title: Do elderly patients benefit from surgery in addition to radiotherapy for treatment of metastatic spinal cord compression?
abstract: BACKGROUND
  Treatment of elderly cancer patients has gained importance. One question regarding the treatment of metastatic spinal cord compression (MSCC) is whether elderly patients benefit from surgery in addition to radiotherapy? In attempting to answer this question, we performed a matched-pair analysis comparing surgery followed by radiotherapy to radiotherapy alone.
  
  
  METHODS
  Data from 42 elderly (age > 65 years) patients receiving surgery plus radiotherapy (S + RT) were matched to 84 patients (1:2) receiving radiotherapy alone (RT). Groups were matched for ten potential prognostic factors and compared regarding motor function, local control, and survival. Additional matched-pair analyses were performed for the subgroups of patients receiving direct decompressive surgery plus stabilization of involved vertebrae (DDSS, n = 81) and receiving laminectomy (LE, n = 45).
  
  
  RESULTS
  Improvement of motor function occurred in 21% after S + RT and 24% after RT (p = 0.39). The 1-year local control rates were 81% and 91% (p = 0.44), while the 1-year survival rates were 46% and 39% (p = 0.71). In the matched-pair analysis of patients receiving DDSS, improvement of motor function occurred in 22% after DDSS + RT and 24% after RT alone (p = 0.92). The 1-year local control rates were 95% and 89% (p = 0.62), and the 1-year survival rates were 54% and 43% (p = 0.30). In the matched-pair analysis of patients receiving LE, improvement of motor function occurred in 20% after LE + RT and 23% after RT alone (p = 0.06). The 1-year local control rates were 50% and 92% (p = 0.33). The 1-year survival rates were 32% and 32% (p = 0.55).
  
  
  CONCLUSIONS
  Elderly patients with MSCC did not benefit from surgery in addition to radiotherapy regarding functional outcome, local control of MSCC, or survival.
authors.affiliation: Department of Radiation Oncology, University of Lubeck, Ratzeburger Allee 160, 23538, Lubeck, Germany. Rades.Dirk@gmx.net
authors.forename: D
authors.initials: D
authors.lastname: Rades
authors.forename: S
authors.initials: S
authors.lastname: Huttenlocher
authors.forename: J N
authors.initials: JN
authors.lastname: Evers
authors.forename: A
authors.initials: A
authors.lastname: Bajrovic
authors.forename: J H
authors.initials: JH
authors.lastname: Karstens
authors.forename: V
authors.initials: V
authors.lastname: Rudat
authors.forename: S E
authors.initials: SE
authors.lastname: Schild
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D009369:Neoplasms / Q000150:complications / Q000532:radiotherapy / Q000601:surgery; D011878:Radiotherapy; D013117:Spinal Cord Compression / Q000209:etiology* / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome