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  • br Baseline characteristics br These studies

    2020-03-17


    3.1. Baseline characteristics
    These studies comprise a total of 1925 patients. Average age is 58.0 years old. Known genders amount to 1829 (74.9%) males, 382 (25.1%) females. Average documented survival of all patients included in this Talaporfin sodium (ME2906) study is 11.6 months. This does not include patients lost to follow-up.
    Fig. 1. Flowchart of systemic review. Study selection following PRISMA recommendations exposes literature that met inclusion and exclusion criteria.
    Intervention types include surgical approaches (tumor resec-tion, decompression/ reconstruction, vertebrectomy, laminectomy, total en bloc spondylectomy, vertebroplasty, spinal laser intersti-tial thermotherapy (sLITT), – Table 1) and non-surgical approaches (radiation, chemotherapy alone, radiation, radiofrequency abla-tion, and radiosurgery – Table 2). 
    Table 2
    Non-operative treatments number of patients and average survival after treatment in months.
    Treatment N Avg survival
    Only chemotherapy 776 5.7 Radiation 573 10.2 Radiosurgery 108 19 Radio frequency ablation 32
    3.2. Clinical and radiological outcomes
    The outcomes analyzed were average follow-up and survival. Studies that only indicate the last follow-up appointment without stating survival were excluded from analysis of survival time. Results showed statistically significant results from treatment with non-surgical modalities compared to the surgical intervention (p = 0.0130); the surgical subgroup experience a mean survival of 7.5 months (SD 4.5, SEM 0.25) while the non-surgical subgroup experience a mean survival of 8.5 months (SD 6.6, SEM 0.17) (Fig. 2).
    3.3. Outcomes based on primary cancer type
    The various primary lung cancer types include small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC), of which we documented adenocarcinoma, squamous cell carcinoma, large cell carcinoma, and neuroendocrine tumors (Table 3). There is a clinically significant difference in survival times for SCLC (7.0 months) compared to NSCLC (8.3 months), however this was not found to be statistically significant (p = 0.3645).
    3.4. Outcomes based on metastatic lesion characteristics
    Numerous characteristics of the metastatic lesions were ana-lyzed based on location of vertebral lesions (cervical, thoracic, lum-bar, or sacral), vertebral involvement (single versus multiple vertebra involved per lesion), and number of metastases to the spine (single lesions versus multiple lesions) (Table 4). Average survival for single lesions is 13.0 months. Of those, the difference in average survival for those with lesions involving a single level (11.3 months) compared to multiple levels (13.8 months) was not found to be statistically significant (p = 0.6370)
    4. Discussion
    The goal of metastatic lung cancer treatment is to maintain quality of life, manage symptoms, and provide as much comfort as possible to the patient during palliative care. Spinal metastases are common and incur a worse prognosis, as they increase morbid-ity of lung cancer by causing the patient to suffer from pain, neu-rologic deficits, metastatic epidural spinal cord compression (MESCC), and pathologic fractures. The best management for such lesions has been debated in prior literature, with the ideal treat-ment modality dependent on several factors unique to each patient
    Table 1
    Operative treatments number of patients and average survival post-operatively in months.
    Treatment N Avg survival
    Tumor resection 24 15.2 Decompression/Reconstruction 279 6.5 Vertebrectomy 9 14.7 Laminectomy 3 9 Total en bloc spondylectomy 8 12 Verterboplasty 3 4 Spinal Laser Interstitial Thermotherapy (sLITT) 3 N/A
    Fig. 2. Kaplan-Meier curve of cumulative survival between non-operative and operative groups. Survival analysis shows significantly better outcomes for non-operative group (p = 0.013).
    – life expectancy, morbidity of the vertebral lesion, and perfor-mance status.