8. ď§The spinal pain may be due:
ďźIn destruction of the anatomic
vertebral elements as a result of
metastases
ďźResulting spinal instability
ď§The pain is possible to occur as a
result of:
ďźCompression or
ďźinfiltration of the spinal cord â nerves
from neoplasmatic masses.
19. CHEMOTHERAPY
ďHighly sensitive
ďźChildhood cancers like
â˘Acute lymphocytic leukemia
â˘Wilms tumor
â˘Ewingâs tumor
â˘Retinoblastoma
â˘Rhabdomyosarcoma
ďźHodgkinâs lymphoma.
ďźCarcinoma of the testis.
ďźChoriocarcinoma.
ďźBurkitts tumor.
ďźAcute promyelocytic leukemia.
20. ďModerately sensitive
â˘Adenocarcinoma of breast.
â˘Non-Hodgkinâs lymphoma.
â˘Lung cancer.
â˘Osteosarcoma.
â˘Adult myeloid and lymphocytic leukemia.
â˘Carcinoma of the prostate.
â˘Colorectal carcinoma.
â˘Female cancers of the ovary, endometrium, and cervix.
CHEMOTHERAPY
22. BI-PHOSPHONATES
â˘Tend to inhibit osteoclast re-absortion of bone matrix and decrease bone
turnover.
â˘There are three generations of bi-phosphonate currently available.
27. INDICATIONS FOR OPERATIVE TREATMENT
1. Spinal instability
2. Pain resistible to conservative treatment (radiotherapy
chemotherapy)
3. Incomplete neurologic deficit resistible to any type of conservative
treatment
4. Rapid deterioration of the neurologic deficit
28. 5. Recurrence of tumor in an area that has been already submitted in
radiotherapy (at the maximum permitted levels)
6. Ambiguous histological diagnosis
29. FACTORS FOR EVALUATION
â˘The biology of the tumor
â˘The location
â˘The pain
â˘The neurologic deficit
â˘The spinal instability
â˘Life expectancy
â˘Overall condition of the patient
30. METHODS OF EVALUATION
â˘Tokuhashi scoring system
â˘Tomita surgical staging
â˘Karnofsky performance status scale
definitions rating (%) criteria
31. Tokuhashiâs criteria allow the definition of a pre
operative strategy and therefore considerable
variability in the choice of treatment ranging:
â˘Excisional operation should be performed on those who
scored above 9 points.
â˘A palliative operation should be performed on those who
scored under 5 points.
32. Simpler system of preoperative evaluation based on only
three
parameters:
â˘the degree of malignacy.
â˘the presence of visceral metastases.
â˘the presence of bony metastases.