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Advanced management of metastatic spinal tumors

Metastatic Tumor - Etiology

  • Skeleton is the 3rd most common site of mets from carcinoma
        1. Following lung and liver
  • Spine is the most common site of skeletal mets
  • Breast (21%), lung (14%), prostate (7.5%),, and renal (5%), thyroid (2.5%) carcinomas account for most mets
  • GI, gynecologic, and melanoma are less common causes of spinal mets

Metastatic Tumors

  • 90% of patients who die of cancer will have spinal mets at autopsy
  • 1/2 of patients who die with metastatic cancer will have symptoms from spinal mets
  • Location of spinal mets:
        1. Thoracolumbar 70%
        2. Lumbar and sacral 20%
        3. Cervical ‹20%

Options for Therapy

Multi-disciplinary Approach

  • Systemic Therapy
        1. Chemotherapy
        2. Hormonal /Immunotherapy
        3. Targeted Therapy
  • Radiation Therapy
        1. Conventional EBRT (30 Gy in 10 fractions)
        2. Image-guided intensity modulated RT
          1. Hypofractionated RT (10 Gy x 3)
          2. Single Fraction RT (24 Gy)
        3. Brachytherapy (p32) plaques/Ir catheters
  • Surgery
    Percutaneous Cement Augmentation
        1. Percutaneous Pedicle Screws
        2. Open: Anterior, Posterolateral, Combined
        3. En bloc resection for margins
        4. En bloc resection for margins
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Success Stories

Dr Abhijit pawar

My wife Pramila shinde had spinal tuberculosis and she was bed ridden due to paralyisis. Paralysis at such young age and her life became miserable. We met doctor Abhijit Pawar who went out of the way to help us. She underwent a successful spine surgery with instrumentation with Dr Abhijit Pawar. Within one week after surgery her condition improved. She is completely normal now and we have a great family life. Thank you Dr Abhijit Pawar and Endo-Spine Clinic.