The KF Tumor Steering Committee met in Milan, Italy, during the Global Spine Congress 2017. Chairperson Charles Fisher (back row, left) and Ziya Gokaslan. Front row: Arjun Sahgal (left), AOSpine Research Manager Niccole Germscheid, Laurence Rhines, and Stefano Boriani. Missing: Peter Pal Varga, Chetan Bettegowda, and Norio Kawahara

 

The AOSpine Knowledge Forum (KF) Tumor has been spearheading the KFs since their inception and subsequent mission to achieve the best patient outcome. This key opinion leader group is unique amongst all spine study groups: the cause is not to advance any particular aspect of surgery, but in a holistic way, find the best way to manage the patient, understand the evidence, and take into account all different forms of therapy.

 

The Chairperson Dr. Charles Fisher sees the task threefold: "We implement physician driven landmark clinical studies; advance patient care through multi-center analysis and peer review publications; and develop and validate treatment algorithms and outcome measures." The focus is on the more common metastatic and the very rare primary spine tumors. "To truly advance the care of these patients, you must have an international multi-center, multi-physician group like KF Tumor. That's what makes us unique."

 

To meet this objective, the KF meets in person 2-4 times a year and virtually every few months. Through research and discussion, the "To truly advance the care of spine oncology patients, you must have an international multi-center, multi-physician group like KF Tumor."group advances towards a common recommendation, which as a result is truly multi-disciplinary. The only non-surgeon amongst the KF Steering Committee members, radiation oncologist Dr. Arjun Sahgal explains that in other pathologies this can be different: "For spine oncology patients the right decision can only happen in discussion. For a balanced point of view to guide decision making, we must take into account medical oncology, radiation oncology, and surgical oncology. This greatly adds to the quality of our research and knowledge and balances the education. That's why we are so successful."

 

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KF Tumor in Milan, Italy, at the Global Spine Congress 2017

 

Broadening horizons

KF Tumor was the first of the KFs to introduce an associate structure, expanding across new regions, and welcoming members beyond the steering committee. One of them is Dr. Jorrit-Jan Verlaan from the Netherlands, who was invited two years ago. Verlaan is intrigued to see how ideas develop and change, and finds this a great opportunity: "There is a tremendous amount of knowledge in the group, I feel honored to be part of it! In the work, it does not differ so much if you are a steering committee or an associate member; it's all about creating a group with ideas to enhance patient care."

 

A wider membership base will also allow for succession planning in the Steering Committee, provide opportunities for young leaders, "There is a tremendous amount of knowledge in the group, I feel honored to be part of it!"recognizing the importance of new ideas and perspectives. "But we don't want to grow too quickly and sacrifice quality", Fisher reminds. "The associate members must have the same level of commitment to high quality multi-center research. The quality of the data is always an issue; you cannot have quality research without quality data and follow-up."

 

Landmark studies

The AOSpine Research Manager Niccole Germscheid works closely with KF Tumor and has noted the increasing global impact. The early work with SINS (Spinal Instability Neoplastic Score) has become a main stream classification system, embraced by most oncologists dealing with metastatic tumor around the world. Verlaan considers it one of the most powerful tools to identify patients in a timely manner, with direct effect to their quality of life.

 

Major influence comes also from the Primary Tumor Retrospective multi-center study, which according to Fisher accomplished something never done before. "With 1,500 patients entered from all over the world, it is the largest series ever, we solidified and validated "We are getting answers to key questions no one has been able to answer in the past."things that we previously only suspected." Another breakthrough was the high impact study led by Chetan Bettegowda on genomics. The molecular sequencing of chordoma was correlated with patient outcome. This had not been done in the primary spine tumor world, and Fisher remembers the task was not simple: "It was challenging to get the pathologist involved, to get IRB approvals to retrieve the pathologic specimens, and to perform the genomics with formalin-fixed and paraffin-embedded (FFPE) samples."

 

EPOSO (The Epidemiology, Process, and Outcomes of Spine Oncology) is another valuable project. The KF has gathered data on over 400 patients with metastatic spine disease. "We will be able to better understand which patients are ideal for surgery as opposed "A key focus of AOSpine is to transfer research outcomes into education."to radiation. By having a large dataset which is so heterogeneous, we are getting answers to key questions no one has been able to answer in the past."

 

​Chairperson Charles Fisher speaking at the KF Tumor precourse at the Global Spine Congress 2015 in Buenos Aires, Argentina

 

Changing practices

To get the most out of KF Tumor research, you are quickly referred to the Spine Focus Issue, published last year (Spine—October 15, 2016—Volume 41—Issue 20S). It provides the spine oncology community with an updated set of treatment recommendations, building from the first focus issue published in 2009 (Spine—October 15, 2009—Volume 34 Issue 22S). Over 40 collaborators from North America, Europe, Asia, and Australia were brought together; an impressive multi-disciplinary collaboration by any standards. Sahgal confirms his own practice and understanding have changed dramatically with it: "I am educating my colleagues as a result of the knowledge I've gained and the work we've done in the KF, particularly with the Spine Focus Issue."

 

Access the Spine Focus issue here:

journals.lww.com/spinejournal

 

Going forward, the KF Tumor will look deeper into the genomics and molecular aspects of tumors and how they relate to outcome. The aim is to establish a core network of international centers to conduct prospective studies. Two networks are underway for this: Going forward, the KF Tumor will look deeper into the genomics and molecular aspects of tumors and how they relate to outcome. The aim is to establish a core network of international centers to conduct prospective studies.the PTRON (Primary Tumor Research and Outcomes Network) and the MTRON (Metastatic Tumor Research and Outcomes Network).  With such large studies, even faster progress can be expected. A key focus of AOSpine Research strategy is to transfer the outcomes into education.

 

Fisher is confident that the KF Tumor model will continue to be highly productive, with high quality research done on a sustained basis: "We have the infrastructure, the collaboration, and the good ideas. We know good research takes time. With KFs as part of an AO long-term plan, both from the research and the education side, you are really taking better care of patients."

 

Quick facts:

• First of the 5 AOSpine KFs, launched in 2010, co-chaired by Ziya Gokaslan and Stefano Boriani
• Chairperson Charles Fisher (2014–present) leads a steering committee of 7 members; serves as a member of the AOSpine Research Commission
• Steering Committee leads a group of over 30 associate members
• Pathology focus includes both primary and metastatic spine tumors
• Published 37 peer-reviewed journal articles and 90 presentations since 2014
• Volumes 1- 2 of the AOSpine Master Series, editors Charles Fisher, Ziya Gokaslan and Stefano Boriani

Study highlights:

• Validated the Spinal Instability Neoplastic Score (SINS) in radiologists and radiation oncologists
• Collected retrospective data on 1,500 primary tumor cases (PT Retro study)
• Linked pathologic chordoma specimens to clinical outcomes (FFPE Chordoma study)
• Published a Focus Issue with evidence-based treatment recommendations for spine oncology (Spine Vol 41, Issue 20S, October 15, 2016)
• Established a prospective registry on primary (PTRON) and metastatic tumors (EPOSO/ MTRON)
• For more information about the KF Tumor: www.aospine.org/kf-tumor