脊柱转移性肿瘤外科治疗相关问题探讨

Commentary on relevant issues in surgical treatment of spinal metastatic tumors

以外科为主导的多学科综合治疗模式已成为脊柱转移性肿瘤治疗的综合策略和整体观念,但脊柱转移性肿瘤的手术治疗不同于脊柱原发恶性肿瘤,手术只是多学科综合治疗模式当中的一个环节。因此,脊柱转移性肿瘤的外科治疗策略应首先立足于患者的生存评估,综合评估转移瘤的脊柱稳定性破坏、脊髓神经功能障碍、肿瘤生物学特点,制定适度的外科手术干预级别。应重视脊柱转移性肿瘤的微创治疗,结合放疗新技术、新辅助化疗、靶向治疗等内科治疗的进展,制定个体化、阶梯化的综合治疗模式,以缓解患者疼痛、重建脊柱稳定、避免瘫痪。在改善患者生存、增加局部肿瘤控制率和可能提高生存时间的同时,尽可能避免过度手术。

The multidisciplinary treatment model led by surgery has become a comprehensive strategy and overall concept for the treatment of spinal metastatic tumors.But the surgical treatment of spinal metastatic tumors is different from primary malignant tumors of the spine.Surgery is only a part of the multidisciplinary comprehensive treatment.Therefore,the following aspects need to be evaluated comprehensively based on the survival assessment,evaluation of spinal stability damage,nerve dysfunction,and oncological characteristics of the metastatic tumors with a reasonable surgical intervention.The attention should be paid to the minimally invasive treatment of spinal metastases,progress of new radiotherapy technology,neoadjuvant chemotherapy,targeted drug therapy and other medical treatment to make a comprehensive and individualization decision which is benefit to relieve patients' pain,reconstruct spinal stability and avoid paralysis.While improving patient survival,increasing local tumor control rate and possibly prolonging survival time,avoiding excessive surgery as much as possible.