833 Potential Palliative Role for Neoadjuvant Arterial Embolization in Patients with Spine Metastases

Abstract

INTRODUCTION: Approximately two-thirds of all cancer patients will develop bone metastasis, and the spine is the most common site.1 Spine metastases may lead to significant pain, instability, and/or neurological morbidity. A high rate of local control can be achieved with local therapies such as radiation and surgery, but persistent pain is described among some patients. Prior clinical research demonstrated that arterial embolization without surgery may improve pain associated with spine metastases.2 This study aimed to determine the effects of embolization on pain in patients undergoing surgical decompression and stabilization. METHODS: A retrospective single-center review between 2012 and 2020 identified 117 patients receiving adjuvant SRS or SBRT following surgical intervention for spine metastases. The study group included various primary tumor types and patients treated with laminectomy and/or varying degrees of vertebrectomy. Data analyzed included demographic information, embolization and surgical details, KPS, defensive veterans pain rating scale (DVPRS), dose of radiotherapy, and daily doses of analgesic medications. RESULTS: Of 117 patients, 47 (40.2%) underwent preoperative embolization. Forty-nine (70%) and 24 (51.1%) patients underwent laminectomy/partial vertebrectomy in the non-embolization and embolization cohorts, respectively. Demographics were similar between groups at baseline. DVPRS scores did not differ by primary tumor histopathology (p = 0.63). DVPRS daily average and maximum rest scores decreased from 5.6 to 3.7, p < 0.001, and 5.7 to 3.8, p < 0.001, respectively following embolization. Throughout postoperative days 1-14, pain scores and daily doses of analgesic medications were largely similar between cohorts. CONCLUSIONS: Preoperative arterial embolization decreases pain scores immediately after the procedure, consistent with prior literature. This palliative effect largely disappears in the postoperative period, likely due to surgical pain. Future prospective studies identifying long-term palliative effects of embolization for spine metastasis are needed.