A novel strategy of "Separation Surgery Combined with Vertebroplasty and Interstitial Implantation of ¹²⁵I Seeds (SSVPI)" in managing thoracic metastases from lung adenocarcinoma with spinal cord compression.

Abstract

Prolonged survival from targeted/immunotherapy in lung adenocarcinoma has made thoracic metastatic epidural spinal cord compression a critical challenge. This study evaluated a novel surgical strategy, separation surgery combined with vertebroplasty and ¹²⁵I seeds implantation (SSVPI), in this cohort. Seventy-eight patients with lung adenocarcinoma and thoracic vertebral metastases underwent SSVPI. VAS and KPS were assessed preoperatively and at 1 week, 1, 3, 6, and 12 months postoperatively using repeated measures ANOVA. ASIA and ECOG scores were compared before and 3 months after surgery by the Wilcoxon test. OS, PFS, and LPFS were estimated by the Kaplan-Meier method, and Cox regression identified prognostic factors for LPFS. Significant postoperative improvements in pain and functional status were observed (P < 0.001). VAS improved from 7.83 ± 1.34 preoperatively to 1.86 ± 1.48 at 1 week and 2.79 ± 1.24 at 12 months; KPS from 41.41 ± 9.14 to 74.87 ± 15.79 and 71.54 ± 14.48. ASIA and ECOG improvement rates were 91.0% and 94.9%, respectively. Detected mutations included EGFR (48.7%), ALK (15.4%), RET (6.4%), and ROS1 (7.7%). Median OS was 33.5 months, median PFS 16.8 months, and median LPFS was not reached. Complication rate was 19.2% (13 cement leaks, 2 seed migrations). SSVPI is an integrated strategy coupling spinal cord decompression with interstitial ¹²⁵I brachytherapy and vertebroplasty, thus providing minimally invasive decompression, immediate analgesia, local tumor control, and partial spinal stabilization for patients with lung adenocarcinoma and thoracic metastatic epidural spinal cord compression.