Spine Tumor Surgery More Effective Than Ever

Researchers at Memorial Sloan Kettering Cancer Center determined that surgery for spinal tumors has seen a 20% greater success rate in the last 20 years, in addition to huge improvements in quality of life. Find out why.

Cancer treatments have come a long way over the last few decades. Thanks to better therapies, survival rates for cancer overall have increased, and the quality of life for people in treatment keeps on improving.

Man about to have spine tumor surgerySpine tumor surgery at MSKCC saw a big bump in success rate and quality of life improvement in the past 20 years.

Among those who have benefited are people with cancerous spinal tumors. Advancements in immunotherapy, chemotherapy, radiotherapy and surgery have boosted survival, helping tens of thousands of patients to live longer with greater function and less pain.

In 2021, experts from Memorial Sloan Kettering Cancer Center in New York City examined the survival trends of more than 1,500 of these patients for a study published in the journal Neurosurgery. Each patient had spinal metastatic disease (the cancer did not start in the spine) and was treated with surgery, among other therapies. What researchers found was a 20% increase in overall survival over 20 years—about 1% each year. 

What lead to these leaps, and what does it mean for people with the illness? First, it helps to get a little bit of background.

About Spinal Metastases

When someone has cancer in the spine, it’s typically because of metastatic disease. That means cancer cells originate somewhere else in the body, called the primary site, and travel to the backbone, usually through the bloodstream. In the spine they form tumors, called metastases.

“Almost 20 percent of cancer patients will develop spinal metastases over the course of their illness,” says Mark H. Bilsky, MD, a neurosurgeon at Memorial Sloan Kettering Cancer Center (MSKCC) and Chief of the Multidisciplinary Spine Tumor Service in New York City. “So, it’s actually a terribly common problem in the cancer population.”

People with lung, breast, colon, kidney or prostate cancer are most likely to have spinal metastases. The tumors can also form in other areas, such as the thyroid or the liver, where they can be harder to treat.

Most spinal metastases grow in the vertebrae, the bones protecting the spinal cord. It is uncommon for tumors to develop directly on the spinal cord. They can develop anywhere along your spine, but about 70 percent form in the middle part, called the thoracic region. Another 20 percent of tumors appear in the lower back—the lumbar region—while the remaining 10 percent take shape by the neck, in the cervical region. You can develop tumors in multiple regions at the same time, and they can be located far apart or close together.

The most common symptom of spinal tumors is pain in the back and/or neck. It occurs when tumors damage the vertebrae, causing instability or fractures. The pain often feels like an intense ache located deep in the body; it frequently happens at night. If you experience sudden, continued or worsening back pain and have cancer or a history of the disease, call a healthcare provider right away.

The process of diagnosing spinal metastases starts with a physical exam, followed by imaging. Your provider may ask for a computed tomography (CT), magnetic resonance imaging (MRI) or positron emission tomography (PET) scan—or even an X-ray—to get a picture. Blood tests and biopsies can help confirm the type of tumor you have, as well as the stage of your cancer.

How MSKCC Decides on Treatment

Treating spinal metastases typically involves healthcare providers of many specialties. Your team can include an oncologist, radiologist and neurosurgeon, among others. With so many people taking part in treatment, often coming from different departments, it’s important that everyone is on the same page.

To ensure they’re all working together, the doctors at MSKCC use a framework for decision making called NOMS. This stands for neurologic, oncologic, mechanical and systemic—four areas of assessment every team member must consider when evaluating someone with spinal metastatic disease. 

“People were all over the map for what they would treat or not treat,” says Dr. Bilsky. “What these frameworks did was get everybody to think about those four points on every patient. So that radiation oncologists would think about instability. And a spine surgeon would think about radiosensitivity.”

Once the whole team has a good idea of where a patient stands, what they need and what they’re able to tolerate, treatment can begin.

Treating Spinal Metastases

There are several ways to treat metastatic spinal tumors, including immunotherapy, chemotherapy, radiotherapy and surgery. They’re almost always used in some combination. For example, radiotherapy shrinks tumors while immunotherapy drugs, such as checkpoint inhibitors, rev up the immune system to attack cancer cells. 

Surgery’s biggest role is easing spinal cord compression or repairing damage (like fractures) and stabilizing the spine. By doing this, a surgeon can relieve pain and help recover lost neurologic function. This, in turn, improves quality of life—like the ability to walk or go to the bathroom. Surgery can also boost survival, both directly and indirectly.

“It definitely improves quality of life and it definitely improves survival in the sense that if they have those neurologic deficits or they can’t get out of bed, it impacts their survival and their ability to go to treatment,” explains Dr. Bilsky.

The procedures themselves have become more effective and less invasive over the years, thanks to surgical advances and better radiotherapy techniques. “Because the radiation was so good, we could do less aggressive surgery,” explains Dr. Bilsky. “What used to be a six- or eight-hour operation is now usually under two hours.”

Despite this, some people are more ideal candidates for an operation than others. To determine whether surgery is a good idea, doctors will take into account age, chronic illnesses, type of cancer, the extent of the metastases and symptoms, among other factors. A person with widespread disease and multiple serious medical conditions, for example, may not benefit from surgery as much as someone who is relatively healthy.

At MSKCC, Dr. Bilsky explains, “we don’t take that patient who won’t derive benefit.”

Treatment Successes at MSKCC

Over the years, the specialists at MSKCC have made great strides in treating spinal metastases, culminating in the 20% growth in overall survival discussed in the Neurosurgery study.

Dr. Bilsky cites three main reasons for the 20% increase—first and foremost being advances in immunotherapy for treating cancer in general. In the study, MSKCC saw the biggest survival improvements in patients with metastatic colon, kidney, lung and breast cancers, largely due to the effectiveness of these drugs.

“All of a sudden we got these targeted agents,” says Dr. Bilsky, a study co-author. “All of a sudden there wasn’t one for lung cancer. There were five. And checkpoint inhibitors. And they all impacted survival in a meaningful way. And that was probably the biggest change, where these newer agents were just incredibly effective in patients who really had very limited options before.”

The second big factor in MSKCC’s success had to do with those newer surgical techniques, aided by radiotherapy innovation. “We’re doing more effective surgery that is less invasive, and so people get through it much better than what we used to do,” he explains. 

“And the third thing is, we’re just making better decisions about who’s going to benefit from this in a real way,” he explains. At MSKCC, much of that was due to NOMS, though there are similar frameworks used in other medical facilities.

Speaking of other medical facilities, the team at MSKCC hasn’t been alone in their progress. People with metastatic spinal disease all over the United States—and the world—have gained from advances in treatment. Bottom line, it’s lead to an improved outlook for people with spinal metastases. And as time goes on, it’s likely things will only get better.

Updated on: 05/21/21
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Surgery for Spinal Tumors
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