Posters— Surgical Treatment of Sarcomas

SURGERY FOR SARCOMA OF THE SPINE: OUTCOME ANALYSIS OF 59 PATIENTS OVER A 12-YEAR PERIOD

Patrick Boland, MD, Mark Bilsky, MD, Murray Brennan, MD, Robert Woodruff, MD, John Healey, MD, Memorial Sloan Kettering Cancer Center, NY, NY, USA

Introduction: Sarcomas may present in the spine arising as primary tumors in the bone or neural elements or as metastatic disease. While sarcomas are uncommon tumors relative to carcinomas, patients with these tumors more often come to surgery for spine disease because of their relative resistance to irradiation and chemotherapy. Surgery is often employed in order to preserve neurologic function, achieve spinal stability and improve local disease control. This retrospective study examines the role of surgery in patients with primary, metastatic or recurrent sarcoma of the spine.

Methods: 59 patients underwent 99 surgical procedures for sarcomas involving the spine between 1985 and 1997. The most common histologic diagnoses were leiomyosarcoma (14) and osteogenic sarcoma 99). 53 tumors resected were high grade. The indications for surgery were: neurologic compromise (69), oncologic (25) and mechanical instability (5). The initial type of surgery included laminctomy (29), vertebrectomy (17) and spondylectomy (17). 3 patients underwent enbloc vertebrectomy. 51 patients underwent radiation therapy and 39 underwent chemotherapy.

Results: The mean survival from the time of initial diagnosis in all patients was 45 months. Greater than 90% of patients maintained the ability to ambulate and 30% of patients regained the ability to ambulate.

Conclusions: Spine surgery for sarcoma is valuable as a palliative measure to preserve neurologic function and improve quality of life. En bloc spondylectomy should be undertaken in patients with no evidence of metastatic disease in whom there is a potential for cure.