
AN - SCOPUS:85092339114
SN - 2414-469X
VL - 5
SP - 320
EP - 328
JO - Journal of Spine Surgery
JF - Journal of Spine Surgery
IS - 3
ER -