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2015 ; 7
(4
): 476-82
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gab.com Text
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English Wikipedia
Patterns of Treatment for Metastatic Pathological Fractures of the Spine: The
Efficacy of Each Treatment Modality
#MMPMID26640631
Cho JH
; Ha JK
; Hwang CJ
; Lee DH
; Lee CS
Clin Orthop Surg
2015[Dec]; 7
(4
): 476-82
PMID26640631
show ga
BACKGROUND: Metastatic pathological fractures of the spine are a major problem
for cancer patients; however, there is no consensus on treatment strategy. The
purpose of this study was to evaluate various treatment options by analyzing
their patterns for metastatic pathological fractures of the spine. METHODS: In
this study, 54 patients (male:female = 36:18) who were diagnosed with metastatic
pathological fractures of spine were recruited. Demographic data, origin of
cancer, type of treatment, and results were obtained from electronic medical
records. Treatment options were divided into radiotherapy (RT), vertebroplasty
(VP) or kyphoplasty (KP), operation (OP), and other treatments. Treatment results
were defined as aggravation, no response, fair response, good response, and
unknown. The survival time after detection of pathologic fractures was analyzed
with the Kaplan-Meier method. RESULTS: The mean age of the patients was 62.3
years. Hepatocellular carcinoma was the most common cancer of primary origin (n =
9), followed by multiple myeloma (n = 8). RT was the most common primary choice
of treatment (n = 29, 53.7%), followed by OP (n = 13, 24.1%), and VP or KP (n =
10, 18.5%). Only 13 of 29 RT cases and 7 of 13 OP cases demonstrated a fair or
good response. The mean survival time following detection of pathological spinal
fractures was 11.1 months for 29 patients, who died during the study period.
CONCLUSIONS: RT was the most common primary choice of treatment for metastatic
pathological fractures of the spine. However, the response rate was suboptimal.
Although OP should be considered for the relief of mechanical back pain or
neurologic symptoms, care should be taken in determining the surgical indication.
VP or KP could be considered for short-term control of localized pain, although
the number of cases was too small to confirm the conclusion. It is difficult to
determine the superiority of the treatment modalities, hence, a common guideline
for the diagnosis and treatment of metastatic pathological fractures of the spine
is required.