Abstract
Incoming of a spine metastasis remains a major bad prognosis factor in cancer evolution. Consensus over the years is now well accepted in most of European teams dealing with spinal metastasis. Two major opportunities exist in the treatment of spine metastasis:
Conservative treatment with an association of radio and or chemotherapy and or hormonotherapy. Efficiency of such treatments is well documented and must not be considered as a patient abandon.
Surgical treatment is based on two major options. The first one is palliative with the aim of decompression and stabilization. Aim is to cure pain and neurological involvement. The second one is curative with total or partial vertebrectomy in the aim to cure the cancer.
In all cases decision must be made considering age- general condition histo – pathology – neurological status
Considering surgical indications through out this symposium we would like to address three controversial points.
The first topic to be addressed will be: “Total vertebrectomy: when?” presented successively Doctor MARTIN BENLLOCH and Professor BORIANI. The goal of this presentation is to determine the indications of total vertebrectomy more than the surgical technique. These indications appearing essential within the framework of the metastatic patients, while insisting not only on the natural history, but also on the tumoral extension which determines the feasibility of the vertebrectomy. Professor POINTILLART and Professor BORIANI will then discuss about the strategy to adopt when confronted with multi-metastatic patients “Multi-metastatic patients: what strategy?”. This topic will focus primarily on the problem of multi level spinal metastatic lesions: the strategies to be adopted with respect to the patients presenting other metastatic lesions, as well as on a functional forecast (fragility of the long bone), or on the other hand, on metastasis without immediate functional incidence. We also would like to discuss the treatment of the primitive tumour, i.e. if it is the metastasis which is revealing cancer, is it necessary to first treat the primitive tumour, than proceed to the treatment of the metastatic lesions? The third topic of this session will be “When Not to Operate on Metastatic Patients?”, presented by Professor POINTILLART. The goal of this discussion is to be able to give a progress report on the surgical indications within the framework of a spinal metastatic patient. In a certain number of cases surgery is questionable with the discovery of lesions, because of their extended character, or the extreme malignity of the primitive tumour. In other situations, too many lesions will make surgery disputable. Last case scenario is a recurring tumor, because of its extension, its development, even its neurological complications, will make surgery challenging. All these points in our opinion should be openly discussed. Each session will be followed by a 10 minute discussion
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
