Tokuhashi et al developed a score for evaluating a patient with metastastic tumor to the spine. This can help distinguish a patient who is a candidate for surgical resection from the patient who is better managed by palliative care. The authors are from Nihon University in Tokyo, Japan.
Parameters:
(1) Karnofsky performance scale (KPS)
(2) number of extraspinal bone metastases
(3) number of metastases to vertebral bodies
(4) metastases to major internal organs
(5) primary site of the tumor
(6) spinal cord palsy (based on the Frankel classification, page 1111)
|
Parameter |
Finding |
Points |
|
Karnofsky Performance Scale |
good (80 to 100) |
2 |
|
|
moderate (50 to 70) |
1 |
|
|
poor (10 to 40) |
0 |
|
number of extraspinal bone metastases |
0 |
2 |
|
|
1 or 2 |
1 |
|
|
>= 3 |
0 |
|
number of metastases to vertebral bodies |
1 |
2 |
|
|
2 |
1 |
|
|
>= 3 |
0 |
|
metastases to major organs |
none |
2 |
|
|
resectable |
1 |
|
|
unresectable |
0 |
|
primary site for the tumor |
lung or stomach |
0 |
|
|
kidney, liver, uterus, other or unidentified |
1 |
|
|
thyroid, prostate, breast, rectum |
2 |
|
spinal cord palsy |
none |
2 |
|
|
incomplete (Frankel C or D) |
1 |
|
|
complete (Frankel A or B) |
0 |
where:
• Although the score refers to metastases to vertebral "bodies", my interpretation is that it refers to any metastasis involving a vertebra.
• Enkaoua et al recommended reducing the points for an unidentified primary to 0.
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 12
• Patients with a score of 9 to 12 survive 12 months or more and are candidates for surgical excisions.
• Patients with a score of 0 to 5 usually survive 3 months or less (some may survive up to 6 months) and are candidates for palliative care.
• Patients with scores of 6 to 8 show a variable survival with most surviving less than 6 months, some surviving up to 12 months, and a few living longer. The decision to treat or palliate thus needs to be made based on the individual patient characteristics.
Specialty: Hematology Oncology, Surgery, general
ICD-10: ,
