The Role of Separation Surgery (SS) and Advanced Radiotherapy (RT) in Metastatic Epidural Spinal Cord Compression (MESCC): A Single Center Retrospective Study Comparing SBRT and 3D-CRT.
Giuseppina Bevacqua, Valentina Grespi, Eleonora Becattini, Matteo M Ottaviani, Fabio Trippa, Carlo Conti
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引用次数: 0
Abstract
This study aims to evaluate the efficacy and safety of stereotactic body radiotherapy (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 (MESCC).
Methods: This retrospective study included 30 patients diagnosed with MESCC 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.
Results: 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%, 84.6%) compared to the 3D-CRT cohort (53.3%, 40%, 13.3%), with a significant difference in favour of SBRT (p=0.009). SBRT was associated with lower local recurrence rates and better disease control.
Conclusions: 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.
期刊介绍：
World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review.
The journal''s mission is to:
-To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care.
-To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide.
-To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients.
Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS
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