Understanding Metastatic Spinal Tumors

Etiology

Metastatic spinal tumors are neoplasms located in the vertebrae that are most commonly associated with multiple myeloma and primary cancers of the breast, lung, prostate, kidney, and thyroid. Tumors are commonly classified according to their location, whether it be intradural (intramedullary or extramedullary) or extradural. Extradural lesions, those occurring outside of the dura mater of the spinal cord, account for 95% of spinal lesions, the vast majority of these originating from the vertebrae.1

Metastatic spinal tumors, depending on their location, can have debilitating consequences with significant impact on the activities of daily living. These tumors can ultimately impinge on the spinal cord and nerve roots, leading to numbness and, potentially, paralysis in areas throughout the body. Metastatic spinal tumors can also weaken the structure of the vertebrae, leading to vertebral compression fractures, which often present with acute back pain.

Incidence

Metastatic disease in the skeleton occurs in up to 85% of patients with the three most common types of cancer – breast, prostate and lung.2 The spine is the most common site for bone metastasis, commonly referred to as “bone mets.” Acute among bone metastases is spinal meningioma, accounting for roughly 25% of all spinal tumors.3 Studies show that metastatic spinal tumors will develop in between 10% and 40% of all cancer patients, with even higher rates of metastatic spinal tumors in elderly patients.4 Several post-mortem studies have found metastatic spinal tumors in more than 30% of all patients who died as a result of cancer and cancer-related comorbidities.5,6

When metastatic spinal tumors are discovered, the metastatic disease is often found to be affecting multiple levels of the spine and causing tumor growth in two or more vertebrae.

With nearly 1.5 million new cancer cases diagnosed in the United States annually, this metastatic disease state could affect over 150,000 patients every year.

Prevalence

Metastatic spinal tumors are the most common type of malignant lesions of the spine, accounting for an estimated 70 percent of all spinal tumors.7

Patient Quality of Life

Patients often present with acute back pain and, depending on the location of the metastatic spinal tumors, numbness in the buttocks and other areas. When the pain becomes overwhelming, systemic treatment of the primary cancer is often halted, due to risks associated with cumulative toxicity of therapies, in order to address the metastatic spinal tumors and the associated pain.

While most cancer treatments focus on the eradication of the neoplasm, the endpoints in treating painful metastatic spinal tumors are often maximum pain relief and minimum delay in treatment of the primary cancer. Treatment regimens that can balance these two needs are attractive complements to current standards of care.

References

  1. Bartels R, van der Linden Y, and van der Graaf W. “Spinal Extradural Metastasis: Review of Current Treatment Options.” CA Cancer J Clin. 2008;58:245-259.
  2. Kurup AN and Callstrom MR. “Ablation of skeletal metastases: Current status.” J VascInterv Radiol. 2010; 21:S242-S250.
  3. Arnautovic K and Arnautovic A. “Extramedullaryintradural spinal tumors: a review of modern diagnostic and treatment options and a report of a series”, Bosn J Basic Med Sci. 2009; 9 Suppl 1:40-45.
  4. Cardoso ER, Ashamalla H, Weng L, Mokhtar B, Ali S, Macedon M, and Guirguis A. “Percutaneous tumor curettage and interstitial delivery of samarium-153 coupled with kyphoplasty for treatment of vertebral metastases.” J. Neurosurg Spine 2009;10:336-342.
  5. Wong DA, Fornasier VL, and MacNab I. “Spinal metastases: the obvious, the occult, and the impostors.” Spine. 1990; 15(1):1-4.
  6. Ortiz Gómez JA. “The incidence of vertebral body metastases.” IntOrthop. 1995; 19:309-311.
  7. American Association of Neurological Surgeons. 2007.


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