Surgical treatment also results in increased survival time. The better survival time in the surgical group was probably because a greater proportion of patients in this group were ambulatory and remained so for longer than those in the radiation group. Therefore, patients in the surgery group were less susceptible to infections, blood clots, and other problems that result in the death of paraplegic patients. Surgical treatment also reduces the need for corticosteroids and opioid pain relief [154]. Palliative surgery using posterior decompression and fixation combined with intraoperative VA to treat spinal metastases with osseous and epidural disease can improve neurological function, alleviate pain effectively, and allow low cement leakage and timely disposal of leakage if it happens [155]. Radiation Oncology Consultation The current standard of care for the management of diffuse painful osseous metastases is external beam RT [156] for at least partial pain palliation [157]. A short course, such as 8 Gy in 1 fraction (as opposed to 20 Gy in 5 fractions or 30 Gy in 10 fractions), is best for patients who have radiosensitive tumors (hematologic primary, seminoma, small-cell lung cancer) or have a poor survival prognosis (<3 months). Some studies have demonstrated benefit in up to 70% of patients treated with respect to neurologic improvement for patients with symptomatic spinal cord compression [158,159]. Advancements in radiotherapy have allowed for the delivery of high precision dose- escalated treatment, known as SBRT, to targets throughout the body with excellent local control rates. Recently, the first phase II randomized trial comparing conventional radiotherapy to comprehensive SBRT of oligometastatic disease demonstrated an overall survival and progression-free survival advantage [160].
Management of Vertebral Compression Fractures PCAs. Surgical treatment also results in increased survival time. The better survival time in the surgical group was probably because a greater proportion of patients in this group were ambulatory and remained so for longer than those in the radiation group. Therefore, patients in the surgery group were less susceptible to infections, blood clots, and other problems that result in the death of paraplegic patients. Surgical treatment also reduces the need for corticosteroids and opioid pain relief [154]. Palliative surgery using posterior decompression and fixation combined with intraoperative VA to treat spinal metastases with osseous and epidural disease can improve neurological function, alleviate pain effectively, and allow low cement leakage and timely disposal of leakage if it happens [155]. Radiation Oncology Consultation The current standard of care for the management of diffuse painful osseous metastases is external beam RT [156] for at least partial pain palliation [157]. A short course, such as 8 Gy in 1 fraction (as opposed to 20 Gy in 5 fractions or 30 Gy in 10 fractions), is best for patients who have radiosensitive tumors (hematologic primary, seminoma, small-cell lung cancer) or have a poor survival prognosis (<3 months). Some studies have demonstrated benefit in up to 70% of patients treated with respect to neurologic improvement for patients with symptomatic spinal cord compression [158,159]. Advancements in radiotherapy have allowed for the delivery of high precision dose- escalated treatment, known as SBRT, to targets throughout the body with excellent local control rates. Recently, the first phase II randomized trial comparing conventional radiotherapy to comprehensive SBRT of oligometastatic disease demonstrated an overall survival and progression-free survival advantage [160].