title: Radiotherapy or surgery for spine metastases?
abstract: OBJECTIVE
  Radiotherapy (RT) remains the cornerstone of management of spine metastases (SM), even though surgery is a well-established treatment for selected patients. We compared the use of RT and surgery in a population-based cohort of patients with SM, investigated pre-treatment factors that were associated with use of these treatment modalities, and examined survival.
  
  
  METHODS
  903 patients in the south-eastern Norway who were admitted for RT or surgery for SM for the first time during an 18-month period in 2007-2008 were identified and their medical records were reviewed.
  
  
  RESULTS
  The primary treatment was surgery in 58 patients and RT in 845 patients, including 704 multiple-fraction (MF) and 141 single-fraction (SF) RT schedules. 11 of 607 patients without motor impairment (2%) and 47 of 274 patients with motor impairment (17%) underwent primary operations. 11 of 58 operated patients and 244 of 845 irradiated patients died within 2 months after the start of treatment. 26% of those who received multiple-fraction RT or surgery died within 2 months.
  
  
  CONCLUSIONS
  Motor impairment was the main indication for surgery. Better identification of patients with short survival is needed to avoid time-consuming treatment (major surgery and long-term RT).
authors: Department of Orthopaedics, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway. olga.zaikova@oslo-universitetssykehus.no
authors: Olga
authors: O
authors: Zaikova
authors: Sophie D
authors: SD
authors: Fosså
authors: Oyvind S
authors: OS
authors: Bruland
authors: Karl-Erik
authors: KE
authors: Giercksky
authors: Berit
authors: B
authors: Sandstad
authors: Sigmund
authors: S
authors: Skjeldal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009664:Norway / Q000453:epidemiology; D018579:Patient Selection; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000209:etiology / Q000628:therapy; D013125:Spinal Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult