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Prolonged survival achieved with surgical resection for spinal tumor patients
Additional radiotherapy also helped a number of patients live longer, a study has found.
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Surgical resection has been associated with prolonged survival in cases of patients with primary spinal chordoma, chondrosarcoma, Ewing’s sarcoma and osteosarcoma, according to a recent study.
The findings were presented by Scott L. Parker, at the 2010 Annual Meeting of the North American Spine Society.
Parker noted that the literature thus has only looked at small populations in terms of determining what kind of survival can be expected with patients who undergo surgical resection for these lesions of the spine.
“Surgical resection has been shown to improve short-term local disease control, but it remains debated whether surgical resection is associated with overall survival,” he said. “Because of the small numbers, large population-based observational studies are necessary to determine the association of surgical resection and survival in patients with these malignant tumors.”
The SEER database
The team analyzed 30 years of patient survival data from the Surveillance, Epidemiology, and End Results registry (SEER), a United States population-based cancer registry. This analysis included identification of histologically confirmed primary spinal chordoma, chondrosarcoma, osteosarcoma, or Ewing sarcoma. Variables they assessed included patient age, gender, race, tumor-site, extent of tumor invasion, surgical management, and use of radiation therapy.
“The primary interest was overall survival, and for each of the tumor histologies we performed a Cox hazard regression analysis, adjusting for age, whether radiation therapy had been given, and the extent of local tumor invasion,” Parker said.
The group identified 827 patients with non-metastatic primary osseous neoplasms. Parker reported the sacrum was more frequented than the mobile spine for all tumor histologies investigated, and the majority of tumors showed invasion through the periosteum.
Prolonging survival
The data found that patients who underwent at least surgery had a much greater survival rate than patients who went without surgery, with a median survival of chondrosarcoma patients who underwent surgery of 192 months and those who did not undergo surgery of 16 months. Chordoma patients who underwent surgery had a median survival of 87 months compared with 53 months in patients who did not undergo surgery, and those who underwent surgery plus additional radiotherapy had a median survival of 104 months.
Osteosarcoma patients who underwent surgery had a median survival of 37 months. Additional radiotherapy brought median survival up to 43 months, while patients who did not undergo any surgery had a median survival of 11 months. In Ewing’s sarcoma patients, surgery plus radiotherapy gave a median survival time of 72 months. Without surgery, this number was 43 months.
“Adjusting for age, radiation therapy and the extent of local tumor with isolated spine tumors … surgical resection was associated with greater survival in all four types – all being significant,” Parker said.
Five-year survival was higher in patients who underwent surgery or surgery plus radiotherapy than it was in those who did not undergo surgery.
“Patients undergoing surgical resection of primary spinal chordoma, chondrosarcoma, Ewing’s sarcoma as well as osteosarcoma demonstrated prolonged overall survival compared to those not receiving surgery,” Parker concluded. “Therefore, surgical resection will play a role in prolonging survival in the multi-modality treatment of patients with these lesions.” – by Robert Press
Reference:
- Mukherjee D, et al. Association of extent of surgical resection and survival in patients with malignant primary osseous spinal neoplasms: A 30-year population-based study. Paper 224. Presented at the 2010 Annual Meeting of the North American Spine Society. Oct. 5-9, 2010. Orlando, Fl.
- Scott L. Parker can be reached at 4347 Village at Vanderbilt, Nashville, TN 37232-8618, 615-322-1883; e-mail: slparker7@gmail.com.
- Disclosure: Parker and his co-authors have no relevant financial disclosures to report.
