University of Lubeck, Lubeck, Germany.
J Clin Oncol. 2010 Aug 1;28(22):3597-604. doi: 10.1200/JCO.2010.28.5635. Epub 2010 Jul 6.
The appropriate treatment for MSCC is controversial. A small randomized trial showed that decompressive surgery followed by radiotherapy was superior to radiotherapy alone. That study was limited to highly selected patients. Additional studies comparing surgery plus radiotherapy to radiotherapy could better clarify the role of surgery.
Data from 108 patients receiving surgery plus radiotherapy were matched to 216 patients (1:2) receiving radiotherapy alone. Groups were matched for 11 potential prognostic factors and compared for post-treatment motor function, ambulatory status, regaining ambulatory status, local control, and survival. Subgroup analyses were performed for patients receiving adequate surgery (direct decompressive surgery plus stabilization of involved vertebrae), patients receiving laminectomy, patients with solid tumors, patients with solid tumors receiving adequate surgery, and patients with solid tumors receiving laminectomy.
Improvement of motor function occurred in 27% of patients after surgery plus radiotherapy and 26% after radiotherapy alone (P = .92). Post-treatment ambulatory rates were 69% after surgery plus radiotherapy and 68% after radiotherapy alone (P = .99). Of the nonambulatory patients, 30% and 26%, respectively, (P = .86) regained ambulatory status after treatment. One-year local control rates were 90% after surgery plus radiotherapy and 91% after radiotherapy alone (P = .48). One-year overall survival rates were 47% and 40%, respectively (P = .50). The subgroup analyses did not show significant differences between both groups. Surgery-related complications occurred in 11% of patients.
In this study, the outcomes of the end points evaluated after radiotherapy alone appeared similar to those of surgery plus radiotherapy. A new randomized trial comparing both treatments is justified.
MSCC 的适当治疗方法存在争议。一项小型随机试验表明，减压手术后再进行放疗优于单独放疗。该研究仅限于高度选择的患者。比较手术加放疗与放疗的额外研究可以更好地阐明手术的作用。
对接受手术加放疗的 108 例患者的数据进行匹配，与接受单纯放疗的 216 例患者（1:2）进行匹配。两组均针对 11 个潜在的预后因素进行匹配，并对治疗后运动功能、步行状态、恢复步行状态、局部控制和生存情况进行比较。对接受充分手术（直接减压手术加受累脊柱稳定）的患者、接受椎板切除术的患者、实体瘤患者、接受充分手术的实体瘤患者和接受椎板切除术的实体瘤患者进行亚组分析。
手术加放疗后，27%的患者运动功能改善，单纯放疗后 26%的患者运动功能改善（P=.92）。治疗后，接受手术加放疗的患者步行率为 69%，接受单纯放疗的患者步行率为 68%（P=.99）。在非步行患者中，分别有 30%和 26%（P=.86）在治疗后恢复了步行能力。手术加放疗的 1 年局部控制率为 90%，单纯放疗为 91%（P=.48）。1 年总生存率分别为 47%和 40%（P=.50）。亚组分析未显示两组之间存在显著差异。手术相关并发症发生率为 11%。
在这项研究中，单独接受放疗后的评估终点结果与手术加放疗相似。有理由进行比较两种治疗方法的新的随机试验。
