Abstract/References

Recent topics in diagnosis and treatment of malignant spinal tumors

Yoshihiro Matsumoto

Author information
  • Yoshihiro Matsumoto
    Department of Orthopaedic Surgery, Fukushima Medical University

Abstract

The diagnosis and treatment of malignant spinal tumors are complex and require an integrated approach known as Jaffe’s triangle.　This review discusses recent topics in the diagnosis and treatment of primary and metastatic malignant spinal tumors.　Integrated diagnostic methods, including the development of a dumbbell scoring system for benign-malignant differentiation and the use of positron emission tomography and magnetic resonance imaging (PET-MRI), have improved diagnostic accuracy.　Curative resection techniques such as vertebrectomy, sagittal resection, and posterior resection are crucial for primary malignant tumors.　Heavy particle radiation therapy, such as carbon-ion radiotherapy, shows promise against radiation-resistant tumors, whereas novel drug therapies, such as denosumab, are effective for giant cell tumors of the bone arising in the spine.　For metastatic spinal tumors, the collaborative efforts of the Bone Metastasis Cancer Board and minimally invasive spine stabilization have expanded surgical indications and improved patient outcomes.　The treatment system has shifted towards preventive surgery and outpatient management, aiming to maintain quality of life and continue chemotherapy.　Interdisciplinary collaboration is essential for improving treatment outcomes in both primary and metastatic malignant spinal tumors.

Primary malignant spinal cord tumors (PMST) and metastatic spinal tumors (MST) are among the most difficult areas of orthopedic surgery.　Their diagnosis and treatment require multidisciplinary diagnostic and therapeutic strategies that integrate knowledge and skills in orthopedics, pathology, and diagnostic radiology (the so-called Jaffe triangle), as well as in clinical oncology and tumor biology, which have made remarkable progress in recent years.　Here, we review recent topics related to the diagnosis and treatment of PMST and MST.

The content of research paper

References

  1. Matsumoto Y, Harimaya K, Kawaguchi K, et al.　Dumbbell Scoring System:A New Method for the Differential Diagnosis of Malignant and Benign Spinal Dumbbell Tumors.　Spine, 41:E1230-e1236, 2016.
  2. Sagiyama K, Watanabe Y, Kamei R, et al.　Multiparametric voxel-based analyses of standardized uptake values and apparent diffusion coefficients of soft-tissue tumours with a positron emission tomography/magnetic resonance system:Preliminary results.　European radiology, 27:5024-5033, 2017.
  3. Pearce MS, Salotti JA, Little MP, et al.　Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours:a retrospective cohort study.　Lancet, 380:499-505, 2012.
  4. Ponisio MR, McConathy J, Laforest R, et al.　Evaluation of diagnostic performance of whole-body simultaneous PET/MRI in pediatric lymphoma.　Pediatr Radiol, 46:1258-1268, 2016.
  5. Kong CB, Byun BH, Lim I, et al.　18F-FDG PET SUV-max as an indicator of histopathologic response after neoadjuvant chemotherapy in extremity osteosarcoma.　Eur J Nucl Med Mol Imaging, 40:728-736, 2013.
  6. Bajpai J, Kumar R, Sreenivas V, Chand Sharma M, Khan SA, Rastogi S, et al.　Prediction of chemotherapy response by PET-CT in osteosarcoma:correlation with histologic necrosis.　J Pediatr Hematol Oncol., 33:e271-8, 2011.
  7. Chan P, Boriani S, Fourney DR, et al.　An assessment of the reliability of the Enneking and Weinstein-Boriani-Biagini classifications for staging of primary spinal tumors by the Spine Oncology Study Group.　Spine, 34:384-391, 2009.
  8. Boriani S, Weinstein JN, Biagini R.　Primary bone tumors of the spine.　Terminology and surgical staging.　Spine, 22:1036-1044, 1997.
  9. Vasudeva VS, Ropper AE, Rodriguez S, et al.　Contralateral osteotomy of the pedicle and posterolateral elements for en bloc resection:a technique for oncological resection of posterolateral spinal tumors.　Journal of neurosurgery Spine, 26:275-281, 2017.
  10. Imai R, Kamada T, Araki N, et al.　Carbon ion radiation therapy for unresectable sacral chordoma:An analysis of 188 cases.　International journal of radiation oncology, biology, physics, 95:322-327, 2016.2.
  11. Matsunobu A, Imai R, Kamada T, et al.　Impact of carbon ion radiotherapy for unresectable osteosarcoma of the trunk.　Cancer, 118:4555-4563, 2012.
  12. Matsumoto K, Imai R, Kamada T, et al.　Impact of carbon ion radiotherapy for primary spinal sarcoma.　Cancer, 119:3496-3503, 2013.
  13. Sahgal A, Weinberg V, Ma L, et al.　Probabilities of radiation myelopathy specific to stereotactic body radiation therapy to guide safe practice.　International journal of radiation oncology, biology, physics, 85:341-347, 2013.
  14. Matsumoto Y, Matsunobu A, Kawaguchi K, et al.　Clinical results of carbon-ion radiotherapy with separation surgery for primary spine/paraspinal sarcomas.　2019; International journal of clinical oncology.　doi:10.1007/s10147-019-01505-y.
  15. Sahgal A, Atenafu EG, Chao S, et al.　Vertebral compression fracture after spine stereotactic body radiotherapy:a multi-institutional analysis with a focus on radiation dose and the spinal instability neoplastic score.　J Clin Oncol, 31:3426-3431, 2013.
  16. Matsumoto Y, Shinoto M, Endo M, et al.　Evaluation of risk factors for vertebral compression fracture after carbon-ion radiotherapy for primary spinal and paraspinal sarcoma.　Biomed Res Int 2017:9467402, 2017.
  17. Matsumoto Y, Okada Y, Fukushi J, et al.　Role of the VEGF-Flt-1-FAK pathway in the pathogenesis of osteoclastic bone destruction of giant cell tumors of bone.　Journal of orthopaedic surgery and research, 5:85, 2010.
  18. Yasuda H, Shima N, Nakagawa N, et al.　Osteoclast differentiation factor is a ligand for osteoprotegerin/osteoclastogenesis-inhibitory factor and is identical to TRANCE/RANKL. Proceedings of the National Academy of Sciences of the United States of America, 95:3597-3602, 1998.
  19. Chawla S, Henshaw R, Seeger L, et al.　Safety and efficacy of denosumab for adults and skeletally mature adolescents with giant cell tumour of bone:interim analysis of an open-label, parallel-group, phase 2 study.　The Lancet Oncol, 14:901-908, 2013.
  20. Ueda T, Morioka H, Nishida Y, et al.　Objective tumor response to denosumab in patients with giant cell tumor of bone:a multicenter phase II trial.　Annals of oncol :2149-2154, 2015.
  21. Behjati S, Tarpey PS, Presneau N, et al.　Distinct H3F3A and H3F3B driver mutations define chondroblastoma and giant cell tumor of bone.　Nature genet, 45:1479-1482, 2013.
  22. Yamamoto H, Iwasaki T, Yamada Y, et al.　Diagnostic utility of histone H3.3 G34W, G34R, and G34V mutant-specific antibodies for giant cell tumors of bone.　Human pathol, 73:41-50, 2018.
  23. Yonezawa N, Murakami H, Kato S, et al.　Giant cell tumor of the thoracic spine completely removed by total spondylectomy after neoadjuvant denosumab therapy.　Eur spine J, 26:236-242, 2017.
  24. Japanese Society of Medical Oncology, Bone metastasis.　Practical guideline of bone metastasis.　Nanko-do (Tokyo), 2022.
  25. Hikata T, Isogai N, Shiono Y, et al.　A retrospective cohort study comparing the safety and efficacy of minimally invasive versus open surgical techniques in the treatment of spinal metastases.　Clin spine surg, 30:E1082-e1087, 2017.
  26. Lieberman IH, Togawa D, Kayanja MM.　Vertebroplasty and kyphoplasty:filler materials.　Spine J , 5:305s-316s, 2005.
  27. Pflugmacher R, Taylor R, Agarwal A, et al.　Balloon kyphoplasty in the treatment of metastatic disease of the spine:a 2-year prospective evaluation.　Eur spine J, 17:1042-1048, 2008.
  28. Berenson J, Pflugmacher R, Jarzem P, et al.　Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer:a multicentre, randomised controlled trial.　The Lancet Oncol, 12:225-235, 2011.
  29. Miyazaki S, Kakutani K, Sakai Y, et al.　Quality of life and cost-utility of surgical treatment for patients with spinal metastases:prospective cohort study.　Int orthop, 41:1265-1271, 2017.

Figures

Abstract images showing two distinct shapes with varying color gradients, likely representing data or research findings.
Diagram of a vertebra with labeled sections, illustrating anatomical features for educational purposes.
MRI images showing spinal structures, including vertebrae and surgical hardware.
Illustration of anatomical structures related to the spine, including MRI images and surgical views.
Illustration of anatomical structures related to medical research, including diagrams and images of specimens.
MRI images showing different views of the heart, highlighting anatomical structures and potential abnormalities.
ALT: Medical imaging series showing cervical spine X-ray, MRI, and CT scans for diagnostic evaluation.
Histological images showing various tissue samples with distinct staining patterns, highlighting cellular structures and composition.
MRI and X-ray images showing spinal structures and surgical hardware for medical analysis.
MRI images of the lumbar spine showing various views of the L4 vertebra and surrounding structures.
Table displaying histological diagnoses of spinal dumbbell tumors, including benign and malignant categories with corresponding numbers.
Table displaying the Dumbbell scoring system for tumor assessment, including factors and corresponding points.

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