Radiotherapy with or without Decompressive Surgery for Metastatic Spinal Cord Compression: A Retrospective Matched-Pair Study Including Data from Prospectively Evaluated Patients

Abstract

In 2005, a randomized trial showed that addition of surgery to radiotherapy improved outcomes in patients with metastatic spinal cord compression (MSCC). Since then, only a few studies compared radiotherapy plus surgery to radiotherapy alone. We performed a retrospective matched-pair study including data from prospective cohorts treated after 2005. Seventy-nine patients receiving radiotherapy alone were matched to 79 patients assigned to surgery plus radiotherapy (propensity score method) for age, gender, performance score, tumor type, affected vertebrae, other bone or visceral metastases, interval tumor diagnosis to MSCC, time developing motor deficits, and ambulatory status. Improvement of motor function by ≥1 Frankel grade occurred more often after surgery plus radiotherapy (39.2% vs. 21.5%, p = 0.015). No significant differences were found for post-treatment ambulatory rates (59.5% vs. 67.1%, p = 0.32), local progression-free survival (p = 0.47), overall survival (p = 0.51), and freedom from in-field recurrence of MSCC (90.1% vs. 76.2% at 12 months, p = 0.58). Ten patients (12.7%) died within 30 days following radiotherapy alone and 12 patients (15.2%) died within 30 days following surgery (p = 0.65); 36.7% of surgically treated patients did not complete radiotherapy as planned. Surgery led to significant early improvement of motor function and non-significantly better long-term control. Patients scheduled for surgery must be carefully selected considering potential benefits and risk of perioperative complications.

Sternal Puncture-Induced Acute Spinal Cord Syndrome in a Myeloma-Remissive Patient Revealing Pott Disease: A Case Report

“…In case of compression by a neoplasm, radiotherapy is a viable option. However, surgery plus radiotherapy is superior to radiotherapy alone [ 10 ]. In the case of our patient, it was important to have an accurate diagnosis or at least exclude neoplasm in order to decide on the indication of radiotherapy since surgery was not an option for the patient.…”

A New Clinical Instrument for Estimating the Ambulatory Status after Irradiation for Malignant Spinal Cord Compression

“…Moreover, in a matched-pair study, patients with MSCC from unfavorable tumors such as non-small-cell lung cancer, cancer of unknown primary, renal cell carcinoma, or colorectal cancers appeared to benefit from decompressive surgery plus stabilization in addition to radiotherapy [ 12 ]. Two other matched-pair studies not limited to patients with MSCC from unfavorable tumors produced conflicting results [ 5 , 6 ]. In the first of these studies, 108 patients who received surgery followed by radiotherapy were retrospectively matched (1:2) to 216 patients irradiated without upfront surgery [ 5 ].…”

“…In the surgery plus radiotherapy group, 11% of the patients experienced surgery-related complications. In the second of these matched-pair studies that included data from prospectively evaluated patients, the addition of upfront surgery resulted in a significantly higher rate of early improvement of motor function (39.2% vs. 21.5%, p = 0.015) [ 6 ]. No significant differences were found for post-treatment ambulatory rates (59.5% vs. 67.1%, p = 0.32) and survival ( p = 0.51).…”

“…The 1-year local control rate of MSCC was higher after surgery plus radiotherapy than after radiotherapy alone (90.1% vs. 76.2%), although this difference was not significant. However, more than one-third of the patients scheduled for the combined treatment did not complete the planned radiotherapy course, mainly due to a decreased performance status following surgery [ 6 ].…”

“…Outcomes were not significantly different between both treatment groups. Recently, another matched-pair study was reported that included data from prospectively evaluated patients [ 6 ]. In this study, upfront surgery followed by radiotherapy resulted in significantly better early improvement of motor function and non-significantly better long-term control of MSCC.…”