Wednesday, September 26, 2018 2:00 PM – 3:00 PM Improving Quality of Life for Patients with Tumors: 76. A multicenter prospective cohort study evaluating quality of life after radiation or surgery for potentially unstable spinal metastases

Abstract

BACKGROUND CONTEXT Optimal treatment selection between surgery and radiotherapy for patients with potentially unstable spinal metastases is unknown. PURPOSE The purpose of this study was to compare HRQOL outcomes for surgery +/− radiotherapy to radiotherapy alone in patients with potentially unstable spinal metastases. STUDY DESIGN/SETTING The AOSpine Knowledge Forum Tumor conducted an international multicenter prospective observational study. PATIENT SAMPLE Patients were eligible for inclusion if they were between 18 and 75 years of age and underwent surgery (+/− radiotherapy) or radiotherapy alone for spinal metastases. For this analysis, only patients with potentially unstable spinal metastases, defined by a spinal instability neoplastic score (SINS) between 7 and 12, were included. OUTCOME MEASURES Health related quality of life (HRQOL) was evaluated at baseline and during following up at fixed time points with the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ2.0), SF-36, EQ-5D and NRS pain score. METHODS The two treatment groups were compared at baseline for differences in demographics, individual SINS factors, grouping of SINS factors and HRQOL. HRQOL scores were modeled over time using mixed effect models with adjustment for differences in baseline characteristics. RESULTS Between August 2013 and May 2017, 202 patients with potential spinal instability were enrolled at 10 tertiary care spine centers across North America and Europe. In total 120 patients were treated with surgery +/− radiotherapy and 82 with radiotherapy alone. At baseline, patients who underwent surgery +/− radiotherapy had a lower performance status, lower HRQOL scores, higher NRS pain scores and a higher median SINS score (10 vs. 8) compared to patients treated with radiotherapy alone. Surgically treated patients experienced a greater and clinically significant increase in adjusted mean SOSGOQ2.0 score (+12.0, 95%CI 5.1–19.0, p CONCLUSIONS Patients treated with surgery +/− radiotherapy for potentially unstable spinal metastases, according to the SINS, experienced greater and clinically significant differences in HRQOL as compared to patients treated with radiotherapy alone. Baseline differences in the individual SINS factors and the grouping of the SINS factors, however, illustrate distinct differences between the two treatment groups. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.