From the Guidelines
Breast, lung, and prostate carcinomas are the most common cancers that metastasize to the spine, accounting for more than 50% of spinal metastases. These primary tumors have a high propensity to spread to the vertebral column due to the rich venous network (Batson's plexus) that connects these organs to the spine, allowing cancer cells to travel and establish secondary tumors 1.
Key Characteristics of Spinal Metastases
- Breast cancer typically affects the thoracic spine
- Lung cancer commonly spreads to the thoracic and cervical regions
- Prostate cancer has a strong predilection for the lumbar spine and sacrum
- Multiple myeloma and lymphomas may also affect the spinal column 1.
Clinical Implications
Spinal metastases often cause significant pain, neurological deficits, spinal instability, and in severe cases, spinal cord compression requiring urgent intervention 1.
Management
Early detection through imaging (MRI being the gold standard) is crucial for management, which may include pain control, radiation therapy, surgery for spinal stabilization or decompression, and systemic therapies targeting the primary cancer 1.
Prognosis
The prognosis depends on the primary tumor type, extent of disease, and the patient's overall condition 1.
Multidisciplinary Approach
The optimal diagnosis and management of patients with spinal metastases requires a multidisciplinary approach, with a focus on proactive management, clear selection criteria for various treatments, and optimized organization, communication, and coordination of care 1.
From the Research
Cancers that Metastasize to the Spine
- The most common cancers that metastasize to the spine are breast, lung, prostate, and kidney cancers 2.
- These cancers can cause osteolytic, osteoblastic, or mixed lesions in the spine, which can affect treatment planning 3.
- The type of primary cancer can significantly predict survival in patients with spinal metastases, with breast and renal cancers having the highest median survival time and prostate and lung cancers having the lowest 2.
Treatment Options
- Surgery can be used as a first-line therapy for preservation of function and symptom relief in patients with spinal metastases, even in those previously treated with radiotherapy 2.
- Stereotactic body radiation therapy (SBRT) is a novel treatment modality that can be used to treat spinal metastases, particularly in cases of oligometastatic disease 4.
- External beam radiation therapy can also be used to treat breast cancer, but it is associated with risks of toxicity, including cardiac and pulmonary toxicity, lymphedema, and secondary malignancy 5.
Clinical Outcome
- Metastasis to the bone, including the spine, can result in skeletal-related events, such as loss of mobility, independence, and social functioning, and can increase mortality 6.
- Advances in understanding the mechanisms of metastasis to bone and the resulting physiologic disturbances can help clinicians combat this problem 6.
- The use of computed tomography (CT) imaging can help determine the structural integrity of the vertebral body and guide treatment planning 3.