Evidence-Based Treatment for a Lung Cancer Patient with Spinal Metastasis_Chinese Journal of Evidence-Based Medicine

Authors：

LI Juan ¹ ,  SHI Rui ² , YU Ping ¹

1. Department of Integrated Lung Tumor Therapy, Sichuan Cancer Hospital, Chengdu 610041, China;2. Department of Orthopedics, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

SHI Rui, Email: dr.shirui@gmail.com

Keywords：

Lung cancer; Spinal metastasis; Evidence-based treatment

DOI：

10.7507/1672-2531.20130136

Video：

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Objective 　To establish the evidence-based treatment strategy for an advanced lung cancer case with spinal metastasis, regarding the patient’s condition and treatment expectations.
Methods 　According to PICO principles, questions in the patient’s treatment were converted into a search strategy. The literature searching was performed in several databases. In accordance with the five evidence grading standards in evidence-based medicine, the best clinical evidence was interpreted to guide the treatment decisions.
Results 　A total of 148 papers were detected and screened, of which 4 systematic reviews or meta-analyses were included finally. Four issues that patients concerned, including restoring spinal cord function (walking and sphincter function), local pain control, long-term survival, and treatment complications, were all supported by grade-1 evidence. The patient finally chose surgical decompression, which was of a higher complication risk, but better possibility of restoring nerve function, significant pain relief, and improved long-term survival. The patient obtained fully recovery and regained walking function after surgery.
Conclusion 　The evidence-based treatment is able to provide reasonable treatment options for lung cancer patients with spinal metastasis. Decompression surgery for patients with walking dysfunction should be carried out as soon as possible, in order to early restore spinal marrow function, relieve pain and improve long-term survival. But both doctors and patients should fully acquaint themselves with the higher risk of surgical complications.

Citation： LI Juan,SHI Rui,YU Ping. Evidence-Based Treatment for a Lung Cancer Patient with Spinal Metastasis. Chinese Journal of Evidence-Based Medicine, 2013, 13(6): 768-772. doi: 10.7507/1672-2531.20130136 Copy

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9.	George R, Jeba J, Ramkumar G, et al. Interventions for the treatment of metastatic extradural spinal cord compression in adults. Cochrane Database Syst Rev, 2008, 8(4): CD006716.
10.	Klimo PJr, Thompson CJ, Kestle JR, et al. A meta-analysis of surgery versus conventional radiotherapy for the treatment of metastatic spinal epidural disease. Neuro Oncol, 2005, 7(1): 64-76.
11.	Helweg-Larsen S. Clinical outcome in metastatic spinal cord compression. A prospective study of 153 patients. Acta Neurol Scand, 1996, 94(4): 269-275.
12.	King GJ, Kostuik JP, McBroom RJ, et al. Surgical management of metastatic renal carcinoma of the spine. Spine (Phila Pa 1976), 1991, 16(3): 265-271.
13.	Maranzano E, Latini P. Effectiveness of radiation therapy without surgery in metastatic spinal cord compression: final results from a prospective trial. Int J Radiat Oncol Biol Phys, 1995, 32(4): 959-967.
14.	Overby MC, Rothman AS. Anterolateral decompression for metastatic epidural spinal cord tumors. Results of a modified costotransversectomy approach. J Neurosurg, 1985, 62(3): 344-348.
15.	Siegal T, Siegal T. Surgical decompression of anterior and posterior malignant epidural tumors compressing the spinal cord: a prospective study. Neurosurgery, 1985, 17(3): 424-432.
16.	Hirabayashi H, Ebara S, Kinoshita T, et al. Clinical outcome and survival after palliative surgery for spinal metastases: palliative surgery in spinal metastases. Cancer, 2003, 97(2): 476-484.
17.	Fourney DR, Abi-Said D, Lang FF, et al. Use of pedicle screw fixation in the management of malignant spinal disease: experience in 100 consecutive procedures. J Neurosurg, 2001, 94(1 Suppl): 25-37.
18.	Weigel B, Maghsudi M, Neumann C, et al. Surgical management of symptomatic spinal metastases. Postoperative outcome and quality of life. Spine (Phila Pa 1976), 1999, 24(21): 2240-2246.
19.	Kovner F, Spigel S, Rider I, et al. Radiation therapy of metastatic spinal cord compression. Multidisciplinary team diagnosis and treatment. J Neurooncol, 1999, 42(1): 85-92.
20.	Patchell RA, Tibbs PA, Regine WF, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet, 2005, 366(9486): 643-648.
21.	Guyatt GH. Evidence-based medicine. ACP J Club, 1991, 114(S2): A16.

1. Smith RA, Brooks D, Cokkinides V, et al. Cancer screening in the United States, 2013: A review of current american cancer society guidelines, current issues in cancer screening, and new guidance on cervical cancer screening and lung cancer screening. CA Cancer J Clin, 2013, doi: 10.3322/caac.21174.
2. Marshall HM, Leong SC, Bowman RV, et al. The science behind the 7th edition Tumour, Node, Metastasis staging system for lung cancer. Respirology, 2012, 17(2): 247-260.
3. Sun H, Nemecek AN. Optimal management of malignant epidural spinal cord compression. Hematol Oncol Clin North Am, 2010, 24(3): 537-551.
4. Abrahm JL, Banffy MB, Harris MB. Spinal cord compression in patients with advanced metastatic cancer: "all I care about is walking and living my life". JAMA, 2008, 299(8): 937-946.
5. 吴娟, 郑伟, 吴志鹏. 手术对脊柱转移性肿瘤患者晚期生命质量的影响. 中国循证医学杂志, 2012, 12(9): 1041-1046.
6. National Collaborating Centre for Cancer. Metastatic spinal cord compression. Diagnosis and management of adults at risk of and with metastatic spinal cord compression. London (UK): National Institute for Health and Clinical Excellence (NICE); 2008 Nov. 39 p. (Clinical guideline; no. 75).
7. Loblaw DA, Mitera G, Ford M, et al. A 2011 Updated Systematic Review and Clinical Practice Guideline for the Management of Malignant Extradural Spinal Cord Compression. Int J Radiat Oncol Biol Phys, 2012, 84(2): 312-317.
8. Kim JM, Losina E, Bono CM, et al. Clinical outcome of metastatic spinal cord compression treated with surgical excision +/- radiation versus radiation therapy alone: a systematic review of literature. Spine (Phila Pa 1976), 2012, 37(1): 78-84.
9. George R, Jeba J, Ramkumar G, et al. Interventions for the treatment of metastatic extradural spinal cord compression in adults. Cochrane Database Syst Rev, 2008, 8(4): CD006716.
10. Klimo PJr, Thompson CJ, Kestle JR, et al. A meta-analysis of surgery versus conventional radiotherapy for the treatment of metastatic spinal epidural disease. Neuro Oncol, 2005, 7(1): 64-76.
11. Helweg-Larsen S. Clinical outcome in metastatic spinal cord compression. A prospective study of 153 patients. Acta Neurol Scand, 1996, 94(4): 269-275.
12. King GJ, Kostuik JP, McBroom RJ, et al. Surgical management of metastatic renal carcinoma of the spine. Spine (Phila Pa 1976), 1991, 16(3): 265-271.
13. Maranzano E, Latini P. Effectiveness of radiation therapy without surgery in metastatic spinal cord compression: final results from a prospective trial. Int J Radiat Oncol Biol Phys, 1995, 32(4): 959-967.
14. Overby MC, Rothman AS. Anterolateral decompression for metastatic epidural spinal cord tumors. Results of a modified costotransversectomy approach. J Neurosurg, 1985, 62(3): 344-348.
15. Siegal T, Siegal T. Surgical decompression of anterior and posterior malignant epidural tumors compressing the spinal cord: a prospective study. Neurosurgery, 1985, 17(3): 424-432.
16. Hirabayashi H, Ebara S, Kinoshita T, et al. Clinical outcome and survival after palliative surgery for spinal metastases: palliative surgery in spinal metastases. Cancer, 2003, 97(2): 476-484.
17. Fourney DR, Abi-Said D, Lang FF, et al. Use of pedicle screw fixation in the management of malignant spinal disease: experience in 100 consecutive procedures. J Neurosurg, 2001, 94(1 Suppl): 25-37.
18. Weigel B, Maghsudi M, Neumann C, et al. Surgical management of symptomatic spinal metastases. Postoperative outcome and quality of life. Spine (Phila Pa 1976), 1999, 24(21): 2240-2246.
19. Kovner F, Spigel S, Rider I, et al. Radiation therapy of metastatic spinal cord compression. Multidisciplinary team diagnosis and treatment. J Neurooncol, 1999, 42(1): 85-92.
20. Patchell RA, Tibbs PA, Regine WF, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet, 2005, 366(9486): 643-648.
21. Guyatt GH. Evidence-based medicine. ACP J Club, 1991, 114(S2): A16.

Chinese Journal of Evidence-Based Medicine

Evidence-Based Treatment for a Lung Cancer Patient with Spinal Metastasis

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