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The results of decompressive surgery followed by radiotherapy for metastatic spinal cord compression are similar to those obtained with radiotherapy alone, according to a new matched-pair analysis. Lead author Dr. Dirk Rades, at the University of Lubeck, Germany, and colleagues note that a randomized trial in 2005 found better outcomes when both therapies were used, but that study involved only 101 highly selected patients.

To analyze the strategy in a larger and more diverse population, the researchers studied 324 patients with metastatic spinal cord compression -- 108 who had surgery plus radiotherapy and 216 matched controls who received radiotherapy alone.

They found no difference in their primary endpoint: 27% of patients in the combination therapy group and 26% in the radiation-only group had improvement of motor function.

There were no differences in other endpoints, either. "After treatment, 75 (69%) of 108 patients of the surgery plus radiotherapy group and 147 (68%) of 216 patients of the radiotherapy-alone group, respectively, were ambulatory," the authors report in the Journal of Clinical Oncology published online July 6th. "Twelve (30%) of 40 and 21 (26%) of 80 of the initially not ambulatory patients, respectively, regained the ability to walk after treatment."

The treatment regimen was not associated with local control rates or survival rates.

Acute radiation toxicity was relatively mild in both groups, and there was no late toxicity. The surgical complication rate, however, was 11%.

Dr. Rades and his associates conclude that radiotherapy alone is not significantly inferior to surgery plus radiotherapy.

"These results suggest the value of performing a new randomized trial comparing surgery followed by radiotherapy to radiotherapy alone in patients with metastatic spinal cord compression," they say.

Source: Reuters Health