Evaluation of lung cancer metastases to the spine

Abstract

Most metastatic spinal lesions (70%) are found at the thoracic level, 20% in the lumbar region, and 10% in the cervical region. A variety of benign and malignant tumours may arise in the lung, but the vast majority is bronchogenic carcinomas (90 to 95%). The aim of this study was to evaluate the lung cancer metastases to the vertebral column in terms of type, localisation and metastasis pattern. Between the years 1995 and 2003, 168 lung cancer patients with metastatic spinal tumour who had received radiotherapy and chemotherapy were retrospectively evaluated. The total number of vertebrae in which metastases were detected was 328. The most common site for metastasis was the thoracic spine. In 49 (29%) patients, there was only one vertebral involvement. Additional extravertebral bony metastases were present in 37 (22%) patients; the femur (20 patients) was the most common site. Only 25 of 168 patients were operated due to spinal cord compression leading to neurological deficit. The rest of the patients were treated by appropriate chemotherapy and radiotherapy protocols. The mean survival after diagnosis of vertebral metastasis was 7.1 months. Squamous cell carcinoma and adenocarcinoma are the lung cancers that mostly metastasise to vertebrae. Most of the metastases involve multiple spinal levels. After the diagnosis of vertebral metastasis, the mean survival is seven months. Pain relief and maintaining quality of life must be balanced with the patient's life expectancy, comorbidities and immunological, nutritional and functional status in treatment decision. © 2006, Acta Orthopædica Belgica.