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METASTASIS BONE TUMOR AT SPINE

Kiki A. Rizki

Surgical Oncology Division,
Departement of Surgery Hasan Sadikin Hospital Bnadung



Introduction
Metastases to the spine are a common problem
in a large oncology center

Between 5% and 10% of all cancer patients
develop spinal metastases during the course of
their disease.

The vertebral column is the most common site for
bony metastases, with an incidence of 30% to
70% in patients with metastatic neoplasms.
Common Primary Sites
Breast (21%)
Lung (14%)
Prostate (7.5%)
Renal (5%)
GI (5%)
Thyroid (2.5%)
Estimated New Cancer Cases* in the US in 2013
Level of Metastases
Thoracolumbar 70%
Lumbosacral 20%
Cervical 10%

Clinical Presentation
Pain (85%)
Hyperemia, expansion, nerve compression,
cord compression, pathologic fractures &
instability

Weakness (34%)
Spinal cord compression in 20%

Mass (13%)

Constitutional Symptoms
AIM THERAPY
Therapeutic intervention can alleviate pain,
preserve or improve neurologic function,
achieve mechanical stability, optimize local
tumor control, and improve quality of life
Osteoclast-Targeted Therapy Reduces
SREs in Breast Cancer
SURGERY
Axial pain secondary to mechanical instability
can causes significant morbidity.

With the advancement in spinal stabilization,
satisfactory neurologic improvement occurs in
48-88% of patients, with 80-100% rates of
pain relief.
SURGERY
Radical surgery not only provides stabilization,
it also confers tissue diagnosis and reduces
tumor burden.
SURGERY
HORMONE THERAPY
Women with metastatic disease that are ER
and/or PR positive are appropriate candidates
for initial endocrine therapy.

CHEMOTHERAPY
Single agent vs combination regimen

Combination chemotherapy is, however,
associated with an increase in toxicity, and is of
little survival benefit


Standard clinical practice is to continue first-line
chemotherapy until progression
SUMMARY
The vertebral column is the most common site for bony
metastases

Patients with metastatic spinal tumors may present with
pain, neurologic deficit, or both.

Therapeutic intervention can alleviate pain, preserve or
improve neurologic function, achieve mechanical stability,
optimize local tumor control, and improve quality of life.

Treatment options available for metastatic spine tumors
include radiation therapy (RT), surgery, hormone therapy
and chemotherapy.

THANK YOU
In premenopausal women, endocrine therapies :
selective ER modulators (tamoxifen or
toremifene);
luteinizing hormone-releasing hormone (LHRH)
agonists (goserelin and leuprolide);
surgical or radiotherapeutic oophorectomy;
progestin (megestrol acetate);
androgens (fluoxymesterone);
high-dose estrogen (ethinyl estradiol).

For postmenopausal women who are
antiestrogen naive or who are more than 1
year from previous antiestrogen therapy, the
options include either an aromatase inhibitor,
selective ER modulator, or an ER down-
regulator.