Impact of the Spinal Instability Neoplastic Score on Surgical Referral Patterns and Outcomes

Current oncology

S. Lucas¹  L. Weir²  J. Wong²  S. Lomas²  S. Tyldesley²  M. Dosani²  C. Cumayas³  C. Fisher⁴ 

[1] British Columbia Cancer Agency;British Columbia Cancer Agency Vancouver Centre;Department of Radiation Oncology, Vancouver Centre, BC Cancer Agency;University of British Columbia and Vancouver General Hospital

关键词: Palliative radiotherapy;    spinal metastases;    spinal surgery;    spine radiotherapy;    radiation;    spinal instability neoplastic score;   

DOI  :  10.3747/co.25.3835

学科分类：肿瘤学

来源: Multimed, Inc.

【 摘 要 】

BackgroundThe Spinal Instability Neoplastic Score (sins) was developed to identify patients with spinal metastases who may benefit from surgical consultation. We aimed to assess the distribution of sins in a population-based cohort of patients undergoing palliative spine radiotherapy (rt) and referral rates to spinal surgery pre-rt. Secondary outcomes included referral to a spine surgeon post-rt, overall survival, maintenance of ambulation, need for re-intervention, and presence of spinal adverse events. MethodsWe retrospectively reviewed ct simulation scans and charts of consecutive patients receiving palliative spine rt between 2012 and 2013. Data were analyzed using Student’s t-test, Chi-squared, Fisher’s exact, and Kaplan-Meier log-rank tests. Patients were stratified into low (<7) and high (≥7) sins groups. ResultsWe included 195 patients with a follow-up of 6.1 months. The median sins was 7. The score was 0 to 6 (low, no referral recommended), 7 to 12 (intermediate, consider referral), and 13 to 18 (high, referral suggested) in 34%, 59%, and 7% of patients, respectively. Eleven patients had pre-rt referral to spine surgery, with a surgery performed in 0 of 1 patient with sins 0 to 6, 1 of 7 with sins 7 to 12, and 1 of 3 with sins 13 to 18. Seven patients were referred to a surgeon post-rt with salvage surgery performed in two of those patients. Primary and secondary outcomes did not differ between low and high sins groups. ConclusionHigher sins was associated with pre-rt referral to a spine surgeon, but most patients with high sins were not referred. Higher sins was not associated with shorter survival or worse outcome following rt.

【 授权许可】

Unknown