The Role of Separation Surgery and Advanced Radiotherapy in Metastatic Epidural Spinal Cord Compression: A Single-Center Retrospective Study Comparing Stereotactic Body Radiation Therapy and 3D-Conformal Radiotherapy.

Abstract

This study aims to evaluate the efficacy and safety of stereotactic body radiation therapy (SBRT) compared with 3D-conformal radiotherapy (3D-CRT) after separation surgery (SS), focusing on local disease control (LC) and overall survival (OS), in patients with metastatic epidural spinal cord compression. This retrospective study included 30 patients diagnosed with metastatic epidural spinal cord compression and treated with SS, followed by either SBRT (n = 14) or 3D-CRT (n = 16). Surgical intervention included laminectomy and tumor decompression to achieve a 2-3 mm margin. Postoperatively, patients received either hypofractionated SBRT (20-40 Gy in 2-5 fractions) or conventional 3D-CRT (16-30 Gy in 2-10 fractions). Statistical analysis was performed using Kaplan-Meier survival curves. The mean age of the patients was 64.6 years (range: 31-84), with a predominance of male patients (60%). The most common primary tumors were non-small cell lung cancer (20%) and renal cell carcinoma (20%). At 12 months, LC was significantly higher in the SBRT group (92.3%) compared to the 3D-CRT group (53.3%) (P = 0.01). OS at 6, 12, and 15 months was superior in the SBRT cohort (92.8%, 71.4%, and 84.6%) compared to the 3D-CRT cohort (53.3%, 40%, and 13.3%), with a significant difference in favor of SBRT (P = 0.009). SBRT was associated with lower local recurrence rates and better disease control. The combination of SS and SBRT has been demonstrated to result in superior OS and LC outcomes in comparison to 3D-CRT. While the presence of visceral metastases remains a key prognostic factor, this hybrid surgical-radiotherapy approach has proven effective in the management of spinal metastases.