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The NOMS Framework: Approach to the Treatment of Spinal Metastatic Tumors

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TLDR
Application of the NOMS paradigm integrates multimodality therapy to optimize local tumor control, pain relief, and restoration or preservation of neurologic function and minimizes morbidity in this often systemically ill patient population.
Abstract
Background. Spinal metastases frequently arise in patients with cancer. Modern oncology provides numerous treatment options that include effective systemic, radiation, and surgical options. We delineate and provide the evidence for the neurologic, oncologic, mechanical, and systemic (NOMS) decision framework, which is used at Memorial Sloan-Kettering Cancer Center to determine the optimal therapy for patients with spine metastases.

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The impact of histology and delivered dose on local control of spinal metastases treated with stereotactic radiosurgery.

TL;DR: High-dose single-session SRS provides durable long-term control, regardless of the histological findings or tumor size, suggesting that radioresistant histological types benefit in particular from radiosurgery.
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Outcomes and Toxicity for Hypofractionated and Single-Fraction Image-Guided Stereotactic Radiosurgery for Sarcomas Metastasizing to the Spine

TL;DR: In the largest series of metastatic sarcoma to the spine to date, IG-SRS provides excellent LC in the setting of an aggressive disease with low radiation sensitivity and poor prognosis.
Journal ArticleDOI

State of the Art Treatment of Spinal Metastatic Disease.

TL;DR: This review recapitulates the current state‐of‐the‐art, evidence‐based data on the treatment of spinal metastases, integrating these data into a decision framework, NOMS, which integrates the 4 sentinel decision points in metastatic spine tumors.
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Separation surgery for spinal metastases: effect of spinal radiosurgery on surgical treatment goals.

TL;DR: The combination of separation surgery and high-dose hypofractionated or single-fraction SRS results in high local tumor control at 1 year and is an effective palliative paradigm for this patient population.
References
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Journal ArticleDOI

Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial

TL;DR: Direct decompressive surgery plus postoperative radiotherapy is superior to treatment with radiotherapy alone for patients with spinal cord compression caused by metastatic cancer.
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Epidural spinal cord compression from metastatic tumor: Diagnosis and treatment

TL;DR: It is concluded that RT without decompressive laminectomy is as effective as decompressive Laminectomy in treating epidural spinal cord compression from systemic cancer.
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A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group.

TL;DR: The Spine Instability Neoplastic Score is a comprehensive classification system with content validity that can guide clinicians in identifying when patients with neoplastic disease of the spine may benefit from surgical consultation and aid surgeons in assessing the key components of spinal instability due to neoplasia.
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Palliative Radiotherapy Trials for Bone Metastases: A Systematic Review

TL;DR: No significant differences in the arms were observed for overall and CR rates in both intention-to-treat and assessable patients, however, a significantly higher re-treatment rate with SFs was evident.
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Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution.

TL;DR: The results indicate the potential of radiosurgery in the treatment of patients with spinal metastases, especially those with solitary sites of spine involvement, to improve long-term palliation.
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