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.

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.