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Surgery before radiation not helpful for metastatic spinal cord compression

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – On a matched-pair analysis, the results of decompressive surgery followed by radiotherapy for metastatic spinal cord compression were seen to be similar to those obtained with radiotherapy alone. That’s according to a report in the Journal of Clinical Oncology issued online July 6.

Dr. Dirk Rades, at the University of Lubeck, Germany, and colleagues note that a study in 2005 found that decompressive surgery added to radiotherapy was superior to radiotherapy alone for the condition, but it included a relatively small number of highly selected patients

To see if the strategy benefits a larger population, the researchers compared data on 324 patients with metastatic spinal cord compression: 108 received surgery plus radiotherapy and were matched to 216 (i.e., 1:2) who received radiotherapy alone.

“After treatment, 75 (69%) of 108 patients of the surgery plus radiotherapy group and 147 (68%) of 216 patients of the radiotherapy-alone group, respectively, were ambulatory (p=0.99),” the authors report. “Twelve (30%) of 40 and 21 (26%) of 80 of the initially not ambulatory patients, respectively, regained the ability to walk after treatment (p=0.86).”

The treatment regimen was not associated with local control rates or survival rates.

Acute radiation toxicity was relatively mild in both groups, and late toxicity did not occur in either, the team found. The surgical complication rate, however, was 11%.

Dr. Rades and his associates conclude that radiotherapy alone is not significantly inferior to surgery plus radiotherapy. “These results suggest the value of performing a new randomized trial comparing surgery followed by radiotherapy to radiotherapy alone in patients with metastatic spinal cord compression.


Matched Pair Analysis Comparing Surgery Followed By Radiotherapy and Radiotherapy Alone for Metastatic Spinal Cord Compression

J Clin Oncol 2010;28.