title: Matched pair analysis comparing surgery followed by radiotherapy and radiotherapy alone for metastatic spinal cord compression.
abstract: OBJECTIVE
  The appropriate treatment for MSCC is controversial. A small randomized trial showed that decompressive surgery followed by radiotherapy was superior to radiotherapy alone. That study was limited to highly selected patients. Additional studies comparing surgery plus radiotherapy to radiotherapy could better clarify the role of surgery.
  
  
  METHODS
  Data from 108 patients receiving surgery plus radiotherapy were matched to 216 patients (1:2) receiving radiotherapy alone. Groups were matched for 11 potential prognostic factors and compared for post-treatment motor function, ambulatory status, regaining ambulatory status, local control, and survival. Subgroup analyses were performed for patients receiving adequate surgery (direct decompressive surgery plus stabilization of involved vertebrae), patients receiving laminectomy, patients with solid tumors, patients with solid tumors receiving adequate surgery, and patients with solid tumors receiving laminectomy.
  
  
  RESULTS
  Improvement of motor function occurred in 27% of patients after surgery plus radiotherapy and 26% after radiotherapy alone (P = .92). Post-treatment ambulatory rates were 69% after surgery plus radiotherapy and 68% after radiotherapy alone (P = .99). Of the nonambulatory patients, 30% and 26%, respectively, (P = .86) regained ambulatory status after treatment. One-year local control rates were 90% after surgery plus radiotherapy and 91% after radiotherapy alone (P = .48). One-year overall survival rates were 47% and 40%, respectively (P = .50). The subgroup analyses did not show significant differences between both groups. Surgery-related complications occurred in 11% of patients.
  
  
  CONCLUSIONS
  In this study, the outcomes of the end points evaluated after radiotherapy alone appeared similar to those of surgery plus radiotherapy. A new randomized trial comparing both treatments is justified.
authors.affiliation: University of Lubeck, Lubeck, Germany. Rades.Dirk@gmx.net
authors.forename: Dirk
authors.initials: D
authors.lastname: Rades
authors.forename: Stefan
authors.initials: S
authors.lastname: Huttenlocher
authors.forename: Juergen
authors.initials: J
authors.lastname: Dunst
authors.forename: Amira
authors.initials: A
authors.lastname: Bajrovic
authors.forename: Johann H
authors.initials: JH
authors.lastname: Karstens
authors.forename: Volker
authors.initials: V
authors.lastname: Rudat
authors.forename: Steven E
authors.initials: SE
authors.lastname: Schild
mesh_terms: D003131:Combined Modality Therapy; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D007796:Laminectomy; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009043:Motor Activity; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000209:etiology / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D013125:Spinal Neoplasms / Q000150:complications* / Q000556:secondary*; D016138:Walking