Management of Vertebral Metastasis in Patients With Uterine Cervical Cancer

Abstract

Aim We sought to identify risk factors and management options for uterine cervical cancer (UCC) patients with a vertebral metastasis (VM) treated over the course of 23 years. Methods Among 844 UCC patients, 18 were diagnosed with a VM. Thirty-six control patients with UCC but without recurrence were matched to these 18 in terms of stage and histological tumor type using a dependent random sampling method. A logistic regression analysis was used to identify factors prognostic of VM; the results are presented as odds ratios with 95% confidence intervals (CIs). Results The mean survival time after VM treatment commenced was 12.1 2.7 months (95% CI, 5.3-12.6 months) in patients who received chemotherapy (CT) and 15.0 +/- 2.3 months (95% CI, 9.7-14.2 months) in those treated via chemoradiotherapy (CRT) (P = 0.566). In patients who underwent CT, the 1- and 2-year survival rates after recurrence were 19.2% and 0%, respectively. However, these figures were 50% and 8.3% in those treated via CRT. Both lymphovascular space invasion and mean corpuscular volume were risk factors for VM. Cox regression analysis showed that these prognostic factors had no effect on survival duration after recurrence. The locations and percentages of vertebra metastasis were as follows: 11.1% lumbar 4, 27.7% lumbar 5, 22.2% lumbar 4-5, 16.7% lumbar 3-4-5, 5.6% lumbar 2-3, 5.6% lumbar 2-3-4, 5.6% lumbar 3-4-5/sacral 1, and 5.6% thoracic 11-12/lumbar 1-2. Conclusions We found that patients with lymphovascular space invasion were at high risk of isolated VM and that the survival times after CT and CRT were similar. Because most VMs are seen in the vertebral space within the borders of radiation therapy, borders of external beam radiotherapy should be carefully determined for each patient.