title: Surgery followed by radiotherapy versus radiotherapy alone for metastatic spinal cord compression from unfavorable tumors.
abstract: OBJECTIVE
  Despite a previously published randomized trial, controversy exists regarding the benefit of adding surgery to radiotherapy for metastatic spinal cord compression (MSCC). It is thought that patients with MSCC from relatively radioresistant tumors or tumors associated with poor functional outcome after radiotherapy alone may benefit from surgery. This study focuses on these tumors.
  
  
  METHODS
  Data from 67 patients receiving surgery plus radiotherapy (S+RT) were matched to 134 patients (1:2) receiving radiotherapy alone (RT). Groups were matched for 10 factors and compared for motor function, ambulatory status, local control, and survival. Additional separate matched-pair analyses were performed for patients receiving direct decompressive surgery plus stabilization of involved vertebrae (DDSS) and patients receiving laminectomy (LE).
  
  
  RESULTS
  Improvement of motor function occurred in 22% of patients after S+RT and 16% after RT (p=0.25). Posttreatment ambulatory rates were 67% and 61%, respectively (p=0.68). Of nonambulatory patients, 29% and 19% (p=0.53) regained ambulatory status. One-year local control rates were 85% and 89% (p=0.87). One-year survival rates were 38% and 24% (p=0.20). The matched-pair analysis of patients receiving LE showed no significant differences between both therapies. In the matched-pair analysis of patients receiving DDSS, improvement of motor function occurred more often after DDSS+RT than RT (28% vs. 19%, p=0.024). Posttreatment ambulatory rates were 86% and 67% (p=0.30); 45% and 18% of patients regained ambulatory status (p=0.29).
  
  
  CONCLUSIONS
  Patients with MSCC from an unfavorable primary tumor appeared to benefit from DDSS but not LE when added to radiotherapy in terms of improved functional outcome.
authors.affiliation: Department of Radiation Oncology, 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: Amira
authors.initials: A
authors.lastname: Bajrovic
authors.forename: Johann H
authors.initials: JH
authors.lastname: Karstens
authors.forename: Irenaeus A
authors.initials: IA
authors.lastname: Adamietz
authors.forename: Nadja
authors.initials: N
authors.lastname: Kazic
authors.forename: Volker
authors.initials: V
authors.lastname: Rudat
authors.forename: Steven E
authors.initials: SE
authors.lastname: Schild
mesh_terms: D000704:Analysis of Variance; D002289:Carcinoma, Non-Small-Cell Lung / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery; D002292:Carcinoma, Renal Cell / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery; D015179:Colorectal Neoplasms / Q000473:pathology; D003131:Combined Modality Therapy / Q000379:methods; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology; D007796:Laminectomy; D008175:Lung Neoplasms / Q000473:pathology; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009043:Motor Activity; D009382:Neoplasms, Unknown Primary / Q000473:pathology; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000209:etiology / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D013125:Spinal Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome; D016138:Walking