Dr. Shehadi’s Metastatic Breast Cancer Publication

Dr. Shehadi and nine fellow doctors published a paper in 2007 that discussed spinal surgery for patients with metastatic breast cancer to the spine. Below is the abstract for the paper. To read the full paper, click here.

Abstract

breast cancer mesastatic

Schematic illustration of tumor growth patterns and the indicated surgical approaches: anterior or anterolateral approach (a), posterior (b-i) or posterolateral (b-ii) approach, posterior bipedicular approach (c), combined anterior–posterior simultaneous approach (d). Borrowed with permission from Journal of Neurosurgery.

Aggressive surgical management of spinal metastatic disease can provide improvement of neurological function and significant pain relief. However, there is limited literature analyzing such management as is pertains to individual histopathology of the primary tumor, which may be linked to overall prognosis for the patient. In this study, clinical outcomes were reviewed for patients undergoing spinal surgery for metastatic breast cancer. Respective review was done to identify all patients with breast cancer over an eight-year period at a major cancer center and then to select those with symptomatic spinal metastatic disease who underwent spinal surgery. Pre- and postoperative pain levels (visual analog scale [VAS]), analgesic medication usage, and modified Frankel grade scores were compared on all patients who underwent surgery. Univariate and multivariate analyses were used to assess risks for complications. A total of 16,977 patients were diagnosed with breast cancer, and 479 patients (2.8%) were diagnosed with spinal metastases from breast cancer. Of these patients, 87 patients (18%) underwent 125 spinal surgeries. Of the 76 patients (87%) who were ambulatory preoperatively, the majority (98%) were still ambulatory. Of the 11 patients (13%) who were nonambulatory preoperatively, four patients were alive at 3 months postoperatively, three of which (75%) regained ambulation. The preoperative median VAS of six was significantly reduced to a median score of two at the time of discharge and at 3, 6, and 12 months postoperatively (P < 0.001 for all time points). A total of 39% of patients experienced complications; 87% were early (within 30 days of surgery), and 13% were late. Early major surgical complications were significantly greater when five or more levels were instrumented. In patients with spinal metastases specifically from breast cancer, aggressive surgical management provides significant pain relief and preservation or improvement of neurological function with an acceptably low rate of complications.

breast cancer mesastatic

Images of patient with breast cancer metastatic to T9, T10 and T11. Preoperative sagittal T2-weighted (a) and axial T1-weighted (b) MR images illustrate metastatic disease with spinal cord compression. Anterior–posterior (c) and lateral (d) plain films showing spinal reconstruction following decompressive surgery.

Conclusion

Spinal surgery for metastatic breast cancer significantly reduces pain and is efficacious in preserving neurological function over short-term follow up with acceptably low morbidity. Future reports on surgical outcomes for patients with metastatic spinal disease should be pathology-specific whenever possible, considering its paramount implications for optimal treatment and prognostication. In addition, future studies should also seek to quantify the contributions to patient outcome that may be provided by concomitant adjuvant therapy given in the peri-operative setting.

If you would like to learn more about this study or have questions, feel free to contact Dr. Shehadi today.