Spinal Tumor Patients Research Articles

DIFFERENTIATION OF SPINAL TUBERCULOSIS AND METASTATIC SPINAL TUMOR USING MRI FEATURE: A SYSTEMATIC REVIEW

Highlights1. Lesions that are regularly diagnosed in the spine include TB of the spine and tumors that have spread throughout the body.2. The examined papers included 35 individuals with tuberculous spondylitis and 31 patients with metastatic spinal malignancies.3. A methodology for MRI imaging and an accurate medical history will aid in establishing an accurate diagnosis. AbstractBackground: Spinal tuberculosis and metastatic tumors are commonly diagnosed lesions in the spine. Tuberculosis spondylitis, also known as Pott's Disease, is the most common extrapulmonary tuberculosis disease. MRI is the gold standard for early diagnosis because there is no significant difference in the results of clinical manifestations and histopathological examination. A biopsy will usually be used for a final exam for diagnosis. Objective: To provide information to confirm the diagnosis of TB spondylitis cases and metastatic spinal tumors. Method: A literature search was conducted via PubMed, Science Direct, and Scopus by selecting studies according to inclusion and exclusion criteria. The quality and risk of bias assessments were performed using Joanna Briggs Institute (JBI) tools. Overall, 35 spinal tuberculosis and 31 metastatic spinal tumor patients from 2 studies were reviewed. Result: Of the 35 patients with tuberculous spondylitis and 31 patients with metastatic spinal tumors from the two studies reviewed. It was found that the thorax was the most common region. The following imaging findings were of statistical significance (p<0.05): skip lesion, solitary lesion, intraspinal lesion, concentric collapse, abscess formation (paraspinal, intraosseous, and epidural lesions), and syrinx formation. Conclusion: An MRI imaging protocol and correct medical history will help establish an accurate diagnosis. Skip lesions, abscesses, and modular lesion margins are considered for diagnosis.

Abstract C001: PIONEER: Computational Probing of dIfferences in symptOms and fuNction of divErsE brain and spine tumoR populations

Abstract Background: Cancer outcomes studies primarily enroll white patients, and symptom care standards are based overwhelmingly on white patients’ experiences, even though many analyses have shown ethno-racial disparities in symptom burden. This study seeks to better understand ethno-racial disparities in the symptom burden of brain and spine tumor patients using novel computational network analysis (NA) approaches. NA identifies complex symptom co-severity patterns across large patient cohorts. This is the first study to use NA to analyze ethno-racial disparities in cancer symptom burden. Methods: Symptom severity data reported using the MD Anderson Symptom Inventory from a two-institutional cohort of 1651 brain and spine tumor patients was analyzed. Symptom data from white (n = 1,382) and non-white patients (n = 269) were analyzed separately. All non-white patients were analyzed together due to sample size limitations. Gaussian Graphical Model networks were constructed for each group. Network characteristics were analyzed and compared using permutation-based statistical tests. Results: Networks for white and non-white patients were constructed with high and moderate accuracy, respectively. Assessment of strength centrality, a measure of how core a symptom is to overall symptom burden, and betweenness centrality, a measure of how much a symptom contributes to the severity of other symptoms, revealed several key symptoms for each group. For white patients, fatigue, nausea, and distress/feeling upset had the highest strength, whereas fatigue, nausea, and pain had the highest betweenness. For non-white patients, drowsiness, disturbed sleep, and sadness had the highest strength, whereas change in appetite, disturbed sleep, sadness, and pain had the highest betweenness. The two network architectures were statistically different from each other in the Network Comparison Test (p = 0.033). White patients had significantly higher strength for fatigue (p = 0.032) and betweenness for nausea (p = 0.005), whereas non-white patients had significantly higher strength for sleep disturbance (p = 0.005). Independent t-test analysis only identified drowsiness as being significantly different between the two groups (p = 0.032), emphasizing how NA can reveal differences in symptom burden undiscoverable by traditional analyses. Discussion: Our results demonstrate that white and non-white patients experience different symptom co-severity patterns, with symptoms such as sleep disturbance being more influential in non-white patients and symptoms such as fatigue and nausea more significant in white patients. These results underscore the importance of considering the differences (and similarities) in symptomatology of patients from different racial and ethnic backgrounds. This will help address disparities and provide more personalized and effective care for diverse brain and spine tumor patient populations. Citation Format: Brandon H. Bergsneider, Elizabeth Vera, Mark R. Gilbert, Terri S. Armstrong, Orieta Celiku. PIONEER: Computational Probing of dIfferences in symptOms and fuNction of divErsE brain and spine tumoR populations [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C001.

Clinical characteristics, prognostic factors, and predictive model for elderly primary spinal tumor patients who are difficult to tolerate surgery or refuse surgery.

As a rare tumor, surgery is the best treatment for primary spinal tumors. However, for elderly patients who cannot undergo surgery, the prognosis is often difficult to evaluate. The purpose of this study was to identify the risk factors that may lead to death and predict the prognosis of elderly patients with primary spinal tumors who have not undergone surgical treatment. In this study, 426 patients aged 60 years or older diagnosed with a primary spinal tumor between 1975 and 2015 were selected and included from the Surveillance, Epidemiology, and End Results database. A retrospective analysis was performed by using the Cox regression algorithm to identify independent prognostic factors. A nomogram model was developed based on the results. Multiple evaluation methods (calibration curve, receiver operating characteristic curve, and decision curve analyses) were used to evaluate and validate the performance of the nomogram. A nomogram was developed, with age, histological type, and stage as independent prognostic factors. The results indicated that the prognostic risk tended to increase significantly with age and tumor spread. Osteosarcoma was found to have the most prominent risk prognosis in this patient group, followed by chondrosarcoma and chordoma. The area under the curve and the C-index of the model were both close to or greater than 0.7, which proved the high-differentiation ability of the model. The calibration curve and decision curve analyses showed that the model had high predictive accuracy and application value. We successfully established a practical nomogram to assess the prognosis of elderly patients with primary spinal tumors who have not undergone surgical treatment, providing a scientific basis for clinical management.

P26. Baseline laboratory values predict postoperative outcomes in spinal tumor patients: an NSQIP database analysis

<h3>BACKGROUND CONTEXT</h3> Spinal tumors, which are classified as tumors of the spinal cord, spinal meninges and cauda equina, are relatively rare with an overall incidence of 0.62 per 100,000 persons in the United States. While these tumors are rare, they can lead to neurological deficits. Because of these neurological complications, surgical resection is a necessity in many cases. The management and surgical intervention of spinal tumors can be complex and expensive. One of the most frequently performed components of the preoperative workup for spine surgery patients is preoperative laboratory testing, accounting for approximately 3 billion dollars in spending annually. Despite this frequent use of preoperative laboratory testing, there is minimal evidence of its impact on clinical decision-making and use in predicting postoperative complications in patients undergoing spinal tumor resection. <h3>PURPOSE</h3> The effect of baseline preoperative laboratory values on postoperative outcomes of spinal tumors remains largely unknown. This study was performed to evaluate the impact of preoperative laboratory values on surgical outcomes of spinal tumors using a large national database. <h3>STUDY DESIGN/SETTING</h3> Retrospective analysis. <h3>PATIENT SAMPLE</h3> A total of 4,662 adult spinal tumor patients (median age 59 years) were included in the analysis. <h3>METHODS</h3> We extracted the data from the American College of Surgeons (ACS) registry, National Surgical Quality Improvement Program (NSQIP), for patients undergoing surgical resection of spinal tumors from 2015 to 2019. We conducted uni- and multivariate analyses for preoperative labs on the following outcome variables: 30-day mortality, Clavien IV complications, unplanned reoperation and readmission, and nonroutine discharge destination. <h3>RESULTS</h3> Based on multivariate analysis, the most significant predictors of 30-day mortality after spine tumor surgery included hypernatremia (odds ratio, OR 5.284, 95% CI 1.152, 24.2,p 1.5 (OR 2.517, 95% CI 1.391, 4.5,p< 0.01), hypoalbuminemia (OR 2.364, 95% CI 1.910, 2.925,p< 0.001), hematocrit < 36% (OR 1.606, 95% CI 1.356, 1.903, p < 0.001), low platelet count (OR 1.597, 95% CI 1.227, 2.079, p < 0.01), leukocytosis (OR 1.594, 95% CI 1.315, 1.931, p < 0.001) and hyponatremia (OR 1.540, 95% CI 1.241, 1.912,p < 0.001). <h3>CONCLUSIONS</h3> Several preoperative labs predict poor outcomes in spinal tumor patients. The baseline laboratory values should be routinely used for preoperative risk stratification of these patients. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Surgical strategy for metastatic spinal tumor patients with surgically challenging situation.

The incidence of spinal metastasis is increasing as cancer patients live longer owing to the improvement of cancer treatments. However, traditional surgery (TS) which fixates at least 2 levels above and 2 levels below the affected vertebrae is sometimes difficult to perform as it is burdensome to the patients. In this article, we introduce our experience and strategy in treating spinal metastasis, focusing particularly on challenging cases.We retrospectively reviewed the data of 110 patients who underwent spinal surgery for metastatic spinal tumors from April 2018 to March 2020. Among them, 5 patients who received anterior approach surgery were excluded. The remaining 105 patients were enrolled. In addition to TS, we also performed cervical pedicle screw, cervicothoracic junction fixation, thoracolumbar short fixation, and decompression surgery, depending on the characteristics of the tumor. The overall survival was analyzed, and the local tumor control rate was evaluated using magnetic resonance imaging. Perioperative clinical characteristics including Spine Oncology Study Group Outcomes Questionnaire, visual analog scale, Eastern Cooperative Oncology Group performance score, and Karnofsky Performance Score were also investigated.The overall survival rate was 57.9% at 1 year, and the local tumor control rate was 81.1% after surgery. There was a statistically significant difference according to the type of the tumor in the survival analysis: the overall survival rates were 72.7% for favorable tumors and 48.6% for unfavorable tumors at 12 months after surgery (P = .04). Spine Oncology Study Group Outcomes Questionnaire, visual analog scale, Eastern Cooperative Oncology Group performance score, and Karnofsky Performance Score was improved after surgery. All surgical methods, including TS, cervical pedicle screw, cervicothoracic junction fixation, thoracolumbar short fixation, and decompression surgery, showed good clinical and radiological outcomes.Optimized surgical methods show similarly good clinical outcomes in managing spinal metastasis as TS.

Frailty Status Is a More Robust Predictor Than Age of Spinal Tumor Surgery Outcomes: A NSQIP Analysis of 4,662 Patients.

ObjectiveThe present study aimed to evaluate the effect of baseline frailty status (as measured by modified frailty index-5 [mFI-5]) versus age on postoperative outcomes of patients undergoing surgery for spinal tumors using data from a large national registry. MethodsThe National Surgical Quality Improvement Program database was used to collect spinal tumor resection patients’ data from 2015 to 2019 (n = 4,662). Univariate and multivariate analyses for age and mFI-5 were performed for the following outcomes: 30-day mortality, major complications, unplanned reoperation, unplanned readmission, hospital length of stay (LOS), and discharge to a nonhome destination. Receiver operating characteristic (ROC) curve analysis was used to evaluate the discriminative performance of age versus mFI-5. ResultsBoth univariate and multivariate analyses demonstrated that mFI-5 was a more robust predictor of worse postoperative outcomes as compared to age. Furthermore, based on categorical analysis of frailty tiers, increasing frailty was significantly associated with increased risk of adverse outcomes. ‘Severely frail’ patients were found to have the highest risk, with odds ratio 16.4 (95% confidence interval [CI],11.21–35.44) for 30-day mortality, 3.02 (95% CI, 1.97–4.56) for major complications, and 2.94 (95% CI, 2.32–4.21) for LOS. In ROC curve analysis, mFI-5 score (area under the curve [AUC] = 0.743) achieved superior discrimination compared to age (AUC = 0.594) for mortality. ConclusionIncreasing frailty, as measured by mFI-5, is a more robust predictor as compared to age, for poor postoperative outcomes in spinal tumor surgery patients. The mFI-5 may be clinically used for preoperative risk stratification of spinal tumor patients.

Prevalence and risk factors for venous thromboembolism in spinal metastasis patients undergoing decompression with internal instruments: Prospective cohort study

Objectivere is paucity in the literature on the epidemiological evidence of pulmonary thromboembolism (PE) and deep venous thrombosis (DVT) in spinal metastatic tumor patients. The aim of our study was to identify the incidence and risk factors for VTE in spinal metastasis patients treated with decompression with internal instruments. MethodsWe prospectively investigated the occurrence of VTE after decompression with internal fixations in 80 spinal metastasis patients. DVT was diagnosed by using a duplex ultrasonographical. PE was diagnosed by multidetector computed tomographic (CT) pulmonary angiography. Patient information and clinical parameters were collected. Risk factors were analyzed by comparing the difference between VTE and non-VTE cases. ResultsThe incidence of developing a DVT was 6.3% (5/80). No patient suffered PE. In univariate analysis, the mean length of hospital stay after surgery until discharge for VTE group was longer than non-VTE group, ODI scores and AIS in VTE group were significantly worse than non-VTE group, D-dimer one-day postoperatively for VTE group was significantly higher than non-VTE group. In logistic regression, D-dimer at one-day postoperatively was the only risk factor. The areas under the ROC curves for the D-dimer (post) to distinguish between non-VTE and VTE was 0.971(P value=0.000). By means of the ROC analysis, the optimum thresholds of D-dimer(post) were determined to be 9.51 mg/L. The sensitivity and specificity for the optimum threshold were 100.0% and 92.0%. ConclusionThe prospective study of 80 patients with spinal metastasis who underwent decompression with internal fixation revealed an incidence of DVT of 6.3%, patients with increasingly D-dimer level at one-day postoperatively had a higher risk of DVT, and the optimum thresholds of D-dimer(post) were determined to be 9.51 mg/L.

Patient Reported Outcomes in Metastatic Spine Disease: Concurrent Validity of PROMIS with the Spine Oncology Study Group Outcome Questionnaire.

Cross-sectional prospective study. To evaluate the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), Pain Interference (PI), and Depression domains in comparison to the Spine Oncology Study Group-Outcomes Questionnaire (SOSG-OQ) in patients with metastatic spine disease. While there remains a significant movement toward incorporating patient-reported outcome measures (PROMs) into clinical care, there are few validated PROMs for patients with metastatic spine disease. The SOSG-OQ was designed and validated for metastatic spine tumor patients. However, the use of general symptom-based PROMs, such as PROMIS domains, may reduce both patient and physician burden and improve interdisciplinary care if shown to be concurrently valid. Metastatic spine tumor patients from January 2017 to July 2021 at a single academic medical center were asked to complete PROMIS PF, PI, and Depression domains and the SOSG-OQ. Spearman correlation (p) coefficients were calculated. A total of 103 unique visits, representing 79 patients met our inclusion criteria. A majority were men (59; 57%) and Caucasian (93; 90%), and the average age was 64-years-old (range: 34-87). There were 13 different types of histologies reported, with multiple myeloma, breast cancer, and prostate cancer representing 28 (27%), 26 (25%), and 13 (13%), respectively. Additional cancers included renal cell carcinoma, lung cancer, colon cancer, thyroid cancer, large B-cell lymphoma, nonHodgkin lymphoma, esophageal cancer, plasmacytoma, metastatic paraganglioma, and metastatic spindle cell sarcoma. SOSG-OQ was strongly correlated with PROMIS PI (ρ = 0.78) and PROMIS PF (ρ = 0.71), and moderately correlated with PROMIS Depression (ρ = 0.58). PROMIS PF, PI, and Depression appear to capture similar clinical insight as the SOSG-OQ. Spine surgeons can consider using these PROMIS domains in lieu of the SOSG-OQ in metastatic spine tumor patients.

Profile of spinal tumor patients at Dr. Hasan Sadikin General Hospital Bandung Indonesia in 2015–2021

Background: Spinal tumors comprise some of the neurological disorders that affect the spine. Primary tumors originate from the spine while metastatic tumors are related to the tumors of near or distant organs. This results in a variety of locations of the affected spinal cord, diagnosis, treatment, and surgical procedures performed in patients. Data and research on the profile of spinal tumor patients are still rare in Indonesia. Methods: This study was conducted using secondary data with a retrospective descriptive method. Data were collected for 2015–2021 using total sampling technique from medical records of 122 patients with spinal tumors in The Neurosurgery Department, Dr. Hasan Sadikin General Hospital, Bandung. Results: The highest incidence rate in spinal tumor patients occurred in female patients (59.9%) and in the age group of 40–60 years (47.5%), with the most common location of the affected spinal cord on the level of the thoracic spine (65.5%). The majority of patients was diagnosed with schwannoma dd meningioma (27.1%). The most widely performed surgical procedure and treatment was laminectomy tumor removal (43.4%). The peak age was between 40 and 60 years old, with schwannoma dd meningioma as the most common diagnosis and type, while the majority of metastatic tumors occurred in more than 60 years old. The thoracic spine was found to be the most frequent location of the affected spinal cord. Conclusion: Further evaluation of management and follow-up studies need to be done to improve the implementation of treatment for patients and optimize patient’s quality of life.

Focused versus conventional radiotherapy in spinal oncology: is there any difference in fusion rates and pseudoarthrosis?

Radiotherapy is considered standard of care for adjuvant peri-operative treatment of many spinal tumors, including those with instrumented fusion. Unfortunately, radiation treatment has been linked to increased risk of pseudoarthrosis. Newer focused radiotherapy strategies with enhanced conformality could offer improved fusion rates for these patients, but this has not been confirmed. We performed a retrospective analysis of patients at three tertiary care academic institutions with primary and secondary spinal malignancies that underwent resection, instrumented fusion, and peri-operative radiotherapy. Two board certified neuro-radiologists used the Lenke fusion score to grade fusion status at 6 and 12-months after surgery. Secondary outcomes included clinical pseudoarthrosis, wound complications, the effect of radiation timingand radiobiological dose delivered, the use of photons versus protons, tumor type, tumor location, and use of autograft on fusion outcomes. After review of 1252 spinal tumor patients, there were 60 patients with at least 6months follow-up that were included in our analyses. Twenty-five of these patients received focused radiotherapy, 20 patients received conventional radiotherapy, and 15 patients were treated with protons. There was no significant difference between the groups for covariates such as smoking status, obesity, diabetes, intraoperative use of autograft, and use of peri-operative chemotherapy. There was a significantly higher rate of fusion for patients treated with focused radiotherapy compared to those treated with conventional radiotherapy at 6-months (64.0% versus 30.0%, Odds ratio: 4.15, p = 0.036) and 12-months (80.0% versus 42.1%, OR: 5.50, p = 0.022). There was a significantly higher rate of clinical pseudoarthrosis in the conventional radiotherapy cohort compared to patients in the focused radiotherapy cohort (19.1% versus 0%, p = 0.037). There was no difference in fusion outcomes for any of the secondary outcomes except for use of autograft. The use of intra-operative autograft was associated with an improved fusion at 12-months (66.7% versus 37.5%, OR: 3.33, p = 0.043). Focused radiotherapy may be associated with an improved rate of fusion and clinical pseudoarthrosis when compared to conventional radiation delivery strategies in patients with spinal tumors. Use of autograft at the time of surgery may be associated with improved 12-month fusion rates. Further large-scale prospective and randomized controlled studies are needed to better stratify the effects of radiation delivery modality in these patients.

Safety and Neurologic Recovery of L2 Nerve Root Sacrificed in Total En Bloc Spondylectomy Involving the L2 Vertebra.

The L2 nerve root is considered part of the lumbar plexus that innervates the iliopsoas (IP) and quadricep muscles (Qd). Total en bloc spondylectomy (TES) at the L2 vertebra requires bilateral nerve root transection to facilitate surgical dissection and vertebral body removal. Information regarding neurological function recovery of the IP and Qd in patients with muscle weakness before TES is lacking. We aimed to report the neurological recovery of IP and Qd after TES involving the L2 vertebra in preoperative lower extremity weakness in spinal tumor patients. We prospectively recorded all L2-involved spinal tumor patients undergoing TES between January 2018 and November 2020. As a primary outcome, we recorded the Manual Muscle Testing (MMT) grade of the IP and Qd preoperatively, immediately postoperatively, and at follow-up. Secondary outcomes included the Frankel neurological status, sensation impairment, and the Eastern Cooperative Oncology Group score. From 8 TES-involving L2 patients, 6 (4 males) met the inclusion criteria. One patient had first-grade deterioration of the Qd MMT immediately postoperatively. All patients could ambulate independently 6 months after surgery. Five patients required follow-up for more than 1 year and could walk without any gait aids. All patients had persistent anterior groin and bilateral thigh numbness until the final follow-up. Neurological recovery of the IP and Qd muscles as measured by MMT can occur within 6 months of bilateral L2 nerve root transection. Bilateral L2 nerve root sacrifice can have acceptable neurological outcomes and recovery, even in patients with preoperative IP and Qd weakness. 4.

Analysis of Factors Influencing the Long-term Outcome in Primary Spinal Cord Tumors: Review of Literature

Abstract Introduction Primary spinal cord tumors are amenable to total surgical excision but the outcomes are still diverse. Objective The purpose of this study is to identify the significant factors which influence the long-term outcome of spinal cord tumors. Materials and Methods A total of 84 consecutive spinal cord tumor patients who underwent microsurgical excision during April 2003 to 2014 were retrospectively studied. Patients operated after April 2014 were not considered. Ten factors were taken and correlated with the outcome. Multiple regression analysis was used. Patients were periodically evaluated at 1, 6 months, 1, 2, and 5 years. In 72 cases, postoperative MRI scans were performed. The follow-up period ranged between 5 to 15 years. Results In our study, we had 64 extramedullary tumors and 21 intramedullary tumors with varied pathology. Axial location of the tumour (20.294/0.000), extent of the resection of the tumour (13.827/0.001), preoperative Nurick grade (11.349/0.023), and location of the tumour in the spine with respect to vertebral segments (8.151/0.017) were significant predictive factors. We had good outcomes in 65 cases and poor outcomes in 19 cases. Conclusion Our results show location of the tumor with respect to axial plane and vertebral segments were the main contributing factors. They influence the extent of excision of the spinal cord tumor. Preoperative neurological status is the fourth factor which independently determines the long-term outcome. It is one of the few papers where patients have been followed-up for a long period ranging from 5 to 15 years.

Impact of the Affordable Care Act on Insurance Status of Spine Patients Presenting to the Emergency Department.

Although the Affordable Care Act (ACA) has been shown to broadly affect access to care, there is little data examining the change in insurance status with regard to nonelective spinal trauma, infection, and tumor patients. The purpose of this study is to evaluate the changes in insurance status before and after implementation of the ACA in patients who present to the emergency room of a single, level 1 trauma and regional spinal cord injury center. Patient demographic and hospital course information were derived from consult notes and electronic medical record review. Spinal consults between January 1, 2013, and December 31, 2015, were initially included. Consults between January 1 and December 31, 2014, were subsequently removed to obtain two separate cohorts reflecting one calendar year prior to ("pre-ACA") and following ("post-ACA") the effective date of implementation of the ACA on January 1, 2014. Compared with the pre-ACA cohort, the post-ACA cohort had a significant increase in insurance coverage (95.0% versus 83.9%, P < 0.001). Post-ACA consults had a significantly shorter length of stay compared with pre-ACA consults (7.94 versus 9.19, P < 0.001). A significantly greater percentage of the post-ACA cohort appeared for clinical follow-up subsequent to their initial consultation compared to the pre-ACA cohort (49.5% versus 35.3%, P < 0.001). Spinal consultation after the implementation of the ACA was found to be a significant positive predictor of Medicaid coverage (odds ratio = 1.96 [1.05, 3.82], P = 0.04) and a significant negative predictor of uninsured status (odds ratio = 0.28 [0.16, 0.47], P < 0.001). Increase in overall insurance coverage, increase in patient follow-up after initial consultation, and decrease in hospital length of stay were all noted after the implementation of the ACA for spinal consultation patients presenting to the emergency department.

QOLP-33. EVIDENCE OF FINANCIAL TOXICITY IN PRIMARY CENTRAL NERVOUS SYSTEM TUMOR PATIENTS: CORRELATIONS BETWEEN EMPLOYMENT STATUS, SYMPTOM BURDEN AND HEALTH-RELATED QUALITY OF LIFE

Abstract SIGNIFICANCE AND AIMS Financial toxicity (FT) after a cancer diagnosis is the consequence of decreased earnings and increased spending. In patients with primary central nervous system (PCNS) tumors, the correlation between FT and factors such as symptom burden, psychological distress, and health-related quality of life has not been extensively studied. We assessed employment status and several patient illness factors in a PCNS tumor cohort. METHODS Patient and disease characteristics and patient-reported outcomes (PROs) were collected from adults diagnosed with PCNS tumors between 9/2016-12/2019. Descriptive statistics and regression analyses were used to describe PROs. RESULTS Of 277 patients, 77 (28%) reported being unemployed due to tumor diagnosis. They reported difficulty walking (64%) and performing usual activities (64%). This group had lower general health status (p&amp;lt; 0.001) and higher tumor-related symptom severity (p=0.004) than employed patients. Unemployed patients reported high symptom burden with an average of 6 moderate-severe symptoms for those with brain tumors and 10 for those with spine tumors. Both brain and spine tumor patients who were unemployed reported increased mood-related interference (p=0.020), as well as moderate-severe anxiety (30%) and depression (25%) compared to employed patients (15% vs 8%, respectively). Unemployed brain tumor patients reported worse scores in cognitive and neurologic symptom subscales (p&amp;lt; 0.001). CONCLUSIONS AND IMPLICATIONS These data provide indirect evidence that financial toxicity that correlates with high symptom burden across several domains and lower health-related quality of life. Future research work will include the COST questionnaire to further evaluate the implications of FT in the PCNS tumor patient population.

NCOG-42. SYMPTOM ONSET TO TIME OF DIAGNOSIS IN PRIMARY CENTRAL NERVOUS SYSTEM TUMOR PATIENTS: A REVIEW OF FINDINGS FROM THE NOB-NHS

Abstract Prior reports suggest the low prevalence of primary central nervous system (PCNS) tumors and the healthcare setting where patients seek care can contribute to diagnostic delays, potentially affecting prognosis. This descriptive report highlights findings from patient-reported data at presentation collected from a sample of 623 PCNS tumor patients. Participants were White (88%), males (56%), median age at diagnosis 41 (2-79) with high grade (HG) (66%) brain tumors (BT) (89%). Among BT patients, 30% reported ≥ 3 concurrent symptoms at presentation including headaches (40%), seizures (30%), and memory problems or difficulty with balance/walking (20% each). Over half (57%) had symptoms for &amp;lt; 6 months before diagnosis and 60% presented to the Emergency Room. Sixty-five percent of HG BT patients had symptoms for &amp;lt; 6 months prior to diagnosis compared to low grade (LG) tumors (40%) and had surgery in &amp;lt; 1 month from presentation (68% vs 51%, p &amp;lt; 0.01). More HG BT patients presented with weakness in the arms/legs than LG BT (14% vs 8%). Among spine tumor (ST) patients, 45% reported ≥ 3 concurrent symptoms at presentation including back pain (65%), sensory changes (45%), and weakness (40%). Almost half (46%) were symptomatic for &amp;gt; 1 year before diagnosis, presented in an outpatient clinic (64%) with 41% having surgery &amp;lt; 1 month from presentation. Younger (40% vs 16%) and HG ST patients (56% vs 21%) more often reported symptoms for &amp;lt; 6 months before diagnosis. HG ST patients more often presented to Emergency Rooms (67% vs 25%) and had surgery &amp;lt; 1 month from presentation (60% vs 36%). Further analysis of symptom presentation and clinical course is ongoing. Tumor location, grade, patient age and healthcare setting were associated with the time from clinical presentation to diagnosis. Development of aids providing guidance on diagnostic evaluation/treatment to front-line healthcare providers is warranted.

NCOG-23. PATIENT-REPORTED SYMPTOM BURDEN AND INTERFERENCE: A COMPARISON BETWEEN COVID-19 PANDEMIC YEAR AND NORMATIVE DATA IN PATIENTS WITH CENTRAL NERVOUS SYSTEM (CNS) TUMORS

CNS tumor patients are highly symptomatic causing interference with activity and worse quality of life. Social distancing due to the COVID-19 pandemic increased demands on the patient, caregivers, clinicians, and the health care system. The NCI’s Neuro-Oncology Branch Natural History Study (NHS) systematically collected patient-reported outcomes (PROs) provide insight into how these challenges influenced symptom burden and interference during the COVID year. METHODS: Patient and disease characteristic as well as patient-reported symptoms and interference (MDASI-BT/-SP) and general health status (EQ-5D-3L) from 3/2020-2/2021) were compared to NHS normative sample collected prior to 3/2020. RESULTS: The sample (n = 178) was primarily White (82%), male (55%), median age of 45 (range 18 – 79) and KPS ³ 90 (51%). The majority had high-grade (70%) brain (83%) tumors (BT) with ≥ 1 prior recurrence (60%) and 25% were on active treatment. Clinical visits were primarily conducted via telehealth (64%) and 20% of all patients were diagnosed with progression at the time of assessment. Most commonly reported moderate-severe symptoms among BT patients were fatigue (30%), difficulty remembering (28%), feeling drowsy (22%). Among spinal cord tumor patients, fatigue (39%), pain (35%) and numbness/tingling in arms/legs/trunk (35%) were most frequently reported. These symptoms were reported in similar frequencies by the normative sample. Nearly half of the COVID year sample (48%) reported moderate-severe activity-related interference. Reported problems with mobility (38%), self-care (19%), pain/discomfort (40%), and usual activities (50%) were similar in both groups except for increased mood disturbance (53%) was reported during the COVID year. CONCLUSION: These findings support CNS tumor patients remained highly symptomatic with significant impact on health-related quality of life during the COVID year. Clinicians should develop timely individual care plans to help BT patients navigate their disease course. Evaluation of risk associated with more severe symptoms and functional limitations are ongoing.

P73. Evaluating the concurrent validity of PROMIS PF, PI, and depression domains with the SOSG-OQ in metastatic spine tumor patients

<h3>BACKGROUND CONTEXT</h3> While there remains a significant movement towards incorporating PROMs (patient-reported outcome measures) into clinical spine practice to improve patient-centered care, a commonly used PROM in practice remains elusive. This is especially true in the case of patients with metastatic spine disease. The SOSG-OQ (Spine Oncology Study Group-Outcomes Questionnaire) was designed and validated for metastatic spine tumor patients. The use of general symptom-based PROMs, such as PROMIS (Patient-Reported Outcomes Measurement Information System) domains, may reduce both patient and physician burden and improve interdisciplinary care if shown to be concurrently valid. <h3>PURPOSE</h3> To evaluate the concurrent validity of PROMIS PF (Physical Function), PI (Pain Interference), and Depression domains with the SOSG-OQ in patients with metastatic spine disease. <h3>STUDY DESIGN/SETTING</h3> Cross-sectional study at a single academic medical center. <h3>PATIENT SAMPLE</h3> Metastatic spine tumor patients. <h3>OUTCOME MEASURES</h3> SOSG-OQ; PROMIS PF, PI, and Depression domains. <h3>METHODS</h3> Metastatic spine tumor patients from 1/2017 to 1/2021 at a single academic medical center were asked to complete PROMIS PF, PI, and Depression domains and the SOSG-OQ. Only patients who completed both the SOSG-OQ and PROMIS instruments were included in the analysis. Spearman correlation (ρ) coefficients were calculated, and the absolute value of each correlation was taken for ease of analysis. Patients missing a single question in the SOSG-OQ were excluded from the correlation analysis of the corresponding section. Significance was set at p<0.05. <h3>RESULTS</h3> A total of 73 unique visits, representing 55 patients met our inclusion criteria. A majority were men (39; 53%) and Caucasian (66; 91%), and the average age was 64 years (range: 34-87). There were 11 different types of tumors reported, with multiple myeloma, breast cancer, and lung cancer representing 22 (30%), 21 (29%), and 7 (9.6%), respectively. Additional cancers included prostate, colon, renal cell, thyroid, esophageal, non-Hodgkin's lymphoma, large B cell lymphoma, and metastatic spindle cell sarcoma. SOSG-OQ was strongly correlated with PROMIS PI (ρ = 0.83, p<0.0001; n = 68) and moderately correlated with both PROMIS PF (ρ = 0.76, p<0.0001; n = 68) and PROMIS Depression (ρ = 0.65, p<0.0001; n = 68). <h3>CONCLUSIONS</h3> PROMIS PF, PI, and Depression appear to capture similar clinical insight as the SOSG-OQ. Thus, spine surgeons can consider using these PROMIS domains in lieu of the SOSG-OQ in metastatic spine tumor patients. This is important for establishing broader, more interdisciplinary clinical care for this complex patient population, as PROMIS domains are symptom-based and can also be used by oncologists and other health care providers to deliver improved care. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Carbon fiber-reinforced PEEK instrumentation in the spinal oncology population: a retrospective series demonstrating technique, feasibility, and clinical outcomes.

The authors aimed to demonstrate the feasibility and advantages of carbon fiber-reinforced PEEK (CFRP) composite implants in patients with both primary and secondary osseous spinal tumors. Twenty-eight spinal tumor patients who underwent fixation with CFRP hardware were retrospectively identified in a Spine Tumor Quality Database at a single institution. Demographic, procedural, and follow-up data were retrospectively collected. The study population included 14 females and 14 males with a mean age of 60 years (range 30-86 years). Five patients had primary bone tumors, and the remaining patients had metastatic tumors. Breast cancer was the most common metastatic tumor. The most common presenting symptom was axial spine pain (25 patients, 89%), and the most common Spine Instability Neoplastic Score was 7 (range 6-14). Two patients in this series had anterior cervical procedures. The remaining patients underwent posterior thoracolumbar fixation. The average fusion length included 4.6 vertebral segments (range 3-8). The mean clinical follow-up time with surgical or oncology teams was 6.5 months (range 1-23 months), and the mean interval for last follow-up imaging (CT or MRI) was 6.5 months (range 1-22 months). Eighteen patients received postoperative radiation at the authors' institution (16 with photon therapy, 2 with proton therapy). Eleven of the patients (39%) in this series died. At the last clinical follow-up, 26 patients (93%) had stable or improved neurological function compared with their preoperative status. At the last imaging follow-up, local disease control was observed in 25 patients (89%). Two patients required reoperation in the immediate postoperative period, one for surgical site infection and the other for compressive epidural hematoma. One patient was noted to have lucencies around the most cephalad screws 3 months after surgery. No hardware fracture or malfunction occurred intraoperatively. No patients required delayed surgery for hardware loosening, fracture, or other failure. Early tumor recurrence was detected in 3 patients. Early detection was attributed to the imaging characteristics of the CFRP hardware. CFRP spinal implants appear to be safe and comparable to conventional titanium implants in terms of functionality. The imaging characteristics of CFRP hardware facilitate radiation planning and assessment of surveillance imaging. CFRP hardware may enhance safety and efficacy, particularly with particle therapy dosimetry. Larger patient populations with longer-term follow-up are needed to confirm the various valuable aspects of CFRP spinal implants.

En bloc resection and reconstruction of a huge chondrosarcoma involving multilevel upper thoracic spine and chest wall: case report

BackgroundEn bloc resection of malignant tumors involving upper thoracic spine is technically difficult. We surgically treated a patient with grade 2 chondrosarcoma involving T1–5, left upper thoracic cavity, and chest wall.Case presentationA 37 years old, male patient was referred to our hospital for a huge lump involved left shoulder and chest wall. In order to achieve satisfied surgical margins, anterior approach, posterior approach, and lateral approach were carried out sequentially. After en bloc tumor resection, the upper thoracic spine was reconstructed with a 3D-printed modular vertebral prosthesis, and the huge chest wall defect was repaired by a methyl methacrylate layer between 2 pieces of polypropylene mesh. Postoperatively, the patient suffered from pneumonia and neurological deterioration which fully recovered eventfully. At 24 months after operation, the vertebral prosthesis and internal fixation were intact; there was no tumor local recurrence, and the patient was alive with stable pulmonary metastases.ConclusionThis case report describes resection of a huge chondrosarcoma involving not only multilevel upper thoracic spine, but also entire left upper thoracic cavity and chest wall. Although with complications, en bloc tumor resection with combined surgical approach and effective reconstructions could improve oncologic and functional prognosis in carefully selected spinal tumor patients.

Spinal Tumor Surgery- Our Experiences of 35 Cases in a Peripheral Hospital in Bangladesh

Introduction: Surgical outcome of spinal tumour varies depending on a number of factors such as: site of the tumour, compression within the spinal canal, the histological characteristics of the tumour, the neurological progression and initial response to corticosteroid therapy, patient’s age, comorbidity, tumour extension, involvement of neighboring structures and organs etc.&#x0D; Materials &amp; Methods: The 35 patients with spinal tumour underwent surgery by our team in 10 years (January 2009 - December 2018) were reviewed retrospectively.&#x0D; Results: Analysis of the surgical outcome of our spinal tumour patients was done on different variables like age, sex, presenting symptoms, neuroimaging, comorbidities etc. The aim of surgery was decompression of the spinal cord, total removal of the tumour when possible and spinal stabilization when needed. Out of our 35 patients with spinal tumour, extradural tumour comprises 8, intradural extramedullary tumour 25 and intramedullary tumour 2.&#x0D; Conclusion: The aim of this study is to analyze the data to made conclusion for more effective strategy as per site, size, type, resectibility and histological variety to establish and effective treatment protocol and prevention of per-operative and post-operative complications. Intradural extramedullary tumour can be radically resected with no mortality and minimal peri-operative morbidity. But resection of intramedullary spinal tumour is difficult, hazardous and usually incomplete, so needs much more skilled and meticulous surgical hands.&#x0D; Medicine Today 2021 Vol.33(1): 38-41