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Oral Presentation

Tumor

Globus Spine Tumor Award: The Impact of Targeted Systemic Therapy and Radiotherapy on Patients Undergoing Spine Surgery for Metastatic Breast Cancer: A Dual-Institution Study

Sunday, May 5, 2024
2:49 PM – 2:54 PM CT
Location:  S403ab
Disclosure(s):
Surya Gangavarapu, BA: No financial relationships to disclose
Hani Chanbour, MD: No financial relationships to disclose
Introduction: While targeted systemic therapies and radiotherapy (RT) have improved outcomes in patients with metastatic breast cancer, it remains unknown how specific treatments impact outcomes. In patients undergoing spine surgery for metastatic breast cancer, we sought to: 1) describe patterns of postoperative therapy, 2) compare perioperative outcomes among: systemic therapy alone, RT alone, both, and neither, and 3) evaluate the impact of treatment on local recurrence (LR) and overall survival (OS).

Methods: A dual-institution, retrospective cohort study of patients undergoing spine surgery for metastatic breast cancer from 2010-2022 was undertaken. Patients were divided into: 1) systemic therapy alone, 2) RT alone, 3) both, and 4) neither. Outcomes included Karnofsky Performance Score (KPS), LR, 1-year survival, and OS.

Results: Of 67 patients undergoing spine surgery for metastatic breast cancer, median(IQR) follow-up was 1.8(0.7-3.1)years. Postoperatively, 8(11.9%) received systemic therapy alone, 5(7.5%) RT alone, 44(65.7%) both, and 10(15.0%) neither. All groups were similar in demographics, tumor size, and spinal instability neoplastic score. Patients who underwent both had a significantly higher preoperative KPS compared to neither therapy (p=0.019). 7(10.4%) underwent reoperation, 5 in the combined therapy, and one in the systemic therapy and no therapy groups (p=0.882). Reasons included dehiscence (42.9%), infection (14.3%), hematoma (14.3%), and other (28.6%). No significant association was found between LR and systemic therapy alone (0%), RT alone (20.0%,5.0years), both (4.6%,0.4year), or neither (10.0%,2.1years)(p=0.439). Dual therapy had significantly longer OS (median=5.5years) compared to neither therapy (1.0years;p=0.006), but not compared to systemic therapy alone (5.7years;p=0.453) and RT only (5.1years;p=0.942). Patients receiving both had a significantly higher 1-year survival (88.6%) compared to systemic therapy alone (50.0%;p=0.008) and no therapy (50.0%;p=0.005); but not with RT alone (60.0%;p=0.083).

Conclusion : In this dual-institution study of patients undergoing spine surgery for metastatic breast cancer, dual therapy was significantly associated with higher 1-year survival but not with LR.