WE NEED TO BETTER ASSESS THE RISK OF FRACTURE IN SPINE METASTATIC PATIENTS

Cancer affects 584/100,000 men and women yearly in Europe. As treatment of cancer improves, patients have longer and higher survival expectation. Patients living with cancer have a high risk of metastases and bone metastases are a frequent condition in patients with advanced malignancies. About 65 to 75% of patients with metastatic cancer develop bone metastases over the course of their disease, and the spine is often the first bone metastatic site. Bone lesions can increase the bone resorption, leading to frequent skeletal-related events, in particular pathological fractures. Pathological fractures have devastating effects on metastatic patients, causing severe pain, neurological deficit, impaired function, and have been associated with a reduced survival. In a recent study on the quality of life in our population of patients surgically treated for spinal metastases, multivariate analysis identified three independent variables, capable of influencing the trend of HRQOL: the presence of pathological fracture, the preoperative neurological status and the local recurrence of disease. We report here two cases of patients who were admitted with pathological fracture and advanced neurological impairment. One patient (male, 57 years) had a nephrectomy for kidney carcinoma, followed by the occurrence of a metastasis in L2, that was treated with radiotherapy and vertebroplasty. Ten months later he presented at our Hospital with L2 pathological fracture, reporting progressive loss of muscle strength until complete paraplegia. He was incontinent to urine and feces. He was treated with decompression and stabilization, but he died two months later. The second patient (female, 50 years), affected by breast carcinoma, presented with osteolysis of T2 initially for a needle biopsy, reporting severe pain in the right shoulder and upper limb with preserved reflexes; one week later, she was admitted in emergency for loss of strength of the lower limbs with impossibility to stand from three 3 days and bedridden from the day before. No bowel activity for several days, difficulty urinating. She was treated with decompression and stabilization, she died ten months later. Thus, in the presence of pathological fracture, earlier surgical intervention has the potential to prevent permanent neurological deficit and disability and to maintain function and quality of life, with consequent possibility of longer survival. On the contrary, an unnecessary surgical treatment can have negative repercussions on the patient, because it entails a suspension of oncology therapies and may cause complications and sequelae. Acknowledgements: METASTRA project funded by the European Union HEU topic HLTH-2022-12-01 grant 101080135.