The role of revision surgery and adjuvant therapy following subtotal resection of osteosarcoma of the spine: A systematic review with meta-analysis

Ganesh M. Shankar, Michelle J. Clarke, Tamir Ailon, Laurence D. Rhines, Shreyaskumar R. Patel, Arjun Sahgal, Ilya Laufer, Dean Chou, Mark H. Bilsky, Daniel M. Sciubba, Michael G. Fehlings, Charles G. Fisher, Ziya L. Gokaslan, John H. Shin

Research output: Contribution to journalReview article

7 Citations (Scopus)

Abstract

OBJECTIVE Primary osteosarcoma of the spine is a rare osseous neoplasm. While previously reported retrospective studies have demonstrated that overall patient survival is impacted mostly by en bloc resection and chemotherapy, the continued management of residual disease remains to be elucidated. This systematic review was designed to address the role of revision surgery and multimodal adjuvant therapy in cases in which en bloc excision is not initially achieved. METHODS A systematic literature search spanning the years 1966 to 2015 was performed on PubMed, Medline, EMBASE, and Web of Science to identify reports describing outcomes of patients who underwent biopsy alone, neurological decompression, or intralesional resection for osteosarcoma of the spine. Studies were reviewed qualitatively, and the clinical course of individual patients was aggregated for quantitative meta-analysis. RESULTS A total of 16 studies were identified for inclusion in the systematic review, of which 8 case reports were summarized qualitatively. These studies strongly support the role of chemotherapy for overall survival and moderately support adjuvant radiation therapy for local control. The meta-analysis revealed a statistically significant benefit in overall survival for performing revision tumor debulking (p = 0.01) and also for chemotherapy at relapse (p < 0.01). Adjuvant radiation therapy was associated with longer survival, although this did not reach statistical significance (p = 0.06). CONCLUSIONS While the initial therapeutic goal in the management of osteosarcoma of the spine is neoadjuvant chemotherapy followed by en bloc marginal resection, this objective is not always achievable given anatomical constraints and other limitations at the time of initial clinical presentation. This systematic review supports the continued aggressive use of revision surgery and multimodal adjuvant therapy when possible to improve outcomes in patients who initially undergo subtotal debulking of osteosarcoma. A limitation of this systematic review is that lesions amenable to subsequent resection or tumors inherently more sensitive to adjuvants would exaggerate a therapeutic effect of these interventions when studied in a retrospective fashion.

Original languageEnglish (US)
Pages (from-to)97-104
Number of pages8
JournalJournal of Neurosurgery: Spine
Volume27
Issue number1
DOIs
StatePublished - Jul 1 2017

Fingerprint

Osteosarcoma
Reoperation
Meta-Analysis
Spine
Drug Therapy
Survival
Radiotherapy
Neoplasms
Therapeutic Uses
Therapeutics
Disease Management
Decompression
PubMed
Retrospective Studies
Biopsy
Recurrence

Keywords

  • Chemotherapy
  • Oncology
  • Osteosarcoma
  • Radiation therapy
  • Revision surgery
  • Systematic review

ASJC Scopus subject areas

  • Medicine(all)

Cite this

The role of revision surgery and adjuvant therapy following subtotal resection of osteosarcoma of the spine : A systematic review with meta-analysis. / Shankar, Ganesh M.; Clarke, Michelle J.; Ailon, Tamir; Rhines, Laurence D.; Patel, Shreyaskumar R.; Sahgal, Arjun; Laufer, Ilya; Chou, Dean; Bilsky, Mark H.; Sciubba, Daniel M.; Fehlings, Michael G.; Fisher, Charles G.; Gokaslan, Ziya L.; Shin, John H.

In: Journal of Neurosurgery: Spine, Vol. 27, No. 1, 01.07.2017, p. 97-104.

Research output: Contribution to journalReview article

Shankar, GM, Clarke, MJ, Ailon, T, Rhines, LD, Patel, SR, Sahgal, A, Laufer, I, Chou, D, Bilsky, MH, Sciubba, DM, Fehlings, MG, Fisher, CG, Gokaslan, ZL & Shin, JH 2017, 'The role of revision surgery and adjuvant therapy following subtotal resection of osteosarcoma of the spine: A systematic review with meta-analysis', Journal of Neurosurgery: Spine, vol. 27, no. 1, pp. 97-104. https://doi.org/10.3171/2016.12.SPINE16995
Shankar, Ganesh M. ; Clarke, Michelle J. ; Ailon, Tamir ; Rhines, Laurence D. ; Patel, Shreyaskumar R. ; Sahgal, Arjun ; Laufer, Ilya ; Chou, Dean ; Bilsky, Mark H. ; Sciubba, Daniel M. ; Fehlings, Michael G. ; Fisher, Charles G. ; Gokaslan, Ziya L. ; Shin, John H. / The role of revision surgery and adjuvant therapy following subtotal resection of osteosarcoma of the spine : A systematic review with meta-analysis. In: Journal of Neurosurgery: Spine. 2017 ; Vol. 27, No. 1. pp. 97-104.
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abstract = "OBJECTIVE Primary osteosarcoma of the spine is a rare osseous neoplasm. While previously reported retrospective studies have demonstrated that overall patient survival is impacted mostly by en bloc resection and chemotherapy, the continued management of residual disease remains to be elucidated. This systematic review was designed to address the role of revision surgery and multimodal adjuvant therapy in cases in which en bloc excision is not initially achieved. METHODS A systematic literature search spanning the years 1966 to 2015 was performed on PubMed, Medline, EMBASE, and Web of Science to identify reports describing outcomes of patients who underwent biopsy alone, neurological decompression, or intralesional resection for osteosarcoma of the spine. Studies were reviewed qualitatively, and the clinical course of individual patients was aggregated for quantitative meta-analysis. RESULTS A total of 16 studies were identified for inclusion in the systematic review, of which 8 case reports were summarized qualitatively. These studies strongly support the role of chemotherapy for overall survival and moderately support adjuvant radiation therapy for local control. The meta-analysis revealed a statistically significant benefit in overall survival for performing revision tumor debulking (p = 0.01) and also for chemotherapy at relapse (p < 0.01). Adjuvant radiation therapy was associated with longer survival, although this did not reach statistical significance (p = 0.06). CONCLUSIONS While the initial therapeutic goal in the management of osteosarcoma of the spine is neoadjuvant chemotherapy followed by en bloc marginal resection, this objective is not always achievable given anatomical constraints and other limitations at the time of initial clinical presentation. This systematic review supports the continued aggressive use of revision surgery and multimodal adjuvant therapy when possible to improve outcomes in patients who initially undergo subtotal debulking of osteosarcoma. A limitation of this systematic review is that lesions amenable to subsequent resection or tumors inherently more sensitive to adjuvants would exaggerate a therapeutic effect of these interventions when studied in a retrospective fashion.",
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T2 - A systematic review with meta-analysis

AU - Shankar, Ganesh M.

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AU - Ailon, Tamir

AU - Rhines, Laurence D.

AU - Patel, Shreyaskumar R.

AU - Sahgal, Arjun

AU - Laufer, Ilya

AU - Chou, Dean

AU - Bilsky, Mark H.

AU - Sciubba, Daniel M.

AU - Fehlings, Michael G.

AU - Fisher, Charles G.

AU - Gokaslan, Ziya L.

AU - Shin, John H.

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N2 - OBJECTIVE Primary osteosarcoma of the spine is a rare osseous neoplasm. While previously reported retrospective studies have demonstrated that overall patient survival is impacted mostly by en bloc resection and chemotherapy, the continued management of residual disease remains to be elucidated. This systematic review was designed to address the role of revision surgery and multimodal adjuvant therapy in cases in which en bloc excision is not initially achieved. METHODS A systematic literature search spanning the years 1966 to 2015 was performed on PubMed, Medline, EMBASE, and Web of Science to identify reports describing outcomes of patients who underwent biopsy alone, neurological decompression, or intralesional resection for osteosarcoma of the spine. Studies were reviewed qualitatively, and the clinical course of individual patients was aggregated for quantitative meta-analysis. RESULTS A total of 16 studies were identified for inclusion in the systematic review, of which 8 case reports were summarized qualitatively. These studies strongly support the role of chemotherapy for overall survival and moderately support adjuvant radiation therapy for local control. The meta-analysis revealed a statistically significant benefit in overall survival for performing revision tumor debulking (p = 0.01) and also for chemotherapy at relapse (p < 0.01). Adjuvant radiation therapy was associated with longer survival, although this did not reach statistical significance (p = 0.06). CONCLUSIONS While the initial therapeutic goal in the management of osteosarcoma of the spine is neoadjuvant chemotherapy followed by en bloc marginal resection, this objective is not always achievable given anatomical constraints and other limitations at the time of initial clinical presentation. This systematic review supports the continued aggressive use of revision surgery and multimodal adjuvant therapy when possible to improve outcomes in patients who initially undergo subtotal debulking of osteosarcoma. A limitation of this systematic review is that lesions amenable to subsequent resection or tumors inherently more sensitive to adjuvants would exaggerate a therapeutic effect of these interventions when studied in a retrospective fashion.

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