Wednesday, September 26, 2018 2:00 PM – 3:00 PM Improving Quality of Life for Patients with Tumors: 81. Choice of treatment in spinal metastatic disease with indeterminate instability (SINS 7-12): impact on survival and preservation of ambulatory status

Abstract

BACKGROUND CONTEXT The management of spinal metastasis has evolved with the development of improved radiation delivery methods and surgical techniques. The Spinal Instability Neoplastic Score (SINS) provides guidance on treatment for spinal instability. However, the best treatment modality for neurologically intact patients with indeterminate instability (SINS 7–12) remains unclear. PURPOSE The purpose of this study was to compare length of survival (LOS) and preservation of ambulatory status (PAS) in this patient population treated by three different techniques. STUDY DESIGN/SETTING Retrospective. PATIENT SAMPLE N=60 20 patients surgery + EBRT 20 patients XRT along 20 patients kyphoplasty +/− EBRT. OUTCOME MEASURES LOS - length of survival, PAS - preservation of ambulatory status. METHODS We queried our institution's database for neurologically intact patients treated for spinal metastatic disease with a SINS of 7-12. The cohort was stratified by treatment approach: external beam radiation (EBRT), surgery + EBRT (S+E), and kyphoplasty +/− EBRT (K). Demographic, clinical, and outcomes data were compared using Chi Squared tests and ANOVA. Kaplan-Meier analysis with the log-rank test was used to assess differences in LOS and PAS. Cox proportional hazard models were used to assess adjusted survival and time to loss of ambulation. RESULTS Sixty cases were included in our analysis (EBRT n=20; S+E n=20; Kn=20). There was no significant difference in gender, age or cancer type across the treatment groups. Tokuhashi scores were greater in the S+E group (p=.03). Kaplan Meier analysis revealed that there was no significant difference in LOS and PAS across the treatment arms (p=.10, p=.07). When adjusting these models for age, gender, SINS and Tokuhashi score; Toskuhashi score was associated with improved outcomes (LOS HR: 0.76 to 0.94, p=.002; PAS HR: 0.78 to 0.95, p=.005). CONCLUSIONS The choice of treatment for neurologically intact patients with indeterminate instability does not impact LOS or PAS. Patients with greater preoperative Tokuhashi scores had statistically longer LOS and PAS. When spinal instability and neurological status do not clearly guide treatment, the Tokuhashi score provides the best predictor in management decision-making. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.