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  • Clinical Presentation, Management and Outcomes of Sacral Metastases: A Multicentre, Prospective Case Series

    Final Number:

    R. CharestMorin MD; C. G. Fisher MD; A. Versteeg MD, MHSc; A. Sahgal; P. P. Varga; D. M. Sciubba MD; J. M. Schuster MD, PhD; M. Weber MD, PhD, FRCSC 1; L. D. Rhines MD; M. J. Clarke MD; S. Boriani MD; C. Bettegowda MD, PhD; M. G. Fehlings MD PhD FRCS(C) FACS; Z. L. Gokaslan MD; P. M. Arnold MD; N. Dea MD, MSc, FRCS(C)

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Sacral metastases are rare and literature regarding their management is sparse. This multicenter prospective observational study aimed to determine Health Related-Quality of Life (HRQOL) and pain in patients treated for sacral metastases with surgery and/or radiation therapy (RT). The secondary objectives were to describe the adverse event (AE) profile and change in neurologic function in this population.

    Methods: A case series of 23 patients presenting with symptomatic sacral metastases were identified from the Epidemiology, Process and Outcomes of Spine Oncology (EPOSO) dataset, a prospective multicenter study on spinal metastases. Patients requiring surgery and/or RT between August 2013 and February 2017 were prospectively enrolled. HRQOL, assessed by the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQv2.0), the Short Form-36 version 2 (SF-36v2), and the EuroQol-5Dimension (EQ-5D) was documented at baseline, 6 weeks, 3 months, and 6 months post-treatment. Pain numeric rating scale (NRS), AEs, lower extremities motor score (ASIA), and bowel and bladder function were recorded at baseline and follow-up.

    Results: 8 patients underwent surgery RT and 15 patients underwent RT alone. Mean age was 59.3 years (SD 11.7) and 13 patients were female. At 6-months, 3 (37.5%) surgical patients and 2 (13.3%) RT patients were deceased. There was a trend showing that surgical patients had worse baseline HRQOL and pain. Pain NRS, EQ-5D, SOSGOQv2.0, and the mental component of the SF-36v2 showed improvement, irrespective of treatment (p > 0.05). Ten AEs occurred in the surgical cohort, dominated by wound complications (n = 3). Bowel and bladder function improved at 6 weeks in both groups. The lower extremity mean motor score marginally improved at 3 months.

    Conclusions: Surgical treatment and RT are valid complementary alternatives for symptomatic sacral metastases. Improvement in HRQOL can be expected with an acceptable AE rate.

    Patient Care: Better patient's counselling.

    Learning Objectives: By the end of this session, participants should be able to : 1) Describe modern management of sacral metastases 2) Discuss the role of surgery and RT in the treatment of sacral metastases 3) Explain that improvement in HRQOL and pain can be anticipated with treatment of sacral metastases.


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