A new algorithm developed by an international consortium led by Michigan Medicine is helping clinicians to better manage patients with spinal metastases by optimizing their spine oncology treatments.
Care coordination is a common problem in treating patients with spine metastases, says Daniel Spratt, MD, director of the University of Michigan Spine Oncology Program. He says patients are often managed in silos without integrated care or a standardized method of treatment using a multidisciplinary approach.
“We assembled a group from around the world—the International Spine Oncology Consortium—to get together and review all the existing data and come up with an evidence-based algorithm,” says Spratt who is a radiation oncologist and led the team. “It’s a deep dive into the existing evidence that’s scattered across different disciplines and systematically pulls out the data from each specialty, synthesizing it together into a unified approach.”
The algorithm integrates multiple specialties—including interventional radiology, medical and radiology oncology, neurosurgery, orthopedic spine surgery, as well as physical medicine and rehabilitation—to provide a much more personalized treatment approach for patients with metastatic spine cancer, contends Spratt.
“It’s about finding best practices across each one of those disciplines and simplifying it down to the same language they can all understand, because obviously surgeons and radiation doctors have their own lingo,” he adds.
Spratt and Nicholas Szerlip, MD, a neurosurgeon at the University of Michigan, co-founded U-M's multidisciplinary spine oncology clinic, which has adopted the algorithm as part of its standard practice for all patients. “I imagine it will be widely utilized by practices across the country over time because there is nothing that currently exists to guide them as to how to manage these patients systematically,” says Spratt.
A recent article in The Lancet Oncology, co-authored by Spratt, Szerlip and others, discusses the variables that should be considered during the management of patients with spinal metastasis and reviews the “role of each discipline and their respective management options to provide optimal care.”
To help clinicians make treatment decisions, the algorithm takes them through a series of steps beginning with an assessment of life expectancy, followed by a consideration of the systemic burden of the disease and calculation of how controlled the disease is, as well as a consideration of systemic treatment options.
“One of the big changes that’s occurred are more effective systemic therapies, whether it’s immunotherapy, targeted therapy or newer chemotherapies that are helping patients live a lot longer,” observes Spratt. “In addition, radiation is able to be delivered so much more accurately. We can very effectively treat tumors right next to the spinal cord, which years ago was not even possible.”
Among the newest forms of radiation therapy for spine cancer is called stereotactic body radiotherapy (SBRT), which Spratt notes leverages ultra-precise high doses of radiation in only one to three treatments, compared with conventional lower-dose radiation delivered in 10 treatments.
“Imaging has allowed us to very accurately define where we’re treating” with SBRT, concludes Spratt. “The ability to kill the tumor is in excess of 90 percent, so it’s very effective—much more effective than the older, lower-dose radiation that had maybe a 50 percent shot of controlling the tumor. Plus, because it’s so accurate, the side effects are extremely low as well.”
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