| The Tokuhashi Scale has limited applicability to most patients with medullary compression secondary to spinal metastasis18
|
To evaluate the number of completed Tokuhashi Scoring System (TSS) until a therapeutic decision is made |
Case Series |
TSS survival prognosis requires time and technological and financial resources. In urgent treatment of spinal metastases it is impossible to fill out the TSS due to urgency. It was sustained that the criteria for a surgical decision should be based on clinical and neurological disorders instead of on prognostic scales. |
3B |
B |
| Overall survival following reirradiation of spinal metastases – independent validation of predictive models19
|
To validate the available survival forecasting tools in a group of patients submitted to reirradiation of spinal metastases in a single institution |
Case Series |
The estimate of reirradiation survival used by the radio-oncologist: primary tumor, central nervous system metastases, and general metastatic load – little efficacy compared to SPT-Nieder that uses the KPS-Karnofsky Performance Status index, liver metastases and steroid use. SPT-Nieder higher prognostic precision, but the item pleural effusion was not correlated in the study. |
3B |
B |
| Synthesis and characterization of calcium phosphate incorporated with 166Ho and 153Sm nuclides: a new biomaterial for the treatment of spinal metastases20
|
To summarize and characterize bioceramics based on calcium orthophosphates incorporated with holmium (166Ho) and samarium (153Sm) |
Non-living experimental model |
Radiovertebroplasty with use of radioactive bone cement, calcium orthophosphate Ho/Sm bioceramics and computational dosimetry in the 166Ho model. Therapeutic doses in the lesion less than 10% of the normally used radiotherapy dose. I uphold that the treatment will promote tumor control, less incidence of damage, and clinical studies should be conducted to validate risks, benefits, and indications. |
5 |
D |
| Single center prospective study of the efficacy of percutaneous cement reinforcement in the treatment of fractures with vertebral compression21
|
To evaluate prospectively patients with fractures with vertebral compression using an 11-point visual analog scale for pain and the Qualeffo-41 quality of life questionnaire |
Single center prospective |
The use of percutaneous cement reinforcement is safe and effective in the treatment of spinal fractures with painful compression related to osteoporosis, trauma, and cancer, achieving rapid and significant pain reduction and improved physical function, measured by a visual analog scale and the Qualeffo-41 questionnaire |
1C |
A |
| Effectiveness of surgical intervention in the quality of life and survival of patients with metastatic lesions of the spine22
|
To evaluate the quality of life of patients with metastatic spinal lesions, observing pain, neurological profile, and survival |
Prospective |
Surgery does not influence patient survival, except in patients with neurological deficit with poor prognosis. Treatment of the metastatic lesion is many times palliative, but patients present neurological improvement justifying surgical intervention. The neurological deficit involves worsening of the prognosis |
2C |
B |
| Regensburg Protocol for Spinal Mestastases23
|
To show the spinal metastasis treatment protocol of the University Hospital of Regensburg, Germany. |
Experience Report |
The Regensburg Protocol assesses spinal instability, neurological deficit, survival greater than 6 months, possibility of resection of the metastasis. If positive, perform embolization, resection of the metastasis, implants for stabilization. If negative, percutaneous surgical techniques only for pain control: vertebroplasty, kyphoplasty, or it is not performed due to risk of death. Individualized surgical treatment: conditions of the patients, neurological deficit, spinal instability, and survival rate |
3B |
B |
| Management of metastatic spinal neoplasias – an update24
|
To find out about therapeutic modalities in spinal metastasis |
Literature Review |
Treatment of spinal metastasis should be individualized and multidisciplinary: neurosurgeons, oncologists, oncologic surgeons, radiotherapists, physiatrists, pain specialists, psychologist among others. The rational choice of the therapeutic modality should be based on the clinical and neurological condition of the patient, life expectancy, degree of spinal impairment, histological type of the neoplasia, and desire of the patient and the family. |
3A |
B |
| Evaluation of the interobserver reproducibility of a new scale for orientation of therapeutic conduct in spinal metastases: SINS score (Spine Instability Neoplastic Score)25
|
To evaluate the impact on conduct and quantify the interobserver reproducibility of the SINS score. In addition, to determine its applicability in our environment. |
Retrospective reproducibility study |
The SINS is applicable in Brazil. Divergence between the evaluations in terms of the stability of lesions before and after the application of SINS. However, the therapeutic conduct was not modified for this new score. The SINS has moderate interobserver reproducibility. |
1A |
A |
| Current paradigms for metastatic medullary disease: an evidence-based review26
|
To review decision-making strategies that determine the most effective treatment options. |
Evidence-based review |
Surgical oncology developing change in the management of surgical patients with metastatic tumors. Greater vision: tumor biology, of the surgical approaches, oncology by radiation instrumentation, stereotactic radiosurgery, and intensity-modulated radiation therapy |
3 A |
B |
| Prognostic factors associated with the survival of patients with symptomatic bone metastases: retrospective cohort study of 1,043 patients27
|
To identify prognostic factors associated with survival in patients with symptomatic SBM and to create a validated risk stratification model. |
Retrospective single center cohort |
The Frankel scale: not for spinal metastases. Created three-variable flowchart – clinical profile; KPS index, visceral and/or cerebral metastases, their marked use favorable clinical patient profile. Use flowchart comparing efficiency of treatment modalities, radiotherapy center, and quality of life |
1C |
A |
| Spinal metastasis in thyroid cancer28
|
To analyze management options proposed in the literature and the recommendations that can improve the prognosis of patients with spinal metastases of thyroid carcinomas. |
Systematic literature review |
Administer radioiodine I-131 & surgery. Associate SET (selective embolization therapy), bisphosphonates, VEGFR (vascular endothelial growth factor receptors) inhibitors. Young patient surgery: radiotherapy verify SET or cytotoxic chemotherapy. VEGFR useful non-aggressive disease, bisphosphonate palliation / SET. Necessary studies on the combination of therapies. Ideal future interception in the molecular pathways of the tumor genes to prevent dissemination. Current surgery more logical – but not curative, palliative |
3 A |
B |
| Patients with spinal metastases submitted to neurology decompression and stabilization29
|
To analyze surgery of metastases, arthrodesis / pedicle screws via isolated posterior approach. |
Retrospective / case series |
Surgery through arthrodesis / pedicular instrumentation / decompression brings significant clinical benefits, improved pain and neurological profiles. |
3B |
B |
| Title |
Objective(s) |
Method |
Evidence Data |
LE |
DR |
| Score evaluation in decision-making in spinal metastases30
|
To evaluate the intra- and interobserver concordance of the SINS, Harrington, Tokuhashi, and Tomita scores. |
Retrospective reproducibility study |
Predictive instability scores – Harrington, prognostic – Tomita, have higher intra- and interobserver reliability among spinal surgeons with more than 10 years of experience. The SINS score – election for daily practice and the most frequent capable of modifying the conduct. |
1A |
A |
| Effectiveness of surgical intervention in the quality of life and survival of patients with metastatic lesions of the spine.22
|
To evaluate the impact of the surgical treatment of spinal epidural metastatic lesions on the quality of life, pain improvement, and survival of the patients |
Prospective observational |
Used the Oswestry questionnaire, the Frankel et al. Scale, Tokuhashi score, VAS score, criteria of Panjabi et al., Kostuik criteria. Concluded early diagnosis of spinal metastases through action of multidisciplinary team, pain must be valued especially with weight loss and progressive worsening. Surgery depends on clinical conditions, degree of instability, and tumor location. The surgery does not influence patient survival, except in neurological deficit. Surgery is palliative – less pain and neural protection |
1C |
A |
| Tokuhashi Score and other prognostic factors in 260 patients with surgery for spinal metastases31
|
To evaluate the performance of the Tokuhashi score in a cohort of 260 patients and to look for other variables that can improve the forecasting of results prior to surgery. |
Retrospective single center cohort |
It supports the validity and reproducibility of Tokuhashi. Our discovery that less time for the diagnosis of metastases and age ≥ 70 year also were significantly associated with survival in our populations; suggests additional effort to improve and update the Tokuhashi score. |
2B |
B |
| Prognostic factors in patients with symptomatic spinal metastases and normal neurological function32
|
To evaluate potential prognostic factors to predict survival after radiotherapy in patients with painful spinal metastases and normal neurological function. |
Cohort study |
Predictive factors: primary cancer site, KPS, albumin level, number of visceral metastases, and analgesic use. The pretreatment albumin level is an important predictor in calculating the survival rate and determining treatment. Use of analgesics at the onset of treatment significant factor in results as well as chemotherapy use. Multivariate analysis may make the scoring more universal and suitable for all patients with metastases, regardless of treatment received. |
2B |
B |
| Number of Extra-spinal Organs with Metastases: prognosis of patients with metastatic compression of the spinal cord according to the number of extra-spinal organs involved33
|
To investigate the survival prognosis of patients with metastatic spinal cord compression (MSCC) with extra-spinal involvement |
Retrospective cohort |
Eight prognostic factors were investigated: age, sex, ECOG (Eastern Cooperative Oncology Group) performance status, primary tumor type, number of vertebrae involved, interval between cancer diagnosis and Radiotherapy (RT), pre-RT clinical status, and time to development of motor deficits. New studies are recommended. The number of extra-spinal organs with metastases is an independent prognostic factor for the survival of MSCC patients. |
2B |
B |
| The Oswestry Risk Index: an aid in the treatment of metastatic spinal disease34
|
To verify whether the Oswestry Risk Index is applicable to spinal metastatic disease |
Prospective cohort |
Tokuhashi, Tomita, and Bauer exhaustive. The Oswestry Spinal Risk Index (OSRI), simple summation of two elements: primary tumor pathology (PTP) and general condition (GC): OSRI = PTP + (2 - GC), simple point system predicts life expectancy and may be useful in the treatment of spinal metastasis. |
2B |
B |
| Results and toxicity for image-guided hypofractionated stereotactic radiosurgery for metastatic spinal sarcomas35
|
To investigate whether hypofractionated (HF) or single fraction (SF) image-guided stereotactic radiosurgery (IG-SRS) can effectively control the lesions. |
Retrospective cohort |
In most of series of metastatic spinal sarcomas of the study image-guided single fraction stereotactic radiosurgery demonstrated minimal toxicity and excellent local control. |
2B |
B |
