Characteristics of Patients and Treatment Recommendations from a Multidisciplinary Spinal Tumor Program

Abstract

Spinal tumors arise frequently for patients with advanced cancer and optimal management involves consideration of neurologic, oncologic, mechanical, and systemic features. We describe characteristics of patient and treatment recommendations from a multidisciplinary spinal tumor board at one institution. A multidisciplinary spinal tumor program including radiation oncology, neuroradiology, orthopedic surgery, neurosurgery, and palliative care providers convened weekly to review complex spine cases and formulate a consensus plan. Patient and tumor characteristics were abstracted from electronic medical record with IRB approval, and treatment recommendations descriptively summarized. Between April 2017 and February 2019, 622 cases were reviewed, representing 438 unique patients. The median age was 62 years (range 21-92), comprising 52.5% men (n=230). In total, 31% (n=236) patients were deceased at last follow up. Most patients (91.8%) had metastatic disease, most commonly, breast (15.2%, n=67), NSCLC (14.8%, n=65), prostate (11.6%, n=51), renal cell (9.1%, n=40), or sarcoma (6.4%, n=28). 4.3% of patients had primary CNS tumors (n=19), and 2.5% had benign findings after pathology review, including 2 with infection. Radiation treatment was recommended in 52% of cases, including conventional EBRT in 34% (n=210) and SBRT in 18% (n=111). Surgical intervention was recommended for 26.2% (n=163) of patients. Vertebroplasty/kyphoplasty, biopsy, nerve root injection, or cryoablation was recommended for 15.9% (n=99), 9.3% (n=58), 0.8% (n=5), and 3.7% (n=23) of cases, respectively. Primary palliative care or medical oncology evaluation was recommended in 4.5% (n=28) and 5.3% (n=33). Additional imaging was requested for 16.6% (n=103), and 4% (n=25) cases had no further intervention recommended. Multidisciplinary care characterized 30% (n=189) of treatment recommendations, involving coordination of care of at least 2 (n=181) or 3 (n=8) disciplines for further local therapy or intervention. Multidisciplinary input is integral to the optimal care of spinal tumor patients. The risk of death for this patient population highlights the need to prioritize modalities that optimize overall quality of life in the context of a patient’s individual prognosis.