Page 13 - Predicting survival in patients with spinal bone metastasesL

depending on their lytic of blastic characteristics, can be hyper- or hypo-intense I on T2 weighted images, respectively. Gadolinium enhancement is not required
for demonstrating SBM, however, leptomeningeal metastatic disease can be
missed without the addition of contrast. Computed Tomography (CT) is required
for surgical or radiotherapy planning, if an indication for treatment is present. Conventional X-ray has little added value in the diagnostic phase, but can be helpful in a post-operative setting. If the primary tumor is unknown at the time of diagnosis of the SBM, PET-CT imaging should be performed, complemented with a biopsy of one of the suspect lesions. Timing of all investigations should depend on the presence or absence of any neurologic symptoms requiring emergency treatment.
Figure 1. CT-scan versus T1-weighted MRI. Notice the hypo-intense lesion in the vertebral body of Th11 on MRI, which cannot be seen on the CT-scan
TREATMENT OF SPINAL BONE METASTASES
Therapy for symptomatic SBM consists of a local treatment through radiotherapy or surgery, or a combination of both, combined with adequate pain medication and – in the case of neurological deficit caused by spinal cord or nerve root compression – corticosteroids. Generally speaking, treatment will be palliative in nature and aimed at alleviating the aforementioned symptoms and achieving local control of the metastasis, thereby improving, or at least stabilizing the quality of life of the patient.
Radiotherapy is considered the cornerstone of treatment, achieving a 60-80% decline in pain and improving neurologic symptoms in 10-90% of cases.17-20 The major benefit is that it is non-invasive and any side-effects are generally transient
GENERAL INTRODUCTION
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