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Figure 2. Sagittal section (T2-weighted) of a total spine MRI with contrast agent: metastatic destruction of L3 and multiple metastases

spinal metastases in breast cancer patients. An improved quality of life results of preserved mobility and
autonomy with less pain. If possible, pathologic fractures and neurologic deficits up to paraplegia should be
avoided [2,3,8,18,19,29,42,43,47,50] .

SPECIAL CASE: SOLITARY METASTASIS
Prognostic statements are especially important in case of a solitary, locally curable metastasis (principle of
[4]
limited metastasis ) and a treatable primary tumor in a curative way. For us the question was, if solitary
metastasis with any phenotype is always to be treated the same way [Figure 5].

Either a Ct-controlled or an open biopsy finally ensures the histopathological phenotype. Until the year 2015
[18]
[19]
the curative therapeutic approach with en-bloc spondylectomy according to Tokuhashi et al and Tomita et al
was only recommended in hormone positive receptor status (luminal A and B) with a median survival time
of 26 months [2,13] . In triple-negative or Her-2 enriched phenotypes with an estimated survival time of 5-9 months,
a limited posterior instrumentation (screw and rod system) and decompression of neural structures was
indicated [2,13] . Modern oncologic treatment concepts provide clearly longer survival times and therefore,
[18]
according to Tokuhashi et al , curative treatment options (mean survival time > 12 months) can principally
be applied to all phenotypes in breast cancer with solitary metastasis. In the worst case (triple-negative
phenotype) the mean survival time is actually reported with 15-19 months [2-4,10,34,35] .

Indicating en-bloc spondylectomy will never be an automatism and controversial discussions in tumor
boards can be expected. Critically evaluation of the individual wish, priorities, general condition,