Evaluating the efficacy of the SENO decision framework in managing metastatic spinal disease: a comparative study

The management of metastatic spinal disease presents a complex challenge, with no universally accepted guidelines currently available. A new treatment approach, termed the "SENO" (Systemic Conditions, Effectiveness of Systemic Treatment, Neurology, and Oncology) decision framework, was developed, incorporating a 12-point grading system for epidural spinal cord compression.

This study aims to assess the clinical efficacy of the SENO decision framework and compare its outcomes with those from traditional treatment frameworks.

This is an observational cohort study that includes the propensity score matching analysis.

This multicenter study included 840 patients with metastatic spinal disease, treated across two tertiary hospitals.

The study evaluated therapeutic strategies, ambulatory status at hospital discharge, time to initiation of systemic cancer treatments, quality of life at 3-, 6-, and 12-month postdischarge, and overall survival.

Of all patients, 523 patients received treatment based on the SENO decision framework (the SENO group), while 307 patients were managed using conventional decision frameworks (the traditional group). Baseline characteristics of patients in both groups were collected and analyzed to ensure comparability. Quality of life was assessed using the Functional Assessment of Cancer Therapy-General Scale questionnaire.

Patients in the SENO group were less likely to undergo open decompression surgery (16.3% vs 25.1%) and more likely to receive minimally invasive surgery (64.8% vs 54.7%) compared to those in the traditional group (p=.004). Furthermore, the SENO group demonstrated a higher rate of ambulation postdischarge (91.2% vs 86.0%, p=.026), a shorter interval before initiating systemic treatments for tumors (6.89 days vs 10.14 days, p<.001), and longer survival times (323 days vs 298 days, p=.008). Quality of life metrics, including physical, social, emotional, and functional well-being, were significantly better in the SENO group compared to the traditional group (All p<.015). After the propensity score matching analysis, the baseline characteristics between the SENO and traditional treatment groups were perfectly matched. The SENO group still showed a lower percentage of patients undergoing open decompression surgery (p=.038), a shorter time to receive systemic treatments (p<.001), longer median survival times (p=.016), and markedly better quality of life scores at 3, 6, and 12 months across various domains, with total scores reaching 92.08 compared to 85.51 in the traditional group at the final follow-up (p<.001).

The SENO decision framework has the potential to serve as an effective treatment strategy for patients with metastatic spinal disease. By facilitating the use of minimally invasive surgery, this framework leads to better overall functional outcomes, prolonged survival, and an improved quality of life. However, before widespread promotion of the SENO decision framework, it is essential to conduct randomized controlled trials to thoroughly validate its effectiveness.