نتایج یک نظرسنجی پرسشنامه ای در مورد معالجه تومورهای نخاعی
Abstract
Introduction
Materials and methods
Results
Discussion
References
Abstract
Purpose: Questionnaire survey among the members of the German Spine Society (Deutsche Wirbels€ aulen-Gesellschaft, DWG) to objectify oncological infrastructure and current standard of care in spinal tumor treatment in Germany. Methods: All DWG-members were contacted via the society's e-mail and asked to respond in anonymized form to a related questionnaire. Questions were asked regarding surgical specialty, type of institution involved, numbers of spinal procedures, as well as questions on treatment for primary tumors, whether the respondent belonged to a tumor center, decision-making procedures for surgery, and the type of procedure. Results: 84 centers providing surgical treatment for spinal tumors in their departments were identified. 52.6% were carrying out more than 500 spinal procedures per year. There was a significant association (P 0.05) between the numbers of spinal surgeries, the number of treated tumor patients per year, the organisation in a tumor center and the treatment of primary tumors. 76% are part of a local tumor center for interdisciplinary decision making (i.e.surgical treatment and adjuvant therapy). 74% of the institutions stated that conventional postoperative radiotherapy is standardly administered in the case of secondary lesions, with 24% of them referring patients to external services for radiotherapy. Conclusion: In spite of often large numbers of spinal operations, the centers perform relatively small numbers of tumor operations, particularly for primary tumors. A nearly three-quarter majority of the departments are integrated into interdisciplinary tumor care. However, there is a marked number that do not belong to an interdisciplinary organisation. Further advances in multidisciplinarity and oncology training are a continuous issue to increase treatment quality in spinal tumor patients.
Introduction
The diagnosis of a tumor on the spine is a severe and momentous event for those affected and represents an equally great challenge for the specialist disciplines treating these lesions. There is controversy regarding the value, necessity, options and extent of surgical interventions and on whether they are lastingly effective [1]. Oncological treatment is now primarily based on and guided by the biology of the underlying tumors, and currently a paradigm shift in surgical therapy is observed. Among the involved disciplines, the spinal surgeon is usually the first who is contacted either by the symptomatic patient or diagnostic radiologist. However, to provide the complete range of treatment, other disciplines as radiooncology, pathology, pain therapy, internal oncology etc. as well as the necessary infrastructure also have to be available locally to consecutively guarantee the patient a oncological treatment in accordance with the latest standards and guidelines. The treatments are mainly palliative in nature due to secondary lesions developing in 10e20% of all cancer patients [2]. Surgical procedures are aimed at relieving neurological complications, severe pain or restoring spinal integrity and vertebral stability in order to ensure an acceptable quality of life for the period remaining. With regard to primary tumors or so called „solitary“ metastases in definded constellations, the current data in the literature show that radical resection combined with adjuvant therapy is markedly superior to intralesional procedures [3e5].