Department of Radiation Oncology, University of Lubeck, Ratzeburger Allee 160, 23538, Lubeck, Germany.
Strahlenther Onkol. 2012 May;188(5):424-30. doi: 10.1007/s00066-011-0058-z. Epub 2012 Feb 16.
Treatment of elderly cancer patients has gained importance. One question regarding the treatment of metastatic spinal cord compression (MSCC) is whether elderly patients benefit from surgery in addition to radiotherapy? In attempting to answer this question, we performed a matched-pair analysis comparing surgery followed by radiotherapy to radiotherapy alone.
Data from 42 elderly (age > 65 years) patients receiving surgery plus radiotherapy (S + RT) were matched to 84 patients (1:2) receiving radiotherapy alone (RT). Groups were matched for ten potential prognostic factors and compared regarding motor function, local control, and survival. Additional matched-pair analyses were performed for the subgroups of patients receiving direct decompressive surgery plus stabilization of involved vertebrae (DDSS, n = 81) and receiving laminectomy (LE, n = 45).
Improvement of motor function occurred in 21% after S + RT and 24% after RT (p = 0.39). The 1-year local control rates were 81% and 91% (p = 0.44), while the 1-year survival rates were 46% and 39% (p = 0.71). In the matched-pair analysis of patients receiving DDSS, improvement of motor function occurred in 22% after DDSS + RT and 24% after RT alone (p = 0.92). The 1-year local control rates were 95% and 89% (p = 0.62), and the 1-year survival rates were 54% and 43% (p = 0.30). In the matched-pair analysis of patients receiving LE, improvement of motor function occurred in 20% after LE + RT and 23% after RT alone (p = 0.06). The 1-year local control rates were 50% and 92% (p = 0.33). The 1-year survival rates were 32% and 32% (p = 0.55).
Elderly patients with MSCC did not benefit from surgery in addition to radiotherapy regarding functional outcome, local control of MSCC, or survival.
老年癌症患者的治疗变得越来越重要。关于转移性脊髓压迫症（MSCC）的治疗，有一个问题是：老年患者是否从手术加放疗中获益？为了回答这个问题，我们进行了一项配对分析，比较了手术加放疗（S+RT）与单纯放疗（RT）的疗效。
42 例接受手术加放疗（S+RT）的老年（>65 岁）患者的数据与 84 例单纯放疗（RT）患者（1:2）进行配对。两组患者根据 10 个潜在预后因素进行配对，并在运动功能、局部控制和生存方面进行比较。还对接受直接减压手术加受累椎体稳定术（DDSS，n=81）和接受椎板切除术（LE，n=45）的亚组患者进行了额外的配对分析。
S+RT 组和 RT 组的运动功能改善率分别为 21%和 24%（p=0.39）。1 年局部控制率分别为 81%和 91%（p=0.44），1 年生存率分别为 46%和 39%（p=0.71）。在接受 DDSS 的患者的配对分析中，DDSS+RT 组和单纯 RT 组的运动功能改善率分别为 22%和 24%（p=0.92）。1 年局部控制率分别为 95%和 89%（p=0.62），1 年生存率分别为 54%和 43%（p=0.30）。在接受 LE 的患者的配对分析中，LE+RT 组和单纯 RT 组的运动功能改善率分别为 20%和 23%（p=0.06）。1 年局部控制率分别为 50%和 92%（p=0.33）。1 年生存率分别为 32%和 32%（p=0.55）。
MSCC 的老年患者从手术加放疗中并未在功能结局、MSCC 的局部控制或生存方面获益。
