Spinal tumours (metastatic)

The commonest primary tumours which cause metastatic deposits in the spine include:

• breast
• lung
• prostate
• kidney

The thoracic vertebrae are most affected although metastasis may occur at any site. Frequently, lesions are multiple.

Presentation is typically of bone pain and tenderness. Limb and autonomic dysfunction follow as collapse of the vertebral body permits tumour tissue and softened bone to extrude into the extradural space and compress the spinal cord or cauda equina.

Plain X ray may reveal osteolytic lesions or vertebral collapse. Myelography and MRI can identify extradural compression and the presence of multiple lesions.

Treatment historically, has been with decompressive laminectomy, i.e. removal of the laminae and spinous processes

• other evidence suggests that that local radiotherapy may be as equally effective
  • .radiotherapy (RT) plays an important role in the treatment of bone metastases. Its effectiveness in pain control has been demonstrated in many studies (1,2)
    • role in preventing pathologic fractures, as well as the improvement of survival seems to be less significant in the primary tumors are either breast, lung, kidney or prostate

Reference:

• Hartsell WF, Scott CB, Bruner DW, et al.: Randomized trial of short- versus long-course radiotherapy for palliation of painful bone metastases. J Natl Cancer Inst 2005; 97:798-804.
• Kachnic L, Berk L: Palliative single-fraction radiation therapy: How much more evidence is needed? J Natl Cancer Inst 2005; 97:786-788.
• Fottner A, Szalantzy M, Wirthmann L, et al.: Bone metastases from renal cell carcinoma: Patient survival after surgical treatment. BMC Musculoskelet Disord 2010; 11:145.
• Sugiura H, Yamada K, Sugiura T, et al.: Predictors of survival in patients with bone metastasis of lung cancer. Clin Orthop Relat Res 2008; 466:729-736.