A meta-analysis of surgery versus conventional radiotherapy for the treatment of metastatic spinal epidural disease

Paul Klimo, Clinton J. Thompson, John R.W. Kestle, Meic H. Schmidt

Research output: Contribution to journalArticle

210 Citations (Scopus)

Abstract

Radiotherapy has been the primary therapy for managing metastatic spinal disease; however, surgery that decompresses the spinal cord circumferentially, followed by reconstruction and immediate stabilization, has also proven effective. We provide a quantitative comparison between the "new" surgery and radiotherapy, based on articles that report on ambulatory status before and after treatment, age, sex, primary neoplasm pathology, and spinal disease distribution. Ambulation was categorized as "success" or "rescue" (proportion of patients ambulatory after treatment and proportion regaining ambulatory function, respectively). Secondary outcomes were also analyzed. We calculated cumulative success and rescue rates for our ambulatory measurements and quantified heterogeneity using a mixed-effects model. We investigated the source of the heterogeneity in both a univariate and multivariate manner with a meta-regression model. Our analysis included data from 24 surgical articles (999 patients) and 4 radiation articles (543 patients), mostly uncontrolled cohort studies (Class III). Surgical patients were 1.3 times more likely to be ambulatory after treatment and twice as likely to regain ambulatory function. Overall ambulatory success rates for surgery and radiation were 85% and 64%, respectively. Primary pathology was the principal factor determining survival. We present the first known formal meta-analysis using data from nonrandomized clinical studies. Although we attempted to control for imbalances between the surgical and radiation groups, significant heterogeneity undoubtedly still exists. Nonetheless, we believe the differences in the outcomes indicate a true difference resulting from treatment. We conclude that surgery should usually be the primary treatment with radiation given as adjuvant therapy. Neurologic status, overall health, extent of disease (spinal and extraspinal), and primary pathology all impact proper treatment selection.

Original languageEnglish (US)
Pages (from-to)64-76
Number of pages13
JournalNeuro-oncology
Volume7
Issue number1
DOIs
StatePublished - Jan 1 2005

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Spinal Diseases
Meta-Analysis
Radiotherapy
Radiation
Therapeutics
Pathology
Nervous System
Health Status
Walking
Spinal Cord
Cohort Studies
Survival

All Science Journal Classification (ASJC) codes

  • Oncology
  • Clinical Neurology
  • Cancer Research

Cite this

A meta-analysis of surgery versus conventional radiotherapy for the treatment of metastatic spinal epidural disease. / Klimo, Paul; Thompson, Clinton J.; Kestle, John R.W.; Schmidt, Meic H.

In: Neuro-oncology, Vol. 7, No. 1, 01.01.2005, p. 64-76.

Research output: Contribution to journalArticle

Klimo, Paul ; Thompson, Clinton J. ; Kestle, John R.W. ; Schmidt, Meic H. / A meta-analysis of surgery versus conventional radiotherapy for the treatment of metastatic spinal epidural disease. In: Neuro-oncology. 2005 ; Vol. 7, No. 1. pp. 64-76.
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