Surgery Helps Cancer Patients With Spinal-Cord Compressions to Remain Mobile
By Charlene Laino

SALT LAKE CITY, UT -- October 31, 2003 -- For patients with spinal-cord compressions caused by cancer metastasis, radical direct decompressive surgery plus postoperative radiotherapy is much more effective than radiation alone, a new study finds.

The study was presented here on October 20th at the 45th Annual Meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO).

The randomised trial was stopped prematurely due to the significant superiority of the surgery in maintaining patent's mobility and continence, said lead author William F. Regine, MD, Chair of the Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, United States.

While case studies have suggested that radical surgical resection of spinal-cord compressions caused by metastatic tumours helps more patients to remain mobile and improves overall quality of life, this is the first controlled trial designed to determine its efficacy, Dr. Regine said.

The study randomly assigned 101 patients with cord compressions to either radiotherapy alone (n=51) or decompression surgery followed by radiotherapy (n=50). The surgery, which was performed within 24 hours of study entry, involves removing as much tumour as possible, with the goal of immediately decompressing and stabilising the spine.

Radiation therapy began within 2 weeks of surgery in the surgery plus radiation group and within 24 hours of study entry in the radiation-only arm. Both groups of patients received the same corticosteroid protocol and 30 Gy of radiation.

The study showed that those patients who underwent surgery were able to walk more than 3.5 times longer than those who received radiotherapy alone: a median of 126 days versus 35 days, respectively (P=0.006).

Of the 16 patients in each group who entered the trial unable to walk, 56% of those in the surgery arm regained mobility, compared with 19% of patients who received radiation alone (P=0.03), Dr. Regine reported.

Also, surgically treated patients maintained continence and functional Frankel and American Spinal Injury Association scores significantly longer than patients in the radiation group.

There was also a trend towards longer survival time in the surgery group: a median of 129 days, compared with 100 days in the radiation-only arm (P=0.08), Dr. Regine reported.

In addition, patients in the surgery arm required less pain medication than those who received radiation alone.

Up to 1 in 10 cancer patients are affected by spinal-cord compression and, for them, "surgery can make a huge difference in quality of life," said co-investigator Roy A. Patchell, MD, University of Kentucky, Lexington, United States.

"Without the operation, about two thirds [of these patients] spend the end of their lives unable to walk and incontinent. With it, most [of these] patients remain ambulatory and continent," he said.


[Study title: Metastatic Spinal Cord Compression: A Randomized Trial of Direct Decompressive Surgical Resection Plus Radiotherapy vs. Radiotherapy Alone. Abstract 3]



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