Every kind of cancer can spread to the spine, yet two physician-scientists who treat these patients describe a paucity of guidance for effectively providing care and minimizing pain. To resolve the confusion and address the continually changing landscape of spine oncology, a recent Michigan Medicine-led publication details a guide to explain the management of spinal metastases. Credit: Michigan Medicine

The one-size fits all approach to treating cancers that spread to the spinal cord could become a thing of the past.

A team of researchers from the University of Michigan has created a new algorithm designed to enable more personalized treatment for cancers that metastasized to the spine.

The algorithm is a systematic method designed to help providers treat their patients and not just the tumor, taking into account the patient’s performance status, life expectancy, burden of systemic disease and treatment options.

The algorithm, which pulls information from 243 studies, begins with an assessment of life expectancy. The systemic burden of the disease is then considered, followed by a calculation of how controlled the disease is and a consideration of systemic treatment options.

“Most of the frameworks that have been available prior to this have focused on just surgery or just radiation,” first author Dr. Daniel Spratt, who co-founded the University of Michigan's multidisciplinary spine oncology clinic, said in a statement. “This algorithm integrates all of the specialties together, including PM&R (physical medicine and rehabilitation), radiology and medical oncology, to provide a much more personalized treatment approach for patients with metastatic cancer to the spine.”

Patients with cancer that spreads to the spine are often managed in silos without integrated care. They are also often required to see a variety of subspecialty doctors.

Recommendations could range from pain management to more aggressive treatment, and referring providers do not always know what will come out of a referral to spine oncology experts, or when a referral is necessary.

“Spine oncology is such a multidisciplinary pathology,” Dr. Nicholas Szerlip, a neurosurgeon at the University of Michigan and senior author of the study, said in a statement. “We wanted to form a transparent understanding so everyone, from the oncologists and primary care providers to fellow neurosurgeons who aren't specifically trained on this, could lean on one algorithm in language we can all understand.”

When cancer metastasizes in the spine, it can complicate typical treatment plans due to the sensitivity of the spinal cord.

“A spine metastasis causes a lot of pain,” Szerlip said. “People can live with metastases in other areas of the body without much discomfort, but bone pain hurts a lot, and the ability to treat a tumor near the spinal cord is less.

“Surgeries on other bones are much easier than surgeries on the spine, and less morbid,” he added.

Popular treatment paths often address both the neurologic benefit and the oncologic benefit. That might mean a surgical decompression of the tumor, followed by radiation to attempt to control the cancer.  

The researchers say that spine stereotactic body radiotherapy (SBRT), a form of high-dose radiation that requires just one to three treatments, has shown greater than 90 percent pain reduction and more effective tumor growth control beyond one year post-treatment.

The researchers will look now at more data to continue to develop best practices and prove that current efforts are the most effective.

“Identifying which patients should get these treatments is also difficult,” Szerlip said.

The study was published in Oncology.