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Cancers
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Advances in Spine Oncology: Research and Clinical Studies
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Advances in Spine Oncology: Research and Clinical Studies

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Clinical Research of Cancer".

Deadline for manuscript submissions: 31 December 2025 | Viewed by 2964

Special Issue Editor

Dr. Oluwaseun O. Akinduro

E-Mail Website
Guest Editor
Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
Interests: metastatic spine tumor; chordoma; chondrosarcoma; spondylectomy; proton therapy

Special Issue Information

Dear Colleagues, 

Spine oncology is a rapidly advancing and evolving field, with ongoing integration of enabling technologies and cutting-edge translational work to improve outcomes for this fragile patient population. Primary and metastatic tumors of the spinal column are complex entities with innumerous nuances that make diagnosis and treatment a challenge. In this Special Issue, we hope to highlight some of the advances that have improved the treatment for these patients. 

This Special Issue aims to improve our ability to diagnose and treat primary and secondary tumors of the spinal column. We hope that it will highlight novel and unique treatment paradigms that will be applied to patients across the globe.  

Original research articles and reviews are welcome for this Special Issue. Research areas may include, but are not limited to, the following: advances in imaging and radiotherapy for spinal tumors; surgical techniques for resection of spinal tumors; targeted therapy for spinal tumors; and novel technologies for the diagnosis and treatment of spinal tumors. 

We look forward to receiving your contributions. 

Dr. Oluwaseun O. Akinduro
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • metastatic spine cancer
  • targeted therapy
  • stereotactic body radiotherapy
  • proton radiotherapy
  • chordoma
  • chondrosarcoma
  • spondylectomy

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Published Papers (4 papers)

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Research

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10 pages, 1544 KiB  
Article
Role of Denosumab in Patients with Intermediate Spinal Instability Neoplastic Score (SINS)
by JunYeop Lee, Bong-Soon Chang, Hyoungmin Kim, Sung Taeck Kim, Seonpyo Jang and Sam Yeol Chang
Cancers 2025, 17(9), 1539; https://doi.org/10.3390/cancers17091539 - 1 May 2025
Viewed by 191
Abstract
Objectives: The current study aimed to evaluate the effect of denosumab on patients with impending instability due to spinal metastasis, including whether it can improve spinal instability neoplastic score (SINS) and reduce the need for surgical treatment. Methods: This study retrospectively reviewed patients [...] Read more.
Objectives: The current study aimed to evaluate the effect of denosumab on patients with impending instability due to spinal metastasis, including whether it can improve spinal instability neoplastic score (SINS) and reduce the need for surgical treatment. Methods: This study retrospectively reviewed patients initially treated non-operatively for metastatic spinal lesions with intermediate SINS (7–12 points) between January 2017 and December 2023 in a single tertiary cancer hospital. Patients were divided into two groups based on the use of denosumab for the intermediate SINS lesion: D-group and N-group. Propensity score matching (PSM) was conducted with a caliper width of 0.025 for the covariates (age, sex, and primary cancer). The study outcomes were (1) the rate of conversion to surgery, (2) the change in SINS, and (3) the change in HU (Hounsfield unit) during the follow-up period. Results: A total of 286 patients (male 151, female 135) with a mean age of 68.0 ± 12.6 years and a mean follow-up period of 37.1 ± 26.5 months were included. Forty-one (14.3%) patients received denosumab (D-group), whereas 245 (85.7%) did not receive denosumab (N-group). Before PSM, 9.8% (4/41) in the D-group and 18.8% (46/245) in the N-group underwent surgical treatment. The rate of conversion to surgery was similar after PSM: the D-group, 8.3% (3/36) vs. the N-group, 16.6% (6/36). Survival analysis using Kaplan–Meier curves also showed that the D-group had a significantly lower probability of conversion to surgery before and after PSM (p = 0.015 and p = 0.023, respectively). In addition, the D-group showed significant improvements in the SINS (total score, pain, and bone lesion scores) and HU after denosumab treatment. Conclusions: In this study, denosumab lowered the rate of conversion to surgery in patients with impending instability (intermediate SINS) due to spinal metastasis. Patients who received denosumab treatment showed significant improvements in the SINS and HU for their metastatic spinal lesions. Full article
(This article belongs to the Special Issue Advances in Spine Oncology: Research and Clinical Studies)
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13 pages, 2183 KiB  
Article
The Clinical Impact of a Multidisciplinary Strategy: Diagnostic and Therapeutic Flow-Chart for Vertebral Metastases with Spinal Cord Compression
by Rossella Rispoli, Fabrizia Giorgiutti, Claudio Veltri, Edi Copetti, Pietro Imbrucè, Giorgia Iacopino and Barbara Cappelletto
Cancers 2025, 17(9), 1479; https://doi.org/10.3390/cancers17091479 - 28 Apr 2025
Viewed by 316
Abstract
Introduction: Metastatic spinal cord compression (MSCC) is a life-threatening complication caused by the involvement of the spinal cord or nerve roots. It can result in severe neurological deficits, including paralysis, sensory loss, and bladder or bowel dysfunction, significantly affecting patients’ quality of life. [...] Read more.
Introduction: Metastatic spinal cord compression (MSCC) is a life-threatening complication caused by the involvement of the spinal cord or nerve roots. It can result in severe neurological deficits, including paralysis, sensory loss, and bladder or bowel dysfunction, significantly affecting patients’ quality of life. Prompt diagnosis and intervention are critical to minimizing these outcomes and improving neurological recovery. This study evaluates the efficacy of a diagnostic and therapeutic protocol introduced at our institution in 2022, designed to enhance early detection, optimize management, and improve outcomes for patients with MSCC. Materials and Methods: The protocol was developed through a multidisciplinary collaboration involving emergency physicians, oncologists, spine surgeons, neuroradiologists, and radiation oncologists. Each specialty contributed its expertise to create a streamlined approach emphasizing early symptom recognition, rapid diagnostic imaging, and timely therapeutic interventions, such as surgical decompression and radiotherapy. To assess the protocol’s effectiveness, a retrospective analysis was conducted. Clinical data from the pre-implementation period (years 2019–2021) were compared to the post-implementation period (2022–2024). Results: The implementation of the algorithm significantly improved MSCC management, increasing outpatient consultations from 671 to 828 (+23%). Comparing the pre- to post-implementation periods, emergency consultations rose from 14% to 23%, while intrahospital consultations decreased from 20% to 16%. Surgical procedures increased slightly, from 60 to 66 (+10%), including 26 emergency surgeries (+4%) and 40 elective delayed surgeries (+14%). Conclusions: The introduction of a multidisciplinary diagnostic and therapeutic protocol significantly improved outpatient management of patients with metastatic spine disease, demonstrated by a significant increase in urgent outpatient consultations and a reduction in intrahospital consultations. The number of surgical interventions for metastatic spinal cord compression slightly increased after the protocol’s adoption, although the proportion of elective surgeries remained unchanged. Neurological presentation at the time of surgery did not show a statistically significant difference between the pre- and post-implementation periods. These findings highlight the protocol’s effectiveness in optimizing patient flow and triaging, while further research is needed to evaluate its long-term clinical impact. Full article
(This article belongs to the Special Issue Advances in Spine Oncology: Research and Clinical Studies)
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21 pages, 2540 KiB  
Article
Determinants of Overall and Readmission-Free Survival in Patients with Metastatic Epidural Spinal Cord Compression
by Mirza Pojskić, Benjamin Saß, Miriam H. A. Bopp, Sebastian Wilke and Christopher Nimsky
Cancers 2024, 16(24), 4248; https://doi.org/10.3390/cancers16244248 - 20 Dec 2024
Viewed by 899
Abstract
Background. The aim of this study was to assess the surgical outcomes and survival of patients surgically treated for metastatic epidural spinal cord compression (MESCC), with a specific focus on identifying factors that influence overall survival and readmission-free survival. Methods. All patients who [...] Read more.
Background. The aim of this study was to assess the surgical outcomes and survival of patients surgically treated for metastatic epidural spinal cord compression (MESCC), with a specific focus on identifying factors that influence overall survival and readmission-free survival. Methods. All patients who underwent surgery for spine metastases at our department in the period 2018–2022 were included in the study. Results. A total of 175 patients (n = 71 females, median age 67.15 years) were included. The most common primary tumors were lung carcinoma (n = 31), prostate carcinoma (n = 31), breast carcinoma (n = 28), multiple myeloma (n = 25), and renal cell carcinoma (n = 11). ECOG performance status was 0 (n = 7), 1 (n = 97), 2 (n = 27), 3 (n = 17), and 4 (n = 27). Pathological fractures were present in n = 108 patients. Decompression only was performed in n = 42, additional instrumentation in n = 133, and vertebral body replacement in n = 23. The most common complications were wound healing deficits and hardware failure. Preoperative motor deficits were present in n = 89 patients. Postoperatively, n = 122 improved, n = 43 was unchanged, and n = 10 deteriorated. Mean overall survival (OS) was 239.2 days, with a 30-day mortality rate of 18.3%. Favorable prognostic factors included Tomita score < 7, Frankel score A–C, ECOG 0–1, and Modified Tokuhashi score > 10 (p < 0.01). Factors affecting OS and readmission-free survival (RFS) included prognostic scores, adjuvant therapy, ASA classification, surgical complications, metastasis number, and postoperative improvement. Better prognostic scores, adjuvant therapy, and clinical improvement were associated with longer OS and RFS, while complications or deterioration resulted in worse outcomes. Conclusions. Patients undergoing decompression and/or stabilization for metastatic spinal tumors showed improved outcomes, with favorable prognosis linked to Tomita score < 7, Frankel score A–C, ECOG 0–1, and Modified Tokuhashi score > 10. Full article
(This article belongs to the Special Issue Advances in Spine Oncology: Research and Clinical Studies)
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Review

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13 pages, 3969 KiB  
Review
Gas Plasma Technology and Immunogenic Cell Death: Implications for Chordoma Treatment
by Sander Bekeschus, Karl Roessler, Oliver Kepp and Eric Freund
Cancers 2025, 17(4), 681; https://doi.org/10.3390/cancers17040681 - 18 Feb 2025
Viewed by 1005
Abstract
Cancer is the second-leading cause of death in developed societies. Specifically, cancers of the spine and brain come with significant therapeutic challenges. Chordomas are semi-malignant tumors that develop from embryonic residuals at the skull base (clival) or coccyx (sacral). Small tumor fragments can [...] Read more.
Cancer is the second-leading cause of death in developed societies. Specifically, cancers of the spine and brain come with significant therapeutic challenges. Chordomas are semi-malignant tumors that develop from embryonic residuals at the skull base (clival) or coccyx (sacral). Small tumor fragments can remain in the operation cavities during surgical resection, forming new tumor sites. This requires repeated surgeries or the application of proton-beam radiation and chemotherapy, which often do not lead to complete remission of the tumors. Hence, there is a need for novel therapeutic avenues that are not limited to killing visible tumors but can be applied after surgery to decrease chordoma recurrences. Reactive oxygen species (ROS) generated locally via novel medical gas plasma technologies are one potential approach to address this clinical problem. Previously, broad-spectrum free radicals generated by these cold physical plasmas operated at about body temperature were shown to oxidize cancer cells to the disadvantage of their growth and induce immunogenic cancer cell death (ICD), ultimately promoting anticancer immunity. This review outlines the clinical challenges of chordoma therapy, how medical gas plasma technology could serve as an adjuvant treatment modality, and potential immune-related mechanisms of action that could extend the longevity of gas plasma therapy beyond its acute local tissue effects. Full article
(This article belongs to the Special Issue Advances in Spine Oncology: Research and Clinical Studies)
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