Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
Oncologist. 2013 Jun;18(6):744-51. doi: 10.1634/theoncologist.2012-0293. Epub 2013 May 24.
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.
We provide a literature review of the integral publications that serve as the basis for the NOMS framework and report the results of systematic implementation of the NOMS-guided treatment.
The NOMS decision framework consists of the neurologic, oncologic, mechanical, and systemic considerations and incorporates the use of conventional external beam radiation, spinal stereotactic radiosurgery, and minimally invasive and open surgical interventions. Review of radiation oncology and surgical literature that examine the outcomes of treatment of spinal metastatic tumors provides support for the NOMS decision framework. 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.
NOMS paradigm provides a decision framework that incorporates sentinel decision points in the treatment of spinal metastases. Consideration of the tumor sensitivity to radiation in conjunction with the extent of epidural extension allows determination of the optimal radiation treatment and the need for surgical decompression. Mechanical stability of the spine and the systemic disease considerations further help determine the need and the feasibility of surgical intervention.
癌症患者常发生脊柱转移。现代肿瘤学提供了众多治疗选择，包括有效的全身治疗、放疗和手术治疗。我们描述并提供了神经、肿瘤学、力学和全身（NOMS）决策框架的证据，该框架在纪念斯隆-凯特琳癌症中心用于确定脊柱转移瘤患者的最佳治疗方法。
我们对作为 NOMS 框架基础的综合文献进行了文献回顾，并报告了系统实施 NOMS 指导治疗的结果。
NOMS 决策框架包括神经、肿瘤学、力学和全身方面的考虑，并纳入了常规外照射放疗、脊柱立体定向放疗以及微创和开放性手术干预的应用。对放射肿瘤学和外科文献的回顾，这些文献检查了脊柱转移性肿瘤治疗的结果，为 NOMS 决策框架提供了支持。NOMS 范例的应用将多模态治疗整合在一起，以优化局部肿瘤控制、缓解疼痛以及恢复或保留神经功能，并使这一经常患有全身疾病的患者群体的发病率最小化。
NOMS 范例提供了一个决策框架，该框架将脊柱转移瘤治疗中的关键决策点纳入其中。考虑肿瘤对放疗的敏感性以及硬膜外延伸的范围，可以确定最佳的放疗治疗和手术减压的必要性。脊柱的力学稳定性和全身疾病的考虑因素进一步有助于确定手术干预的必要性和可行性。
