Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P136. Clinical presentation, management and outcomes of sacral metastases: a multicentre, prospective case series

Abstract

BACKGROUND CONTEXT Sacral metastases are rare and literature regarding their management is sparse. PURPOSE This multicenter prospective observational study aimed to determine Health Related-Quality of Life (HRQOL) and pain in patients treated for sacral metastases with surgery and/or radiation therapy (RT). The secondary objectives were to describe the adverse event (AE) profile and change in neurologic function in this population. STUDY DESIGN/SETTING A case series of 23 patients presenting with symptomatic sacral metastases were identified from the Epidemiology, Process and Outcomes of Spine Oncology dataset, a prospective multicenter study on spinal metastases. PATIENT SAMPLE Patients requiring surgery and/or RT between August 2013 and February 2017 were prospectively enrolled. OUTCOME MEASURES Health Related-Quality of Life, assessed by the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQv2.0), the Short Form-36 version 2 (SF-36v2), and the EuroQol-5Dimension (EQ-5D) was documented at baseline, 6 weeks, 3 months and 6 months post-treatment. Pain numeric rating scale (NRS), AEs, lower extremities motor score, and bowel and bladder function were recorded at baseline and follow-up. METHODS Standard descriptive statistics were used to represent demographic data. Differences in baseline parameters were tested by using Fisher's exact test for categorical variables and t-test or Wilcoxon rank sum test for continuous variables. A mixed effect model was used to test for differences in patient reported outcome compared to baseline and between both treatments. P-values were adjusted due to multiple testing by Tukey–Kramer. Adverse events data was analyzed per patient and per adverse event time by using adverse events which occurred up to 6 months after treatment. Confidence intervals for AE percentage were calculated using the exact binomial method. RESULTS Eight patients underwent surgery ±RT and 15 patients underwent RT alone. Mean age was 59.3years (SD 11.7) and 13 patients were female. At 6-months, 3 (37.5%) surgical patients and 2 (13.3%) RT patients were deceased. There was a trend showing that surgical patients had worse baseline HRQOL and pain. Pain NRS, EQ-5D, SOSGOQv2.0 and the mental component of the SF-36v2 showed improvement, irrespective of treatment (p>.05). A total of 10 AEs occurred in the surgical cohort, dominated by wound complications (n=3). Boweland bladder function improved at 6 weeks in both groups. The lower extremity mean motor score marginally improved at 3 months. CONCLUSIONS Surgical treatment and RT are valid complementary alternatives for symptomatic sacral metastases. Improvement in HRQOL can be expected with an acceptable AE rate.