title: Comparison of the therapeutic effects of surgery combined with postoperative radiotherapy and standalone radiotherapy in treating spinal metastases of lung cancer.
abstract: OBJECTIVE
  There are few studies comparing the therapeutic efficacy between surgery combined with postoperative radiotherapy and standalone radiotherapy in treating spinal metastases of lung cancer. The aim of this clinical study was to compare the clinical and functional efficacy, quality of life, and survival outcomes between surgery combined with postoperative radiotherapy and standalone radiotherapy in treating spinal metastases of lung cancer.
  
  
  METHODS
  A retrospective analysis of clinical data from June 2008 to December 2013 was performed with 46 patients suffering spinal metastases of lung cancer. Among the studied patients, 25 patients received standalone radiotherapy (radiotherapy group), and the other 21 patients received surgery combined with postoperative radiotherapy (surgery group). Follow-up and survival time were analyzed. Pain levels of the patients were assessed by visual analogue scale (VAS) from pre-treatment to one month and three months after starting treatment. 3 months after surgery, Neurologic deficit of the patients was evaluated using Frankel Grade, and functional impairment were classified by Karnofsky Score. The quality of life (QOL) was assessed by EORTC QLQ-C30 questionnaire.
  
  
  RESULTS
  The follow-up period of the patients ranged from 2 to 25 months with the average of 8.8 months. In radiotherapy group, the mean survival was 8.5 months with median survival time of 7.8 months. In surgery group, the mean survival was 10.6 months with median survival of 8.4 months. The difference in survival times between the two groups was not statistically significant (P=0.24>0.05). From pre-treatment to one month and three months after treatment initiation, the VAS in both groups showed statistical significant improvement (One month: P<0.01 Three months: P=0.001, p<<0.01). In the surgery group, 85.7% of all patients had functionally useful Frankel Grade D or E after surgery, compared with 71.4% pre-operatively. The percentage was 72.0% in the radiotherapy group post-treatment, compared with 68.0% pre-treatment. The relief of Frankel Grade in surgical group was superior to that of the radiotherapy group (p=0.025, p<0.01). KPS score (80-100) percentages in surgery group and in radiotherapy group were increased by 19% and 13.3%, respectively. The improvement of KPS was more in the surgery group (p=0.013, P<0.01). In radiotherapy group, the EORTC QLQ-C30 score was 86.13 ± 12.11 before treatment and 68.39 ± 14.96 after treatment. In surgery group, the EORTC QLQ-C30 score was 84.09 ± 9.48 before treatment and 54.64 ± 15.17 after treatment. The improvement of patient QOL was more in the surgery group (p=0.004, p<0.01).
  
  
  CONCLUSIONS
  Compared with standalone radiotherapy, surgery combined with postoperative radiotherapy did not significantly prolong the survival time. However, surgery can improve pain, function and QOL of patients with spinal metastases of lung cancer.
authors.affiliation: Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, China. Electronic address: zhangchao198409@163.com.
authors.forename: Chao
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, China. Electronic address: wangguowendr@163.com.
authors.forename: Guowen
authors.initials: G
authors.lastname: Wang
authors.affiliation: Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, China.
authors.forename: Xiuxin
authors.initials: X
authors.lastname: Han
authors.affiliation: Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, China.
authors.forename: Zhiwu
authors.initials: Z
authors.lastname: Ren
authors.affiliation: Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Duo
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery*; D016896:Treatment Outcome
keywords: Lung cancer; Radiotherapy; Spinal metastases; Surgery