Spinal metastases from myxoid liposarcoma warrant screening with magnetic resonance imaging

Authors

  • Joseph H. Schwab MD,

    1. Department of Surgery, Orthopedic Service, Memorial Sloan-Kettering Cancer Center, New York, New York
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  • Patrick J. Boland MD,

    1. Department of Surgery, Orthopedic Service, Memorial Sloan-Kettering Cancer Center, New York, New York
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  • Cristina Antonescu MD,

    1. Department of Pathology, Memorial Sloan- Kettering Cancer Center, New York, New York
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  • Mark H. Bilsky MD,

    1. Department of Surgery, Orthopedic and Neurosurgery Services, Memorial Sloan-Kettering Cancer Center and Medical College of Cornell University, New York, New York
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  • John H. Healey MD

    Corresponding author
    1. Department of Surgery, Orthopedic Service, Memorial Sloan-Kettering Cancer Center, New York, New York
    • Department of Surgery, Orthopedic Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Suite A342, New York, NY 10021
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    • Fax: (212) 639-7610.


Abstract

BACKGROUND.

Myxoid liposarcoma (MLS) has an unusual tendency for extrapulmonary metastasis, particularly to the spine and soft tissues. The objective of this study was to determine the prevalence of spinal metastasis, treatment outcomes, and optimal screening method for spinal metastasis in patients with MLS.

METHODS.

Data from patients with had spinal metastases were obtained from the authors' institutional soft tissue sarcoma database. The accuracy with which positron emission tomography (PET) scans and bone scans identified metastatic lesions was compared with the accuracy of magnetic resonance imaging (MRI). Clinical response to treatment was based on pain, neurologic scores, and survivorship analysis.

RESULTS.

There were 33 patients who developed spinal metastasis after a median 36 months of follow-up (range, from 7.5 months to 33 years). Known spinal metastases were detected by bone scans in 16% of patients and by PET scans in 14% of patients. Patients who underwent surgery had high-grade spinal cord compression more often than patients who did not undergo surgery (72% vs 19%, respectively; P = .002). Pain and neurologic function were improved or maintained in all patients who received radiation alone (n = 8 patients) and in all but 1 patient who underwent surgery (n = 18 patients). The median overall survival was 51.4 months from the time of primary diagnosis and 21.9 months from the time of first metastasis.

CONCLUSIONS.

Bone scans and PET scan lack sufficient sensitivity to detect spinal metastasis from MLS. Treatment of metastasis is palliative, but local treatment can yield long-term disease control in select patients. Screening with whole-spine MRI may lead to the earlier detection of spinal metastasis. Cancer 2007. © 2007 American Cancer Society.

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