AO Spine Knowledge Forum Tumor

Principal Investigator:

Ilya Laufer

Co-Principal Investigator:

Ori Barzilai

Goals:

To assess the effectiveness of surgery and radiotherapy in relieving pain for patients with metastatic spine disease. The proportions of responders and non-responders based on pain relief from the worst baseline index pain (the worst of one kind or multiple kinds of pain, if the patient has experienced multiple kinds of index pain at baseline) after surgery and/or radiotherapy will be described.

The AO Spine Cancer-Related Pain Classification will be used to categorize neoplastic spinal pain by etiology.

Secondary objectives include factors predicting pain relief and the relationship between pain and other patient-reported outcomes.

ClinicalTrials.gov Identifier: NCT06746103

Principal Investigators:

Ori Barzilai, Ilya Laufer

Goals:

To develop a core set of spine tumor pain descriptors and a mechanism-driven classification system for spine tumor pain assessment and focused pain experience measurement to guide treatment decisions.

Principal Investigators:

Consortium of 15 partners including AO Spine. Coordinated by ALMA MATER STUDIORUM - UNIVERSITA DI BOLOGNA

Goals:

To improve fracture prevention in patients with vertebral metastases by developing computational models that assess fracture risk. These models will be integrated into a Decision Support System (DSS) to help clinicians tailor treatments based on individual risk.

The project will also create new guidelines for patient stratification and treatment selection.

ClinicalTrials.gov Identifier: NCT06910618

Additional information:

• METASTRA: Transforming Fracture Risk Assessment for Cancer Patients with Vertebral Metastases | METASTRA (metastraproject.eu)
• Improving assessment methods and treatment options for spinal cancer patients

A multicenter prospective registry for the management and outcomes of metastatic spine tumors

Principal Investigator:

Charles Fisher

Co-Principal Investigators:

Arjun Sahgal, Ilya Laufer

Goals:

To establish a network of spine oncology centers dedicated to prospective multicenter international research of patients diagnosed with metastatic tumors of the spine and will include a comprehensive prospective clinical database which will serve as a shared research platform.

The association of clinical, diagnostic, and therapeutic variables with patient reported outcomes, morbidity data, local tumor control, and survival will be investigated.

ClinicalTrials.gov Identifier: NCT02830451

Research Output:

Publication summary 

Principal Investigator:

Jeremy Reynolds

Co-Principal Investigators:

Nicolas Dea, Laurence Rhines

Goals:

To establish a network of spine oncology centers dedicated to prospective multicenter international research of patients diagnosed with primary spinal column and cord tumors and will include a comprehensive prospective clinical database which will serve as a shared research platform.

The association of clinical, diagnostic, and therapeutic variables with survival, local recurrence, morbidity data, and patient reported outcomes will be investigated.

ClinicalTrials.gov Identifier: NCT02790983

Research Output:

Publication summary

Principal investigator:

Charles Fisher

Co-Principal investigator:

Ziya Gokaslan

Goals:

To prospectively collect patient, diagnostic and treatment variables along with disease-specific and generic health related quality of life (HRQOL) data on consecutively treated patients with metastatic spine tumors.

ClinicalTrials.gov Identifier: NCT01825161

Remark:

This project received co-funding from the Orthopaedic Research & Education Foundation (OREF) through a Spine Prospective Clinical Research Grant

Research Output:

Publication summary
Questionnaire (SOSGOQ2.0)

Principal investigator:

Aron Lazary

Co-Principal investigator:

Nicolas Dea

Goals:

To develop a novel scoring system to guide surgical treatment of patients with spinal metastases.

Principal investigator:

Stephen Yip

Co-Principal investigators:

Raphaële Charest-Morin, Chetan Bettegowda, Nicolas Dea, Rory C. Goodwin

Goals:

1. Investigated the ability of personalized biomarkers to detect circulating tumor DNA (ctDNA) in postoperative blood specimens of chordoma patients who had detectable ctDNA before surgery.
2. Determined if there is a correlation between surgical margins (wide/marginal vs. Intralesional) and the persistence of postoperative ctDNA in these patients.

Research Output:

Principal investigator:

Joost Rutges

Co-Principal investigators:

Daniel Tobert, Joseph Schwab, Jorrit-Jan Verlaan, Harmen Kuijten

Goals:

1. Externally validated 10 survival predication models for metastatic spine disease using data from a recent cohort of patients treated with surgery and/or radiotherapy between 2016 and 2021
2. Predicted the quality of life (QOL) after treatment using data from prospectively collected QOL questionnaires
3. Identified additional prognostic factors using the NOMS framework to improve survival and QOL predictions for new and updated models
4. Assessed the optimal trade-off between gains in QOL and extending survival

Research Outputs:

Principal investigator:

Raphaële Charest-Morin

Co-Principal investigators:

Jeremy Reynolds, Gerard Mawhinney

Goals:

To explore lived experiences of people diagnosed with a primary bone tumor using a peer-to-peer support program (spinal Buddy Program (BP)). 

The study aims to:

1. Implement the BP at two different health centers (Oxford and Vancouver), including necessary training and documentation.
2. Evaluate the BP’s impact on patient satisfaction and expectations before and after surgery using both quantitative and qualitative methods. 
3. Investigate cultural and institutional differences between the two centers.

Principal investigator:

Charles Fisher

Co-Principal investigators:

Stefano Boriani, Michael Fehlings, Daryl Fourney, Ziya Gokaslan, Laurence Rhines, Peter Varga

Goals:

Assessed the inter- and intra-observer reliability and validity of SINS in radiologists and radiation oncologists

Research Outputs:

Publication summary

SINS

Principal investigator:

Charles Fisher

Co-Principal investigators:

Ziya Gokaslan, Sigurd Berven, Mark Bilsky, Patrick Boland, Stefano Boriani, Dean Chou, Mark Dekutoski, Alexander Disch, Michael Fehlings, Nasir Quraishi, Alessandro Luzzati, Laurence Rhines, Peter Varga, Richard Williams

Goals:

Determined what variables (clinical, diagnostic, therapeutic, or demographic) are associated with local recurrence and survival within defined groups of primary malignant and benign bone and soft tissue spine tumors:

1. Overall analysis—analysis of the complete collection (>1500 tumors)
2. Histopathology type analysis—analysis of each tumor histopathology type (13 identified) were individually analysed by assigned project members

ClinicalTrials.gov Identifier: NCT01643174

Research Outputs:

Publication summary

Principal investigator:

Chetan Bettegowda

Co-Principal investigators:

Stephen Yip, Aron Lazary, Ziya Gokaslan, Charles Fisher, Peter Varga, Stefano Boriani, Marco Gambarotti, Laurence Rhines, Billy Wang, Alexander Lazar

Goals:

Aimed to determine the role that the SNP rs2305089 has in the prognosis of chordoma patients by evaluating whether there is a relationship between the status of the SNP and various clinical outcomes/measures (eg, survival, local recurrence, response to radiation therapy, response to chemotherapy, link to metastasis, demographics)

Research Outputs:

Publication summary

Principal investigator:

Chetan Bettegowda

Co-Principal investigators:

Ziya Gokaslan, Stephen Yip, Aron Lazary, Charles Fisher, Peter Varga, Stefano Boriani, Marco Gambarotti, Laurence Rhines, Billy Wang, Alexander Lazar, Michael Fehlings, Gelareh Zadeh, Alessandro Luzzati, Mark Dekutoski, Michelle Clarke

Goals:

Determined the rates of TERT promoter mutation (mutation of the promoter of the telomerase gene [23348506,23348503]) and its prognostic significance in primary spinal column tumors, namely spinal chordomas

Research Outputs:

Publication summary

Principal investigator:

Charles Fisher

Co-Principal investigators:

Michelle Clarke, Daniel Sciubba, Daryl Fourney

Goals:

• Performed a systematic review of the literature for prognostic factors specific to:
  • surgical treatment of prostate metastases to the spine
  • surgical treatment of breast metastases to the spine
  • surgical treatment of renal cell metastases to the spine
  • surgical treatment of lung metastases to the spine
  • symptomatic vertebral hemangioma
• Performed a systematic review of the literature for the management of malignant primary tumors of the spine

Research Outputs:

Publication summary

Principal investigator:

Charles Fisher

Goals:

Produced a spine oncology Focus Issue which synthesizes the best available evidence and expert opinion in the management of primary spinal column tumors and metastatic spine disease to provide clinicians with evidence-based treatment recommendations

Research Outputs:

Focus Issue

Principal investigator:

Marco Palanca

Co-Principal investigators:

Luca Cristofolini

Goals:

Through biomechanical evaluation, they assist surgeons in better identifying cases needing spine stabilization in patients with spinal metastasis classified as "indeterminate" by the SINS

Specific aims included:

1. Characterizing metastatic tissues and their interface with healthy vertebrae.
2. Identifying the effects of metastatic lesions on spine stability to create clear guidelines for indeterminate SINS cases.
3. Clarifying how metastasis size, location, and involvement of cortical and pedicular areas affect mechanical strength through biomechanical tests.

Research Outputs:

Publication summary

Principal investigator:

Hanqiang Ouyang

Co-Principal investigators:

Liang Jiang, Shaomin Yang

Goals:

Using high-throughput sequencing technology, they conducted a genome-wide association analysis to study gene mutations related to early progression of solitary plasmacytoma of bone to multiple myeloma

Research Outputs:

Publication summary

Principal investigator:

Ankit I. Mehta

Goals:

Aims to evaluate doxorubicin-loaded magnetic nanoparticles (MNP-DOX) for IMSCTs compared to systemic and intrathecal chemotherapy in an orthotopic xenograft tumor model

Research Outputs:

The project was unexpectedly discontinued

Principal investigator:

Nicolas Dea

Co-Principal investigators:

Charles Fisher, Anne Versteeg, Arjun Sahgal, Markian Pahuta

Goals:

Developed a method to convert the Spine Oncology Study Group Outcomes Questionnaire v2.0 (SOSGOQ2.0) to utilities, enabling the calculating of quality-adjusted life years (QALYs) for economic analysis.

Research Outputs:

Publication summary

Principal investigator:

Nicolas Dea

Co-Principal investigators:

Jeremy Reynolds, John Shin, Charles Fisher

Goals:

Through an expert survey and systematic literature review, the variability in current treatment protocols for managing newly diagnosed chordoma of the mobile spine and sacrum were investigated.

Research Outputs:

Publication summary

Principal investigator:

H.M. Verkooijen

Co-Principal investigators:

Anne Versteeg, Charles Fisher

Goals:

Obtained an in-depth understanding of patient expectations of outcomes related to surgical and/or radiotherapy treatments for spinal metastases and created a patients’ expectations questionnaire for clinical use in patients with spinal metastases

Research Outputs:

Publication summary

Questionnaire—Surgery

Questionnaire—Radiation Therapy

Additional Information:

Spinal cancer—why patients' treatment expectations matter

Principal investigator:

Raphaële Charest-Morin

Co-Principal investigators:

Nicholas Dea, Arjun Sahgal, Ilya Laufer

Goals:

Aims to define the optimal care pathway for patients with primary spinal column tumors

Principal investigator:

Marco Palanca

Co-Principal investigators:

Luca Cristofolini, Enrico Dall’Ara

Goal:

The different failure pattern experienced by metastatic vertebrae with respect to the different disc degeneration levels were evaluated based on imaging and biomechanical testing

Research Outputs:

Publication summary

Principal investigator:

Michael Weber

Co-Principal investigators:

Miltiadis Georgiopoulos, Raphaële Charest-Morin, Rory C. Goodwin

Goal:

The perceptions, opinions, and practices of spine surgeons about frailty regarding spinal metastatic disease were assessed through an AO Spine-wide survey and what spine surgeons consider to be relevant preoperative factors and postoperative outcomes were identified.

Research Outputs:

Publication summary

Principal investigators:

Laurence Rhines, Arjun Sahgal

Goal:

Produced a spine oncology Focus Issue which highlights key tools and techniques, such as the Spinal Instability Neoplastic Score (SINS) and stereotactic body radiotherapy (SBRT), and emphasizes the importance of personalized medicine, molecular prognostication, and new technologies to optimize patient care.

Research Outputs:

Focus Issue

Principal investigators:

Ilya Laufer, Matthew Goodwin

Goals:

The practice patterns and knowledge gaps of AO members managing spine tumor patients were assessed to identify the questions and decisions AO members find challenging when caring for patients with spinal tumors. This evaluation also determined the effectiveness of knowledge translation for the instruments and recommendations already developed by the KF Tumor

Research Outputs:

Publication summary